Research unexpectedly demonstrates that breastfeeding attenuates the impact of previous sexual assault
Kathleen Kendall-Tackett, PhD, IBCLC, FAPA
An assumption. When discussing breastfeeding promotion, a question frequently arises:
What about women who have been sexually assaulted? Surely, you can’t expect them to breastfeed.
People who raise this issue usually assume that women with histories of sexual trauma will not want to breastfeed. That’s not, however, what previous studies have found. Two previous studies found that women who had histories of child sexual abuse were more likely to say they wanted to breastfeed (Benedict, Paine, & Paine, 1994), and to initiate breastfeeding (Prentice, Lu, Lange, & Halfon, 2002). These studies both had relatively small samples, but their results were unexpected—and intriguing. What these findings really said was, “Don’t assume. Find out what the mothers want to do.”
Would the findings be similar with a larger sample? Using data from the Survey of Mothers’ Sleep and Fatigue, we were able to examine this issue in more detail with a sample of 6,410 mothers with infants 0–12 months old (Kendall-Tackett, Cong, & Hale, 2013). Twenty-five percent of the sample reported contact child sexual abuse, and 994 women had been raped, the most serious form of sexual abuse. We chose to analyze data with the 994 sexual assault survivors and found that women who had been raped had an exclusive breastfeeding rate that was identical to the non-assaulted women: 78% for both groups.
The impact of previous sexual assault
Not surprisingly, sexual assault had a pervasive negative effect across all the sleep and mental health variables we examined. The sexually assaulted women took longer to fall asleep and slept fewer hours than their non-assaulted counterparts. They reported more depression and anxiety, and more anger and irritability. These findings were quite consistent with the results of many previous studies on the effects of sexual abuse and assault, and the effects of psychological trauma in general (Ruglass & Kendall-Tackett, 2015). Mothers with a history of sexual assault are at very high risk for postpartum depression and other postpartum mood and anxiety disorders. An intriguing question is whether breastfeeding can help these mothers.
From previous findings from this same data set, we learned that exclusive breastfeeding (described in the study as “breastfeeding only”) actually protected mothers’ sleep and mental health across all the variables we examined (Kendall-Tackett, Cong, & Hale, 2011). Mothers who were exclusively breastfeeding had better overall sleep quality, including longer sleep duration and fewer minutes to get to sleep. Shorter sleep duration and more minutes to get to sleep are related to risk of postpartum depression (Dorheim, Bondevik, Eberhard-Gran, & Bjorvatn, 2009a, 2009b; Kendall-Tackett et al., 2011). These mothers also had lower anxiety and anger and irritability, and lower rates of depression.
The interaction of breastfeeding and sexual assault history
These two sets of findings, based on our univariate analyses, were consistent with previous studies. But no study had combined these two variables. When we did, we found something that we did not expect: that exclusive breastfeeding attenuated the negative effects of previous sexual assault (Kendall-Tackett et al., 2013). Below are three of the variables we examined.
The first is the total number of hours that mothers reported that they slept. In Dorheim et al.’s (2009b) study, mothers’ subjective reports of hours that they slept was a better predictor of postpartum depression than objective measures of their sleep (such as polysomnograph or actigraph). As you can see from Figure 1, exclusively breastfeeding women, represented by the top line, sleep more than women who are mixed- or formula-feeding. [We combined mixed- and formula-feeding mothers because we found no significant difference in a previous set of analyses that we published (Kendall-Tackett, 2011).] The bottom line is the mixed- and formula-feeding mothers. Clearly, the exclusively breastfeeding mothers with a history of sexual assault did sleep somewhat less than the non-assaulted exclusively breastfeeding mothers. But see how much less it would be if they weren’t exclusively breastfeeding.
We found a similar pattern with depression, seen on Figure 2. The exclusively breastfeeding mothers with a history of sexual assault were at higher risk for depression than their non-assaulted counterparts. But that risk was substantially lower than it was for mixed- or formula-feeding mothers.
