Application Of The Social-Ecological Framework To Understand Breastfeeding Outcomes In Women Veterans

Introduction: While breastfeeding is a major public health priority and provides numerous benefits to mother and child, women veterans encounter many barriers to initiating and sustaining breastfeeding. For women veterans, barriers to breastfeeding may be compounded by their military experiences or, conversely, may be decreased by the sources of support that are uniquely available to them by Veterans Health Administration (VHA). Methods: This investigation utilized a survey of a cohort of 363 women veterans, interviewed before and after delivery, who were enrolled in care at a national sample of VA facilities. Using the Social Ecological Model, regression analyses were used to explore the relationship between breastfeeding at 4 weeks postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors. An additional analysis was conducted to determine the extent to which military sexual trauma (MST) moderated the relationship between a set of individual, interpersonal, community, and system factors and breastfeeding at 4 weeks postpartum. Results: Eighty percent of women Veterans in this study were breastfeeding at 4 weeks postpartum. Employment, deployment history, traumatic brain injury (TBI) and geographic region were significantly related to breastfeeding at 4 weeks in the multivariate model. Self-employed mothers were 3.5 times more likely to breastfeed than those who were employed outside the home. Women Veterans with TBI were significantly less likely to breastfeed at 4 weeks. Mothers who had been deployed at any point in their military career were 2.2 times more likely to be breastfeeding than those who never deployed. This analysis also found significant variation in odds of breastfeeding by geographic region, with southern Veteran service areas having significantly lower rates than all other regions. MST was not a significant predictor of breastfeeding at 4 weeks but was a significant moderator of the relationship between mother’s age and breastfeeding. Conclusion: In this population of women Veterans, breastfeeding rates were comparable to those in the general population at 4 weeks postpartum. More research is needed to examine rates at 6 months and 1 year postpartum. Support for breastfeeding Veterans should account for their military experience and any related injuries incurred during military service.