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Peer-reviewedCC BY-NC-NDBMC public health

Associations between adverse childhood experiences and breastfeeding initiation and duration: a longitudinal birth cohort study in Pakistan.

  • Emilie E Egger1
  • Sarah C Haight2
  • Paola Bojorquez-Ramirez3
  • John A Gallis4
  • Allison Frost5
  • Siham Sikander6
  • Joanna Maselko7
  • Ashley K Hagaman8
8 affiliations
  1. 1Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. [email protected].
  2. 2Department of Epidemiology and Biostatistics, UNC Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.
  3. 3Harvard T.H. Chan School of Public Health, Cambridge, MA, USA.
  4. 4Duke Global Health Institute, Durham, NC, USA.
  5. 5Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
  6. 6Department of Primary Care and Mental Health, University of Liverpool, Liverpool, Great Britain and Northern Ireland, UK.
  7. 7Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  8. 8Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.
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Abstract

Rationale

Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding initiation and duration, but the evidence is inconsistent. ACEs are associated with poor maternal and infant health outcomes. Despite low- and middle-income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes and despite evidence that breastfeeding could alleviate some of these outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and duration of exclusive breastfeeding in LMICs.Objective

The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan.Methods

The prospective cohort analysis included 869 women 18-45 years of age from the Bachpan Cohort Study. Multivariable modified log-Poisson regression models were used to assess the relationship between any ACE exposure with breastfeeding initiation (n = 755) and exclusive breastfeeding at 3 (n = 758) and 6 months (n = 809). Models were adjusted for known confounders.Results

58% of participants reported experiencing at least 1 ACE. 17.5% of women with a history of at least one ACE reported initiating breastfeeding within an hour of childbirth. 43.8% of women with at least one ACE reported exclusively breastfeeding at 3 months postpartum and 7.6% of women with at least one ACE reported exclusively breastfeeding within the last 24 h at 6 months postpartum. There was no significant difference between groups for initiating breastfeeding. However, women who had experienced ACEs were less likely to recall exclusively breastfeeding at 3 (RR = 0.8; 95 CI = 0.7, 1.0) and 6 months (RR = 0.7; 95% CI = 0.5, 1.2) postpartum compared to women with no self-reported history of ACEs.Conclusion

Our findings indicate that ACEs may contribute to differences in exclusive breastfeeding. Understanding the long-term effects of ACEs on breastfeeding is important to help inform the design of intervention programs to prevent or mediate the negative repercussions of ACEs.

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Cite

BibTeXRIS
BibTeX
@article{egger2026associations,
  title = {{Associations between adverse childhood experiences and breastfeeding initiation and duration: a longitudinal birth cohort study in Pakistan.}},
  author = {Emilie E Egger and Sarah C Haight and Paola Bojorquez-Ramirez and John A Gallis and Allison Frost and Siham Sikander and Joanna Maselko and Ashley K Hagaman},
  journal = {BMC public health},
  year = {2026},
  month = jul,
  doi = {10.1186/s12889-026-28648-8},
  url = {https://europepmc.org/article/MED/42894173},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Associations between adverse childhood experiences and breastfeeding initiation and duration: a longitudinal birth cohort study in Pakistan.
AU  - Emilie E Egger
AU  - Sarah C Haight
AU  - Paola Bojorquez-Ramirez
AU  - John A Gallis
AU  - Allison Frost
AU  - Siham Sikander
AU  - Joanna Maselko
AU  - Ashley K Hagaman
PY  - 2026
DA  - 2026/07/01
JO  - BMC public health
DO  - 10.1186/s12889-026-28648-8
UR  - https://europepmc.org/article/MED/42894173
AB  - Rationale  Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding initiation and duration, but the evidence is inconsistent. ACEs are associated with poor maternal and infant health outcomes. Despite low- and middle-income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes and despite evidence that breastfeeding could alleviate some of these outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and duration of exclusive breastfeeding in LMICs.Objective  The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan.Methods  The prospective cohort analysis included 869 women 18-45 years of age from the Bachpan Cohort Study. Multivariable modified log-Poisson regression models were used to assess the relationship between any ACE exposure with breastfeeding initiation (n = 755) and exclusive breastfeeding at 3 (n = 758) and 6 months (n = 809). Models were adjusted for known confounders.Results  58% of participants reported experiencing at least 1 ACE. 17.5% of women with a history of at least one ACE reported initiating breastfeeding within an hour of childbirth. 43.8% of women with at least one ACE reported exclusively breastfeeding at 3 months postpartum and 7.6% of women with at least one ACE reported exclusively breastfeeding within the last 24 h at 6 months postpartum. There was no significant difference between groups for initiating breastfeeding. However, women who had experienced ACEs were less likely to recall exclusively breastfeeding at 3 (RR = 0.8; 95 CI = 0.7, 1.0) and 6 months (RR = 0.7; 95% CI = 0.5, 1.2) postpartum compared to women with no self-reported history of ACEs.Conclusion  Our findings indicate that ACEs may contribute to differences in exclusive breastfeeding. Understanding the long-term effects of ACEs on breastfeeding is important to help inform the design of intervention programs to prevent or mediate the negative repercussions of ACEs.
SN  - 1471-2458
ER  -