Breastfeeding initiation for Aboriginal and Torres Strait Islander women in Victoria: analysis of routinely collected population-based data

Abstract

Background

Increasing breastfeeding rates is one way of improving the short and long term health of Aboriginal and Torres Strait Islander children (hereafter referred to as Aboriginal). Despite the benefits of breastfeeding and recommendations for strategies to increase breastfeeding among Aboriginal people, there is a lack of available population data.

Aim

To use population-based data from Victoria, Australia to compare breastfeeding initiation for Aboriginal and non-Aboriginal women and to explore factors associated with breastfeeding initiation of Aboriginal women.

Methods

Routinely collected infant feeding data obtained from the Victorian Perinatal Data Collection (VPDC) was used. The VPDC is a mandatory, population-based system where maternal and infant data on all Victorian births are collected.

Findings

Compared with non-Aboriginal women, Aboriginal women were less likely to attempt to breastfeed their baby (87.2% vs 95.3%; p < 0.001); more likely to give formula in hospital (39.6% vs 30.6%; p < 0.001) and less likely to give the last feed prior to discharge exclusively from the breast (64.4% vs 75.0% p < 0.001). For Aboriginal women, factors associated with not initiating breastfeeding were being single, multiparous, smoking and length of stay. Infant factors were gestation less than 37 weeks and low birthweight (<2,500 g).

Conclusion

In Victoria, breastfeeding initiation is lower for Aboriginal women compared with non-Aboriginal women. Further research is needed to explore the effectiveness of interventions that may increase breastfeeding for Aboriginal women.

Introduction

Increasing breastfeeding is an important way of improving the short and long term health of Aboriginal and Torres Strait Islander children.¹ Indigenous Indigenous Australians’ life expectancy is 11 years shorter for males and 10 years shorter for females compared with the non-Indigenous population and avoidable mortality rates are three times as high.¹ Low birthweight, preterm birth, and perinatal death are all substantially higher for Aboriginal babies.² Aboriginal people also have higher rates of acute and chronic illnesses, for many of which breastfeeding is protective, such as infections, diabetes, heart and circulatory disease, renal disease, asthma, and hearing loss/ear disease.³ For example, recurrent otitis media in Aboriginal children is much higher than in the general populations and recurrent ear infections can lead to hearing loss, which can lead to learning difficulties and impaired social and emotional development. The Australian Government inquiry into the benefits of breastfeeding concluded that given the very strong evidence of the protection breastfeeding provides against otitis media, “for this reason alone, breastfeeding should be encouraged in Indigenous populations”.^{4, p. 118}

A number of recent Australian government reports have focused their attention on increasing breastfeeding uptake and maintenance among Aboriginal communities to protect the health of future generations. A Victorian Government report on strategic directions for Aboriginal health 2012–2022 includes increasing breastfeeding for mothers of Aboriginal babies as a key priority.⁵ The Australian Parliamentary inquiry into breastfeeding recommended that leadership is needed in the area of monitoring, surveillance and evaluation of breastfeeding initiation and duration and practices in Aboriginal populations in both remote and other areas.⁴ Likewise, the Australian Government’s Office for Aboriginal and Torres Strait Islander Health and Healthy Public Policy Unit commissioned two reports as part of a strategy to encourage longer breastfeeding.⁶ Improved breastfeeding outcomes are also a priority for Aboriginal communities and their health providers. The Victorian Aboriginal Community Controlled Health Organisation’s (VACCHO) report on early childhood nutrition lists improving breastfeeding outcomes as a priority⁷ and this is also included in their 2009–2014 strategy to close the nutrition gap between Aboriginal and non-Aboriginal people.⁸

Despite the benefits of breastfeeding and the recommendations for strategies aimed at increasing breastfeeding initiation and duration among Aboriginal people, there is a lack of available population data. The 2012–2013 National Aboriginal Health Survey reported that 83% of Indigenous children aged 0–3 years had ever been breastfed compared with 93% of non-Indigenous children and Indigenous children aged 0–3 were 2.3 times as likely as non-Indigenous infants to have never been breastfed (17% compared with 7%).⁹ However these data were obtained from surveys that had issues including poor response rates and poor recall.⁹ Given the limitations of previous studies, the aim of this study is to present state-wide routinely collected population data from Victoria, Australia to compare breastfeeding initiation for infants of Aboriginal and non-Aboriginal women and to explore factors associated with breastfeeding initiation for infants of Aboriginal women.