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Brown HK, Mitra M. Perinatal health framework for people with intellectual disability. Disabil Health J 2024; 17:101576. [PMID: 38216418 DOI: 10.1016/j.dhjo.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
We propose a framework for guiding research on perinatal health in people with intellectual disability (ID). We developed this framework based on the perinatal health framework for people with physical disabilities, American Association on Intellectual and Developmental Disabilities conceptual framework of human functioning, disability reproductive justice framework, trauma-informed care, and socio-ecological model. The framework reflects health outcomes of birthing people with ID and their infants that result from interactions of factors across the life course at policy (health, social, and disability policies), community (attitudes, social and physical environment), institutional (health care delivery-related factors, access to information/resources), interpersonal (social determinants of health/histories of trauma, social support, interactions with service-providers), and individual levels (demographics, intellectual functioning, adaptive behavior, health conditions, genetic factors, psychosocial factors, health behaviors). This framework will facilitate research to identify factors leading to perinatal health disparities in people with ID and development and evaluation of resources to address them.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Ramer S, Nguyen AT, Nelson JM, Whiteman MK, Warner L, Thierry JM, Folger S, von Essen BS, Kortsmit K. Breastfeeding by Disability Status in the United States: Pregnancy Risk Assessment Monitoring System, 2018-2020. Am J Public Health 2024; 114:108-117. [PMID: 38091565 PMCID: PMC10726937 DOI: 10.2105/ajph.2023.307438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives. To describe breastfeeding initiation and breastfeeding at 1, 2, and 3 months, and information sources on breastfeeding among women with a recent live birth by disability status. Methods. We analyzed October 2018 to December 2020 data from the Pregnancy Risk Assessment Monitoring System for 24 sites in the United States that included the Washington Group Short Set of Questions on Disability (seeing, hearing, walking or climbing stairs, remembering or concentrating, self-care, communicating). We defined disability as reporting "a lot of difficulty" or "cannot do this at all" on any of these questions. Results. Among 39 673 respondents, 6.0% reported disability. In adjusted analyses, breastfeeding was lower among respondents with disability at 2 (62.6% vs 66.6%; adjusted prevalence ratio [APR] = 0.94; 95% confidence interval [CI] = 0.89, 0.99) and 3 months (54.7% vs 59.6%; APR = 0.92; 95% CI = 0.86, 0.98) than those without disability. Respondents with disability were less likely to receive information from health care providers or support professionals (89.3% vs 92.3%), but as likely from breastfeeding or lactation specialists (78.1% vs 75.3%). Conclusions. Strategies to ensure women with disability, receive breastfeeding support, including breastfeeding information, could improve breastfeeding outcomes. (Am J Public Health. 2024;114(1):108-117. https://doi.org/10.2105/AJPH.2023.307438).
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Affiliation(s)
- Stephanie Ramer
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Antoinette T Nguyen
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Jennifer M Nelson
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Maura K Whiteman
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Lee Warner
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - JoAnn M Thierry
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Suzanne Folger
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Beatriz Salvesen von Essen
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
| | - Katherine Kortsmit
- Stephanie Ramer, Antoinette T. Nguyen, Maura K. Whiteman, Lee Warner, Suzanne Folger, Beatriz Salvesen von Essen, and Katherine Kortsmit are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers of Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Jennifer M. Nelson was is with the Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta. JoAnn M. Thierry is with the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta
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Brown HK, Pablo L, Scime NV, Aker AM, Dennis CL. Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey. Int Breastfeed J 2023; 18:70. [PMID: 38129879 PMCID: PMC10734132 DOI: 10.1186/s13006-023-00608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The World Health Organization recommends breastfeeding as the best method for infant feeding. Known risk factors for breastfeeding non-initiation and early cessation of breastfeeding are diverse and include low breastfeeding self-efficacy, poverty, smoking, obesity, and chronic illness. Although women with disabilities experience elevated rates of these risk factors, few studies have examined their breastfeeding outcomes. Our objective was to examine breastfeeding non-initiation and early cessation of breastfeeding in women with and without disabilities. METHODS We used data from the 2017-2018 Canadian Community Health Survey. Included were n = 4,817 women aged 15-55 years who had a birth in the last five years, of whom 26.6% had a disability, ascertained using the Washington Group Short Set on Functioning. Prevalence ratios (aPR) of breastfeeding non-initiation, and of early cessation of any and exclusive breastfeeding before 6 months, were calculated for women with versus without disabilities. We also examined disability by severity (moderate/severe and mild, separately) and number of action domains impacted (≥ 2 and 1, separately). The main multivariable models were adjusted for maternal age, marital status, level of education, annual household income level, and immigrant status. RESULTS There were no differences between women with and without disabilities in breastfeeding non-initiation (9.6% vs. 8.9%; aPR 0.88, 95% CI 0.63, 1.23). Women with disabilities were more likely to have early cessation of any (44.4% vs. 35.7%) and exclusive breastfeeding before 6 months (66.9% vs. 61.3%), with some attenuation in risk after adjustment for sociodemographic factors (aRR 1.15, 95% CI 0.99, 1.33 and aRR 1.07, 95% 0.98, 1.16, respectively). Disparities were larger for women with moderate/severe disabilities and disabilities in ≥ 2 domains, with differences attenuated by adjustment for socio-demographics. CONCLUSIONS Women with disabilities, and particularly those with moderate/severe and multiple disabilities, could benefit from tailored, accessible breastfeeding supports that attend to the social determinants of health.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Lesley Pablo
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Natalie V Scime
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON, Canada
- Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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