Abstract:
Background: Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age
confers many health benefits for infants; both are crucial high impact, low-cost interventions. However,
determining accurate global rates of these crucial activities has been challenging. We use population-based data to
describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive
breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and
exclusive breastfeeding at 42 days post-partum.
Methods: Prospectively collected data from women and their live-born infants enrolled in the Global Network’s
Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads
in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan,
Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the
entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample
studied at 42 days post-partum.
Result: A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for
the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563
subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the
Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of
lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate
early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and
failure to place baby on the mother’s chest after delivery. Factors associated with failure to achieve exclusive
breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation.
Conclusions: In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding
and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key
breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions.
