Abstract
Background Early initiation of breastfeeding (EIBF) is a costless practice with numerous neonates' survival benefits. Thus, any disparity results in an unacceptably high neonatal death rate but socioeconomic disparities on EIBF have not been well explored in Ethiopia. Therefore, this study is aimed at assessing the socioeconomic inequalities of EIBF in Ethiopia from 2000 to 2016. Methods The Ethiopian demographic and health survey data and the World Health Organization's Health Equity Assessment Toolkit were used to investigate the inequalities in EIBF across the wealth quintile, education, residence, and subnational region. Difference, ratio, slope index inequality (SII), relative index inequality (RII), and population attributable risk (PAR) were used as equity summary measures. Results In Ethiopia, EIBF practice was 47.4% in 2000, 66.2% in 2005, 51.5% in 2011, and 73.3% in 2016. Wealth-related inequality was observed in the 2000, 2005, and 2011 survey years with SII of -7.1%, -8.8%, and 8.7%, respectively, whereas educational-related inequality was observed in 2005 and 2011 with SII of -11.7% and 6.5%, respectively. However, significant change in wealth-, education-, and residence-related inequalities was detected in 2011. Regional inequality on EIBF was observed in all survey years with a difference of 35.7%, 38.0%, 29.1%, and 48.5% in the 2000, 2005, 2011, and 2016 survey years, respectively. But a significant change in regional inequality was noted in 2016 with a PAR of 17.2%. Conclusions In Ethiopia, the wealth-, residence-, and educational-related inequalities of EIBF increased significantly between the years 2000 and 2011. However, regional inequality persistently increased from 2000 to 2016. Overall, one-sixth of the national level EIBF was decreased due to regional disparity in 2016. The northern regions of Ethiopia (Tigray, Afar, and Amhara) poorly performed compared to the peer regions. Therefore, interventions targeting them would significantly improve the national level of EIBF.
Highlights
Initiation of breastfeeding (EIBF) is breastfeeding to newborns initiated within the first one hour of birth to benefit both the neonate and the mother [1]
The World Health Organization (WHO) recommends the Early initiation of breastfeeding (EIBF) to enrich the newborn with protective nutrients which are abundant in the first milk of breastfeeding and to facilitate the emotional bonding of the mother and the newborn which is in turn used for the physiological resilience of the mother in the postpartum period [2]
This study indicated a fluctuation in EIBF practice in Ethiopia for the last seventeen years, with 47.4%, 66.2%, 51.5%, and 73.3% in 2000, 2005, 2011, and 2016, respectively (Figure 1)
Summary
Initiation of breastfeeding (EIBF) is breastfeeding to newborns initiated within the first one hour of birth to benefit both the neonate and the mother [1]. The failure of EIBF in the first hour of birth is estimated to double the risk of neonatal death [5, 6]. Any disparity results in an unacceptably high neonatal death rate but socioeconomic disparities on EIBF have not been well explored in Ethiopia. The Ethiopian demographic and health survey data and the World Health Organization’s Health Equity Assessment Toolkit were used to investigate the inequalities in EIBF across the wealth quintile, education, residence, and subnational region. In Ethiopia, the wealth-, residence-, and educational-related inequalities of EIBF increased significantly between the years 2000 and 2011. Interventions targeting them would significantly improve the national level of EIBF
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