System Level Barriers in Early Initiation of BreastfeedingFinding from a Cross-sectional Survey in Khagaria District of State Bihar, India

Abstract

Purpose: Despite 55% children aged 0-6 months being exclusively breastfed in India, 0.26 million children die each year from diarrhoea and pneumonia that can be prevented through early initiation of and exclusive breastfeeding (EIBF). A study was conducted to assess the factors associated with EIBF in 20 villages from the District Khagaria (State Bihar). Method: The cross-sectional study was carried out from Jan-March 2017 with a sample of 288 married women who had delivered in last 1 year. Bivariate and multivariate logistic regression analyses were performed to identify associated factors of EIBF. Results: Analyses show that institutional delivery (aOR: 2.69; CI 1.22 to 5.93; p<0.05) and delivery with normal mode (aOR: 4.61; CI 1.74 to 12.18; p<0.01) were significant contributors of EIBF. Additionally, likelihoods of EIBF were lower when the delivery was performed in a private institution (OR 0.28, CI 0.14 to 0.59; p<0.001) and by a doctor (OR 0.33, CI 0.18 to 0.60; p<0.001). Besides, higher birth order (OR 2.00, CI 0.98 to 4.10; p<0.05) was also found to be significantly associated with EIBF. Conclusion: System level efforts are needed to promote EIBF, along with improved training and reinforcement in doctors for breastfeeding. Reduction in caesarean section rates can positively contribute to EIBF.