Violent conflict and breastfeeding: the case of Iraq

Abstract

BackgroundThis study explores the relationship between armed conflict and breastfeeding practices of Iraqi mothers. To date, the relationship between violent conflict and breastfeeding is surprisingly understudied. Especially in the Middle East, which is conflict-prone and has a young population, research on war and household behavior is critical for promoting recovery and sustainable development.MethodsThis study employs a unique pairing of the Iraq Body Count Database and the 2006 and 2011 Multiple Indicator Cluster Surveys for Iraq. We use probit models to explore the association between armed conflict and several breastfeeding outcomes – whether a child was ever breastfed, whether a child was breastfed within 1 h after birth, whether a child is currently breastfed, and whether an infant under 6 months of age is exclusively breastfed. Our proxies for conflict intensity are the average rate of conflict-related casualties across the 3 years prior to survey administration and the rate of casualties averaged across the 2 years prior to the birth of the child, in the governorate in which the family resides. We employ a number of other independent variables important for breastfeeding status, including health controls and characteristics of the household, child and mother. We also use a Cox proportional hazards model to study the association between conflict and breastfeeding duration. We complement this analysis with various robustness checks, including disaggregation by year, controls for household wealth and an analysis of breastmilk substitutes and their potential for an interaction with household wealth.ResultsWe find in our main results that increases in conflict-related casualties are associated with a significant decline in the probability that a child was ever breastfed and a decline in the probability that a child is currently breastfeeding. There is no significant association with exclusive breastfeeding or with initiation of breastfeeding within 1 h after birth. This result is robust to alternative measures of conflict, although some coefficients from estimation based on the 2006 subsample are positive and not significant, and reverse causation is a potential source of bias in interpreting cross-sectional feeding patterns. Results on breastfeeding duration are mixed. Our results also suggest an increase in the use of breastfeeding substitutes like formula concurrent to higher levels of conflict among wealthier households.ConclusionThe results are informative in the context of designing policy aimed at stabilizing the long-term health and productivity of populations in conflict areas. Infant formula provided with the objective of offering temporary relief creates risks, including reducing the probability and duration of breastfeeding. Attention to the supply of health care and to support systems for women, especially skilled breastfeeding support and targeted support to infants dependent on formula, are matters of the utmost urgency during and after conflict periods.

Comparison of the Breastfeeding Practices of Refugee Syrian Mothers and Native Turkish Mothers

“…9 In another study conducted in Iraq, it was reported that conflict intensity was negatively associated with breastfeeding incidence. 10 The breastfeeding behaviors of migrant mothers were found to be different from those of the host community mothers. The findings of this study also supported that the breastfeeding behaviors of mothers who migrated due to war were not at the desired level.…”

Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates

“…Breast feeding declined significantly in regions with high levels of conflict-related violence relative to areas which were considered the ‘safest areas’ in Iraq. 29 A mother residing in dangerous areas of Iraq was 17.4% more likely to stop breast feeding compared with mothers living in the safe areas. 29 In Bosnia-Herzegovina, illness of mother/baby disrupted breast feeding and a few mothers made a personal decision not to breast feed.…”

“… 29 A mother residing in dangerous areas of Iraq was 17.4% more likely to stop breast feeding compared with mothers living in the safe areas. 29 In Bosnia-Herzegovina, illness of mother/baby disrupted breast feeding and a few mothers made a personal decision not to breast feed. 35 Other reasons that negatively affected breast feeding practices in conflict affected areas were unavailability of trained healthcare professionals, and disruption in knowledge created by violent conflict.…”

“…13 14 19–22 25 27 29 33–37 40–43 Of these, 12 were reports 13 14 19–22 29 33 37 40 42 43 and 6 were cross sectional studies. 25 27 34–36 41 Seven studies were conducted in Europe, 27 33–37 43 five in Middle East, 13 14 19 21 22 three in Africa, 20 25 41 one in Asia, 29 one study was conducted in both Asia and Europe 40 and one failed to report. 41 Nine studies reported on refugees, 13 14 19 21 25 32 37 40 43 four on internally displaced persons (IDPs), 20 22 34 36 three on non-displaced residents 27 29 41 and two failed to report on the target population.…”

“…13 19 21 33 35 40 42 Breast feeding and complementary feeding practices were influenced by religious and cultural determinants and frequent migrations. 29 33 Studies from Jordan and Bosnia-Herzegovina mentioned about the role of grandmothers in influencing breast feeding and complementary feeding practices. 19 35 Grandmothers often pressurised mothers to feed BMS (water and herbs) to infants and asked mothers to follow their traditional approach.…”