Impact of COVID-19 Pandemic on Breastfeeding by Family Vulnerability: An Observational Study Based on Record Linkage

Objective: The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding, overall and across degrees of family vulnerability.Study Design: A repeated cross-sectional study was conducted based on record linkage analysis of regional administrative databases providing data on breastfeeding prevalence in children, collected at the time of months of age. Breastfeeding data were linked to maternal characteristics to calculate a breastfeeding vulnerability score. Data over a 3-year period were considered as follows: 2019 (prepandemic), 2020 (lockdown and strict COVID-19 control measures), and 2021 (milder COVID-19 control measures).Results: During the study period, 110,925 immunization records were registered; data on breastfeeding were available for 107,138 records. The prevalence of full breastfeeding at 3 months of age decreased from 57.1% in 2019 to 56.1% in 2021 (p-value = 0.003), whereas prevalence of full breastfeeding at 5 months of age increased (from 44.1% in 2019 to 47.6% in 2021; p-value <0.001). The vulnerability score was calculated for the 70,253 records (63.3% of the initial sample) for which data were accessible: 5% of the sample was in the lowest vulnerability class and 15% in the highest one. As the vulnerability score increased, the prevalence of full breastfeeding at 3 and 5 months of age decreased in each of the three study years. Breastfeeding prevalence within each vulnerability class was not affected by the pandemic. On the other hand, the percentage of children in the high vulnerability class (score >= 3) increased by 3.6% in 2021 compared with 2019.Conclusions: The pandemic has not significantly impacted the prevalence of breastfeeding (-1% at 3 months and +3.5% at 5 months), but the proportion of children in the most vulnerable class increased significantly: action should be taken to ensure that during crises or emergencies the most vulnerable groups receive increased breastfeeding protection, promotion, and support.