The Association Between Maternal Experience of Hurricane-Related Stressors and Initiation and Continuation of Breastfeeding in Puerto Rico after Hurricanes Irma and Maria, PRAMS-ZPER 2.0 Telephone Survey 2018 Open Access

Van Meter, Connor (Spring 2020)

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Introduction: The World Health Organization recommends exclusive breastfeeding of newborns for six months after birth due to evidence supporting short- and long-term benefits to mothers and babies. Hurricane Irma passed to the north of Puerto Rico on September 6, 2017 followed shortly after by the landfall of Hurricane Maria on September 20, 2017. Maternal experience of hurricane-related stressors may impact initiation and continuance of breastfeeding, but the association has not yet been explored in Puerto Rico in the aftermath of these hurricanes.

Methods: The study population included 1,230 mothers who delivered a live birth in a Puerto Rico maternity hospital between November and December 2017 and who completed both the PRAMS-ZPER 2.0 representative cross-sectional maternal in-hospital survey and follow-up telephone survey. We estimated crude and adjusted prevalence ratios for the association between maternal self-reported exposure to individual hurricane-stressors in the aftermath of hurricanes Irma and Maria and maternal self-reported initiation and continuation of breastfeeding through analysis of responses to the PRAMS-ZPER 2.0 telephone follow-up survey.

Results: The prevalence of breastfeeding initiation among the PRAMS-ZPER 2.0 cohort was 95.3%, while the prevalence of continued breastfeeding at follow-up was 58.7%. No hurricane related stressors were associated with breastfeeding initiation except reporting fearing that their lives were in danger due to the hurricanes. After controlling for maternal age and education, women who reported feeling like their life was in danger due to the hurricanes were 92% (95% CI: [0.89, 0.95]) as likely to have reported ever breastfeeding their infant compared with women who did not report this stressor.

Conclusions: The prevalence of breastfeeding initiation and continuation among the PRAMS-ZPER 2.0 cohort at survey follow-up was high compared with the reported prevalence of breastfeeding in Puerto Rico in 2016. Few stressors were associated with prevalence of breastfeeding initiation and continuation when assessed individually. Further targeted analyses may provide additional insight into the combination of mechanisms that resulted in the observed increase of prevalence of breastfeeding initiation and continuation in Puerto Rico after Hurricanes Maria and Irma, and may suggest ways that breastfeeding among pregnant women may be promoted and supported during future disasters.

Table of Contents

Table of Contents

Introduction. 1

Methods. 4

Results. 7

Discussion. 9

Conclusion. 12

Tables. 13

Figures. 17

References. 20

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