Abstract
BackgroundPrelacteal feeding, the feeding a newborn substances or liquids before breastfeeding, is a common cultural practice in Pakistan, but is associated with neonatal morbidity and mortality because it delays early initiation of breastfeeding. In this study, we sought to examine the social and cultural factors associated with prelacteal feeding in Pakistan.MethodsThis mixed-method study used data from the Pakistan Demographic and Health Survey (PDHS) 2012–13. Findings from the survey were complemented by qualitative interviews with mothers and healthcare providers. In a subset of PDHS dyads (n = 1361) with children (0–23 months), descriptive statistics and bivariate and multivariable logistic regression analysis examined factors associated with prelacteal feeding. The qualitative study included in-depth interviews with six mothers and six health care providers, which were analyzed using NVivo software version 10.ResultsIn PDHS, a majority of children (64.7%) received prelacteal feeding. The most common prelacteal food was milk other than breast milk (24.5%), while over a fifth (21.8%) of mothers reported giving honey and sugar water. Factors associated with prelacteal feeding included: birth at public health facilities (AOR 0.46, 95% CI 0.02, 0.95), maternal primary education (AOR 2.28, 95% CI 1.35, 3.85), and delayed breastfeeding initiation (AOR 0.03, 95% CI 0.01, 0.61). In our qualitative study, the major themes found associated with prelacteal feedings included: easy access to prelacteal substances at health facilities, deliveries in private health facilities, prelacteals as a family tradition for socialization, insufficient breast milk, Sunna of Holy Prophet, and myths about colostrum.ConclusionsThese data indicate that prelacteal feeding is a well-established practice and social norm in Pakistan. Policies and interventions aimed at promoting breastfeeding need to take these customs into consideration to achieve the desired behavioral changes.
Highlights
Prelacteal feeding, the feeding a newborn substances or liquids before breastfeeding, is a common cultural practice in Pakistan, but is associated with neonatal morbidity and mortality because it delays early initiation of breastfeeding
Deliveries in private hospitals and prelacteal feedings While deliveries in private health facilities are considered to be relatively safer than government facilities or home deliveries, our research indicated that prelacteals are more common in private health facilities
In our mixed-methods study, we found that mothers with pre-college education, primiparous women, mothers delivering at private health facilities, and mothers delaying the early initiation of breastfeeding were more likely to administer prelacteals to their infants
Summary
Prelacteal feeding, the feeding a newborn substances or liquids before breastfeeding, is a common cultural practice in Pakistan, but is associated with neonatal morbidity and mortality because it delays early initiation of breastfeeding. Asim et al International Breastfeeding Journal (2020) 15:53 the potential benefits of colostrum, which may be a major contributor to high morbidity and mortality in the neonatal period [12,13,14,15,16]. This practice may lead to the development of a weak immune system and infection in children. To avoid these negative health outcomes, some believe that shifting prelacteal feeding practices could potentially save the lives of around 830,000 children annually [17]
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