Kihlstrom Anna Charlotta, Stiller Tara, Sultana Nishat, Njau Grace, Schmidt Matthew, Stepanov Anastasia, Williams Andrew D
University of North Dakota.
North Dakota Department of Health.
Res Sq. 2024 Dec 17:rs.3.rs-5139881. doi: 10.21203/rs.3.rs-5139881/v1.
Marriage promotes breastfeeding duration through economic and social supports. The COVID-19 pandemic disproportionately affected marginalized communities and impacted women's employment and interpersonal dynamics. This study examined how marital status affects breastfeeding duration across socioeconomic and racially minoritized groups during COVID-19, aiming to inform social support strategies for vulnerable families in public health crises.
Data were drawn from the 2017-2021 North Dakota Pregnancy Risk Assessment Monitoring System(weighted n=41433). Breastfeeding duration was self-reported, and 2-, 4-, and 6-month duration variables were calculated. Marital status(married, unmarried) and education (<high school education, ≥high school education) were drawn from birth certificates. Income(≤$48,000, >$48,000) and race/ethnicity (White, American Indian, Other) were self-reported. Infant birth date was used to identify pre-COVID(2017-2019) and COVID(2020-2021) births. Logistic regression estimated odds ratios and 95% confidence intervals for the association between marital status and breastfeeding duration outcomes. Models were fit overall, by COVID-19 era and by demographic factors. Lastly, demographic-specific models were further stratified by COVID era. Models were adjusted for maternal health and sociodemographic factors.
Overall, married women consistently had 2-fold higher odds of breastfeeding across all durations during both pre-COVID and COVID eras. Pre-COVID, marriage was a stronger predictor for all breastfeeding durations in low-income women (4-month duration OR4.07,95%CI 2.52,6.58) than for high-income women (4-month duration OR1.76,95%CI 1.06,2.91). Conversely, during COVID, marriage was a stronger predictor of breastfeeding duration for high-income women (4-month duration OR 2.89,95%CI1.47,5.68) than low-income women (4-month duration OR 1.59,95%CI0.80, 3.15). Findings were similar among American Indian women and those with less than high school education, in that both groups lost the benefit of marriage on breastfeeding duration during the COVID-19 pandemic.
Marriage promotes breastfeeding duration, yet the benefit of marriage was reduced for low-socioeconomic and racially minoritized populations during the COVID-19 pandemic. Policies like paid parental leave and enhanced access to lactation consultants could help mitigate disproportionate impacts during public health crises. Continued research examining how major societal disruptions intersect with social determinants to shape breastfeeding outcomes can inform more equitable systems of care.
婚姻通过经济和社会支持促进母乳喂养的持续时间。新冠疫情对边缘化社区造成了不成比例的影响，并影响了女性的就业和人际关系动态。本研究调查了在新冠疫情期间，婚姻状况如何影响不同社会经济和少数族裔群体的母乳喂养持续时间，旨在为公共卫生危机中弱势家庭的社会支持策略提供参考。
数据来自2017 - 2021年北达科他州妊娠风险评估监测系统（加权n = 41433）。母乳喂养持续时间由自我报告得出，并计算了2个月、4个月和6个月的持续时间变量。婚姻状况（已婚、未婚）和教育程度（高中以下教育程度、高中及以上教育程度）来自出生证明。收入（≤48000美元、> 48000美元）和种族/族裔（白人、美洲印第安人、其他）由自我报告。婴儿出生日期用于确定新冠疫情前（2017 - 2019年）和新冠疫情期间（2020 - 2021年）的出生情况。逻辑回归估计了婚姻状况与母乳喂养持续时间结果之间关联的比值比和95%置信区间。模型整体拟合，按新冠疫情时期和人口统计学因素进行拟合。最后，按人口统计学特征的模型进一步按新冠疫情时期分层。模型对孕产妇健康和社会人口学因素进行了调整。
总体而言，在新冠疫情前和疫情期间，已婚女性在所有母乳喂养持续时间上的几率始终高出两倍。在新冠疫情前，婚姻对低收入女性所有母乳喂养持续时间的预测作用（4个月持续时间，比值比4.07，95%置信区间2.52，6.58）比对高收入女性更强（4个月持续时间，比值比1.76，95%置信区间1.06，2.91）。相反，在新冠疫情期间，婚姻对高收入女性母乳喂养持续时间的预测作用（4个月持续时间，比值比2.89，95%置信区间1.47，5.68）比对低收入女性更强（4个月持续时间，比值比1.59，95%置信区间0.80，3.15）。在美洲印第安女性和高中以下教育程度的女性中也有类似发现，即在新冠疫情期间，这两组在母乳喂养持续时间上都失去了婚姻带来的益处。
婚姻促进母乳喂养持续时间，但在新冠疫情期间，低社会经济和少数族裔人群从婚姻中获得的益处减少。带薪育儿假和增加获得哺乳顾问帮助等政策有助于减轻公共卫生危机期间的不成比例影响。持续研究重大社会干扰如何与社会决定因素相互作用以塑造母乳喂养结果，可为更公平的护理系统提供参考。
