Disability and in-hospital breastfeeding practices and supports in Ontario, Canada: a population-based study

BACKGROUND: Breastfeeding provides infants with nutrients required for optimal growth and development. We aimed to examine breastfeeding practices and supports that promote exclusive breastfeeding during the birth hospital stay among birthing parents with physical disabilities, sensory disabilities, intellectual or developmental disabilities, and multiple disabilities compared with those without a disability. METHODS: This population-based cohort study was done in Ontario, Canada. We accessed and analysed health administrative data from ICES and the Better Outcomes Registry & Network. We included all birthing parents aged 15–49 years who had a singleton livebirth between April 1, 2012, and March 31, 2018. The study outcomes were breastfeeding practices and supports that promoted exclusive breastfeeding during the birth hospital stay, conceptualised based on WHO–UNICEF Baby Friendly Hospital Initiative guidelines. Individuals with a physical disability, sensory disability, intellectual or developmental disability, or two or more (multiple) disabilities, identified using diagnostic algorithms, were compared with individuals without disabilities on the opportunity to initiate breastfeeding, in-hospital breastfeeding, exclusive breastfeeding at hospital discharge, skin-to-skin contact, and provision of breastfeeding assistance. Relative risks (RRs) were estimated using modified Poisson regression. FINDINGS: Our cohort included 634 111 birthing parents, of whom 54 476 (8·6%) had a physical disability, 19 227 (3·0%) had a sensory disability, 1048 (0·2%) had an intellectual or developmental disability, 4050 (0·6%) had multiple disabilities, and 555 310 (87·6%) had no disability. Individuals with intellectual or developmental disabilities were less likely than those without a disability to have an opportunity to initiate breastfeeding (adjusted RR 0·82, 95% CI 0·76–0·88), any in-hospital breastfeeding (0·85, 0·81–0·88), exclusive breastfeeding at hospital discharge (0·73, 0·67–0·79), skin-to-skin contact (0·90, 0·87–0·94), and breastfeeding assistance (0·85, 0·79–0·91). Those with multiple disabilities were less likely to have an opportunity to initiate breastfeeding (0·93, 0·91–0·96), any in-hospital breastfeeding (0·93, 0·92–0·95), exclusive breastfeeding at hospital discharge (0·90, 0·87–0·93), skin-to-skin contact (0·93, 0·91–0·95), and breastfeeding assistance (0·95, 0·92–0·98). Differences for individuals with a physical or sensory disability only were mostly non-significant. INTERPRETATION: Our findings show disparities in breastfeeding outcomes between individuals without a disability and individuals with intellectual or developmental disabilities or multiple disabilities, but not individuals with physical or sensory disabilities. There is a need for further research on the factors that contribute to breastfeeding intentions, practices, and supports in people with intellectual or developmental disabilities and multiple disabilities, especially factors that affect breastfeeding decision making.