O3300: Breastfeeding Rates in the Military Are Unchanged Before and After the Onset of the COVID-19 Pandemic

Background: Breastfeeding benefits infants and mothers. The COVID-19 pandemic brought changes in clinical operations and insecurities surrounding breastfeeding. Studies in Italy and Los Angeles found lower breastfeeding rates in mothers who gave birth during the pandemic compared to before. Even pre-pandemic, disparities in breastfeeding exist for military mothers, but the impact of the pandemic on breastfeeding in this population has not yet been studied.

We sought to investigate factors that influenced breastfeeding in a single military treatment facility (MTF) and hypothesized that the exclusive breastfeeding initiation and duration rate in our population decreased with the onset of the pandemic.

Methods: MHS Genesis was queried for mothers who delivered an infant >=35 weeks’ gestation at a MTF before (PRE) and after the onset (PERI) of the pandemic. Demographic data and feeding methods (exclusive, any, and no breastfeeding) from birth to six months of life were obtained. The primary outcome was the initiation and duration rate of breastfeeding between PRE and PERI. Secondary outcomes assessed factors that impacted successful breastfeeding. A logistic regression was used to determine adjusted probability of exclusive or any breastfeeding based on those factors.

Results: 372 mother-infant dyads were included (51% PRE vs. 49% PERI). Maternal/infant demographics were similar across groups (Table 1). There were no differences in breastfeeding initiation rates and duration between the PRE vs. PERI group (p-values ranging from 0.07 to 0.9) (Table 2). Fewer mothers saw a lactation consultant (LC) while in the nursery (93% vs. 98%, p=0.03) and within one-month of life as an outpatient (31% vs. 46%, p< 0.01) in the PRE vs. PERI group (Table 2). Regardless of group, mothers who saw a LC in the nursery were 22 times more likely to exclusively breastfeed (OR 21.884, CI 5.840 – 82.004, p< 0.001) and those who saw a LC within the infant’s first month of life were four times more likely to still be feeding some breastmilk at that time (OR 3.993, CI 1.462-10.903, p< 0.01) (Table 2). Active-duty mothers were more likely to pursue any breastfeeding at 1 month (OR 3.698, CI 1.059 – 12.916, p=0.040) and 2 months of life (OR 2.376, CI 1.030 - 5.477, p=0.042). The strongest predictor for exclusive and any breastfeeding at 2-, 4-, 6- months is exclusive breastfeeding at 1 month of life.

Conclusion: In our military population, overall exclusive or any breastfeeding rates did not decline despite pandemic-related uncertainty and changes. Continued access to inpatient and outpatient lactation consultants appears to be a significant contributing factor. Active-duty status may also be protective of breastfeeding. Accessibility to breastfeeding resources in the first month of life is essential to support and strengthen breastfeeding within the military community and are paramount to a more medically-ready family.