Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO Global Survey

Kenzo Takahashi,João Paulo Souza,Eduardo Ortiz-Panozo,Cynthia Pileggi Castro,Pisake Lumbiganon,Malinee Laopaiboon,Togoobaatar Ganchimeg,Erika Ota,Kapila Jayaratne,Rintaro Mori,Joshua P Vogel

doi:10.1038/srep44868

Abstract

Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors hampering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding >1 hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI <24 hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section.

Highlights

Despite a significant reduction in child mortality from 12.7 million in 1990 to 5.9 million in 2015, neonatal mortality has been decreasing more slowly and constitutes a larger proportion of under-5 mortality[1]
A recent systematic review of the literature on EIBF in South Asia, which included 25 studies from 7 countries, revealed that EIBF is predominately associated with socio-economic, health-related and individual factors, and it highlighted the limited evidence on the health care system in relation to EIBF18
The proportion of EIBF among all live births ranged from 17.7% to 98.4% with the lowest percentages found in Peru (17.7%), Ecuador (20.1%) and the Philippines (39.9%) and the highest in Angola (98.4%), Cuba (89.2%) and Sri Lanka (88.5%)

Summary

Introduction

Despite a significant reduction in child mortality from 12.7 million in 1990 to 5.9 million in 2015, neonatal mortality has been decreasing more slowly and constitutes a larger proportion of under-5 mortality[1]. A recent systematic review of the literature on EIBF in South Asia, which included 25 studies from 7 countries, revealed that EIBF is predominately associated with socio-economic, health-related and individual factors, and it highlighted the limited evidence on the health care system in relation to EIBF18. To address these gaps and promote EIBF, we need to acquire both data on EIBF coverage and a better understanding of the factors associated with delayed breastfeeding, for which little is known, especially in low- and middle income countries

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