Abstract
BackgroundWhile breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India.MethodsThis cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor medicine or oral rehydration solution, between birth and 6 months and was assessed at six months postpartum.ResultsWe surveyed mothers who delivered in rural Mysore taluk between 2008 and March 2011. A total of 1292 mothers participated in the study. The overall breastfeeding rate at six months postpartum was 74.9% and the EBF rate was 48.5%. Factors associated with EBF included higher maternal age (Adjusted Odds Ratio[aOR] 1.04; 95% Confidence Interval [CI] 1.00, 1.09), lower maternal education (aOR1.56, 95% CI 1.10, 2.21), and 7–10 antenatal visits (aOR 1.57; 95% CI 1.09, 2.27). The most common reason for non-exclusive breastfeeding was the mother’s feeling that she did not have enough milk (23.7%). Infants that were not exclusively breastfed were most commonly fed formula/animal milk (42.6%) or castor oil/ghee (18.4%).ConclusionsLess than half of the mothers in our sample reported exclusive breastfeeding in a rural region of Karnataka, India in the first six months, a rate lower than national and state level rates. Future interventions should evaluate whether antenatal education can improve breastfeeding outcomes. The only modifiable factor was number of antenatal visits. Breastfeeding education should be emphasized at every antenatal visit so that even mothers with fewer than 7–10 antenatal visits can learn the best techniques and benefits of breastfeeding.
Highlights
While breastfeeding rates have improved globally, disparities in breastfeeding practices persist in rural and low resource settings
Annual per capita income for rural residents is estimated at INR 16,086 [USD $322] and literacy at 63.3%, compared with an all India annual per capita income of INR 38,005 [USD $760] and literacy rate of 74.0%. [12,13,14] The majority (86%) of residents identify as Hindu and the remaining 14% identify as Muslim or other religions
This cross-sectional analysis was nested within a cohort study conducted by the Public Health Research Institute of India (PHRII)
Summary
While breastfeeding rates have improved globally, disparities in breastfeeding practices persist in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. For optimal growth and development, the World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life. During this period, no other liquids or breastfeeding substitutes should be given to infants except for medicine or oral rehydration solution [1]. According to the National Family and Health Survey-4, on average only 56% of Indian mothers practiced EBF for the full 6 months [10]. As India leads the world in the number of preterm births, under 5 years malnutrition, and neonatal
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