The Effect of Immediate Skin-to-Skin Contact on Exclusive Breastfeeding: An Instrumental Variable Approach.

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Given the significant decline in exclusive breastfeeding rates in the Republic of Korea, this study aimed to estimate the causal effect of immediate skin-to-skin contact on exclusive breastfeeding. Data were analysed from the Korean Early Childhood Education & Care Panel, targeting mothers expected to give birth in 2022 in the Republic of Korea. Instrumental variable analysis was performed using the mode of delivery, categorised as vaginal delivery and emergency caesarean section, as the instrument. Statistical estimation was performed using the two-stage least squares method. Mothers who engaged in immediate skin-to-skin contact were 36.3% more likely to exclusively breastfeed at 1 month postpartum, and 26.9% and 26.2% more likely at 2 and 3 months, respectively, compared to those who did not. Sensitivity analysis confirmed the robustness of these findings. Notably, the effect of immediate skin-to-skin contact on exclusive breastfeeding at 1 month remained statistically significant, despite considerable deviations from the exclusion restriction assumption. Immediate skin-to-skin contact positively influences exclusive breastfeeding rates up to 3 months postpartum. These findings are particularly relevant for healthcare settings where immediate SSC is not routine, highlighting the importance of targeted training and policy interventions to promote SSC and improve breastfeeding outcomes.