The finding on anger and irritability was also interesting (see Figure 3). The exclusively breastfeeding mothers had low levels of anger and irritability. This was not true for mixed- or formula-feeding mothers. The high level of anger and irritability in the mixed- and formula-feeding mothers is consistent with findings in trauma survivors, in general, who often have hair-trigger tempers that can suddenly flare (Ruglass & Kendall-Tackett, 2015). These findings are also consistent with those of Strathearn et al., (2009), who found that mothers who breastfed for at least 4 months were 2.6 times less likely to physically abuse their children and 3.8 times less likely to neglect them.
Psychoneuroimmunology as a possible underlying mechanism
One possible explanation for the protective role of breastfeeding, even when women have experienced serious trauma, can be found in the literature on psychoneuroimmunology. Breastfeeding downregulates the stress response, including the inflammatory response system (Groër & Davis, 2006; Groër & Kendall-Tackett, 2011; Groër & Morgan, 2007) and this increases their physical and mental health. Trauma survivors often have a stress response that is overly reactive and responsive to stress (Kendall-Tackett, 2009). The slightest stressor can set it off. Breastfeeding seems to counter that effect.
That is a hopeful message. Our bodies seem to know that women don’t live or have their babies in a perfect world; that bad things happen to mothers. But breastfeeding allows mothers to essentially have a “do-over,” to parent differently than they were parented.
Do these findings mean that there is no benefit for a mixed-feeding mother? No, not at all. Clearly, breastfeeding is good no matter how much she is able to do. The mother benefits and her baby does too. We just need to recognize that the mixed-feeding mothers may not be getting all the stress-reduction benefits they would if they were exclusively breastfeeding and support them accordingly.
What can we conclude from all of these findings? I think it’s this: breastfeeding makes a difference, and it’s not all about the milk! Breastfeeding protects a mother’s physical and mental well-being, even when she has a history of significant trauma. These mothers may encounter more difficulties with breastfeeding than women without a trauma history, but if they want to breastfeed, we need to support them. The results for that mother and baby will be well worth the extra effort, and the positive effects will last for years.
Benedict, M.I., Paine, L. Paine, L. (1994). Long-term effects of sexual abuse in childhood on psychosocial functioning in pregnancy and pregnancy outcome. Washington, DC: Department of Health and Human Services National Center on Child Abuse and Neglect.
Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009a). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847–855. doi:10.1093/sleep/32.7.847
Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009b). Subjective and objective sleep among depressed and non-depressed postnatal women. Acta Psychiatrica Scandinavia, 119(2), 128–136. doi:10.1111/j.1600-0447.2008.01272.x
Groër, M. W., & Davis, M. W. (2006). Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders. Journal of Obstetric, Gynecologic and Neonatal Nursing, 35, 599-607.
Groër, M. W., & Kendall-Tackett, K. A. (2011). How breastfeeding protects women’s health throughout the lifespan: The psychoneuroimmunology of human lactation. Amarillo, TX: Hale Publishing.
Groër, M. W., & Morgan, K. (2007). Immune, health and endocrine characteristics of depressed postpartum mothers. Psychoneuroendocrinology, 32(2), 133–139. doi:10.1016/j.psyneuen.2006.11.007
Kendall-Tackett, K. (2009). Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative health effects and possible interventions. Psychological Trauma: Theory, Research, Practice, and Policy, 1(1), 35–48. doi:10.1037/a0015128
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26. doi:10.1891/215805311807011593
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8(1), 16–22. doi:10.1089/bfm.2012.0024
Prentice, J. C., Lu, M. C., Lange, L., & Halfon, N. (2002). The association between reported childhood sexual abuse and breastfeeding initiation. Journal of Human Lactation, 18(3), 219–226. doi:10.1177/089033440201800303
Ruglass, L., & Kendall-Tackett, K. A. (2015). The psychology of trauma 101. New York: Springer.
Strathearn, L., Mamun, A. A., Najman, J. M., & O’Callaghan, M. J. (2009). Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study. Pediatrics, 123(2), 483–493. doi:10.1542/peds.2007-3546
Kathleen Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. She is Editor-in-Chief of two peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the Board for the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett specializes in women’s-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2016 Outstanding Service to the Field of Trauma Psychology from the American Psychological Association’s Division 56. Her websites are: