Abstract
Objectives: Breastfeeding rates are decreasing rapidly in many low and middle-income countries, disproportionately affecting urban residences. We use data from Lao People’s Democratic Republic to identify primary mechanisms underlying the urban-rural gap in breastfeeding practices.Methods: We used data from the 2017 Lao Social Indicator Survey II. Residence was categorized as large-urban (>1 million), small-urban (<1 Million), and rural. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) to identify factors attributing to the urban-rural differences in complying with World Health Organization’s breastfeeding recommendations for children <24 months.Results: Mothers in large-urban residences had 3.78 (95% confidence intervals: 1.19, 11.95) and 4.67 (95% CI: 2.30, 9.46) higher odds of non-compliance with exclusive and complementary breastfeeding recommendations, respectively, than mothers living in rural areas in bivariate models. Breastfeeding differentials between small urban and rural residences were largely explained by differences in maternal education and household wealth.Conclusion: Results of our paper suggest large disparities in breastfeeding practices between large-urban, small-urban, and rural residences.
Highlights
IntroductionThe world’s population has steadily become more urbanized—with 56% of the world living in urban residences [1]
Over the past decade, the world’s population has steadily become more urbanized—with 56% of the world living in urban residences [1]
Given that economic development in low- and middle-income countries (LMIC) is usually concentrated in urban areas[7], urbanization may affect breastfeeding in multiple ways
Summary
The world’s population has steadily become more urbanized—with 56% of the world living in urban residences [1]. With rapid urbanization in many low- and middle-income countries (LMIC) comes rapid changes to social behavior and health [2], which may contribute to the rapid declines in breastfeeding in many areas [3,4,5,6]. A meta-analyses of breastfeeding practices in the 21st century shows that an increase in household income in LMICs is associated with lower rates of continued breastfeeding [3]. Given that economic development in LMIC is usually concentrated in urban areas[7], urbanization may affect breastfeeding in multiple ways. In China, for example, rapid economic growth coincided with an increase in marketing of breastmilk substitutes and significant changes in individual nutritional habits [4]
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