Impact of COVID-19 Pandemic on Breastfeeding by Family Vulnerability: An Observational Study Based on Record Linkage
Simona Di Mario1, Carlo Gagliotti2, Adriano Cattaneo3
1SaPeRiDoc-Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, Bologna, Italy.
Insights
The COVID-19 pandemic did not significantly change breastfeeding rates, but increased the proportion of vulnerable children. Targeted support is crucial for high-risk groups during crises to ensure breastfeeding protection and promotion.
Area of Science:
- Public Health
- Epidemiology
- Maternal and Child Health
Background:
- The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to public health systems globally.
- Understanding the pandemic's impact on infant feeding practices, particularly breastfeeding, is crucial for maternal and child well-being.
- Family vulnerability may influence the effects of public health crises on breastfeeding.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on breastfeeding prevalence.
- To examine how family vulnerability modifies the pandemic's effect on breastfeeding rates.
- To identify trends in breastfeeding across different vulnerability levels during the pandemic.
Main Methods:
- A repeated cross-sectional study design was employed.
- Analysis utilized regional administrative databases linking breastfeeding data with maternal characteristics.
- A breastfeeding vulnerability score was calculated, and data from 2019 (pre-pandemic), 2020 (lockdown), and 2021 (milder measures) were analyzed.
Main Results:
- Full breastfeeding prevalence at 3 months slightly decreased (57.1% to 56.1%), while at 5 months it increased (44.1% to 47.6%) between 2019 and 2021.
- Breastfeeding prevalence within specific vulnerability classes remained largely unaffected by the pandemic.
- The percentage of children in the highest vulnerability class (score ≥3) significantly increased by 3.6% in 2021 compared to 2019.
Conclusions:
- The COVID-19 pandemic had a minimal direct impact on overall breastfeeding prevalence.
- A significant increase in the proportion of children from highly vulnerable families was observed during the pandemic.
- Enhanced breastfeeding protection, promotion, and support are essential for vulnerable populations during health crises and emergencies.
Abstract:
The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding, overall and across degrees of family vulnerability. A repeated cross-sectional study was conducted based on record linkage analysis of regional administrative databases providing data on breastfeeding prevalence in children, collected at the time of months of age. Breastfeeding data were linked to maternal characteristics to calculate a breastfeeding vulnerability score. Data over a 3-year period were considered as follows: 2019 (prepandemic), 2020 (lockdown and strict COVID-19 control measures), and 2021 (milder COVID-19 control measures). During the study period, 110,925 immunization records were registered; data on breastfeeding were available for 107,138 records. The prevalence of full breastfeeding at 3 months of age decreased from 57.1% in 2019 to 56.1% in 2021 (p-value = 0.003), whereas prevalence of full breastfeeding at 5 months of age increased (from 44.1% in 2019 to 47.6% in 2021; p-value <0.001). The vulnerability score was calculated for the 70,253 records (63.3% of the initial sample) for which data were accessible: 5% of the sample was in the lowest vulnerability class and 15% in the highest one. As the vulnerability score increased, the prevalence of full breastfeeding at 3 and 5 months of age decreased in each of the three study years. Breastfeeding prevalence within each vulnerability class was not affected by the pandemic. On the other hand, the percentage of children in the high vulnerability class (score ≥3) increased by 3.6% in 2021 compared with 2019. The pandemic has not significantly impacted the prevalence of breastfeeding (-1% at 3 months and +3.5% at 5 months), but the proportion of children in the most vulnerable class increased significantly: action should be taken to ensure that during crises or emergencies the most vulnerable groups receive increased breastfeeding protection, promotion, and support.
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