OP23 The lesser-known breastfeeding problem: prevalence and determinants of prelacteal feeding practice in Indonesia

Abstract

Background Prelacteal feeding (PLF) is anything other than breastmilk given to neonates before breastfeeding is established. There are numerous types of PLF and they are given for various reasons. Except when medically indicated, PLF is considered as one of the many potential barriers to optimal breastfeeding. However, PLF is practiced widely across the world. Meanwhile, it is still understudied and epidemiological research on the different types of PLF is limited in many settings, including in Indonesia. This study looks at the prevalence and determinants PLF in Indonesia, focusing on overall PLF and three common types (formula, other milk, and honey). Methods A cross-sectional, secondary data analysis of the 2017 Indonesia Demographic and Health Survey was undertaken. The study population was 6168 ever-breastfeeding mothers whose last child was Results By 2017, nearly half (45%) of mothers in Indonesia gave PLF. The most common feeds were infant formula (25%), any other milk (14%), plain water (5%), and honey (3%). Factors associated with higher prevalence of overall PLF were upper-middle (Q3-Q4) wealth quintiles (PR 1.17, 95%Confidence Interval (CI) 1.03–1.32 for Q3 and PR 1.18, 95%CI 1.04–1.33 for Q4), rural residence (PR 1.17, 95%CI 1.07–1.27), baby perceived to be small at birth (PR 1.26, 95%CI 1.14–1.38), and caesarean deliveries at either public (PR 1.34, 95%CI 1.19–1.51) or private facilities (PR 1.17, 95%CI 1.03–1.33). Conversely, mothers who gave birth to the second/subsequent child (PR 0.81, 95%CI 0.75–0.87) and mothers who possessed an antenatal card (PR 0.86, 95%CI 0.77–0.96) were less likely to give PLF. When analysed separately, formula displayed relatively similar risk factors to those of overall PLF, yet several associations varied among these three types of PLF. For instance, higher wealth quintiles and rural residence were risk factors for formula but not for other milk and honey. Furthermore, honey was more prevalent in home births than in deliveries at health facilities (PR 6.05, 95% CI 4.02–9.10), but formula and other milk were more frequent among caesarean deliveries. First-time birth was the only factor that showed a consistent association with overall PLF, formula, other milk, and honey. Conclusion PLF is common in Indonesia but the prevalence and determinants vary by PLF type. Identifying high-risk groups, particularly by PLF type, is useful to plan more targeted interventions to improve breastfeeding practices.