Association between perinatal intimate partner violence and breastfeeding outcomes: a systematic review and meta-analysis

Abstract Background Intimate partner violence (IPV) negatively affects the health of both the mother and the child. These risks are particularly critical during the perinatal period, a time of heightened vulnerability. However, the relationship between maternal IPV exposure and breastfeeding outcomes remains uncertain, and existing findings are inconsistent and inconclusive. Therefore, this systematic review and meta-analysis aimed to synthesise the existing evidence on the association between perinatal IPV and breastfeeding outcomes. Methods A systematic literature search was conducted using relevant databases between June 15 and August 2, 2024. All peer-reviewed observational studies that specifically investigated the link between Perinatal (P)-IPV and breastfeeding outcomes, such as early initiation, exclusivity, and duration among the perinatal population, were included. Heterogeneity across the included studies was assessed using the Cochrane Q test and I² statistics. Publication bias was assessed through funnel plots and Egger’s test. Finally, a random effects model was used to estimate the pooled adjusted odds ratios and their 95% CIs. Results Nineteen observational studies published between 2007 and 2024, comprising 347,706 mother-child pairs, were included in the review. Of these, 17 studies were eligible for the meta-analysis. A meta-analysis of nine studies indicated that P-IPV was associated with a 36% higher odds of delayed initiation of breastfeeding (AOR: 1.36; 95% CI: 1.14–1.63), with both physical (AOR: 1.20; 95% CI: 1.02–1.42) and psychological P-IPV (AOR: 1.38; 95% CI: 1.09–1.74) were associated with higher odds of not initiating breastfeeding within one hour of birth. Similarly, women exposed to P-IPV had higher odds of not exclusively breastfeeding (EBF) at six months (AOR: 1.50; 95% CI: 1.21–1.85), with similar associations observed for both physical (AOR: 1.52; 95% CI: 1.18–1.95) and psychological P-IPV (AOR: 1.56; 95% CI: 1.39–1.76). Conclusions This review found that P-IPV was associated with delayed breastfeeding initiation and a lower likelihood of EBF at six months. The findings highlight the potential value of trauma-informed and trauma-sensitive screening, support, and referral pathways for women experiencing P-IPV.