Research Article: Prevalence and factors associated with early initiation of breastfeeding among Bangladeshi mothers: A nationwide cross-sectional study

Date Published: April 25, 2019

Publisher: Public Library of Science

Author(s): Md. Ariful Islam, ASMA Mamun, Md. Murad Hossain, Premananda Bharati, Aik Saw, Pete E. Lestrel, Md. Golam Hossain, Mohammad Rifat Haider.


Early initiation of breastfeeding (EIBF) is associated with better health of the mothers and reduced risk of neonatal mortality. The objective of this study was to determine the prevalence of EIBF and associated factors among Bangladeshi mothers.

The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 4,092 married non-pregnant Bangladeshi mothers who had at least one child aged 2 years or younger were included in this study. A two-level logistic regression model was used to remove the clustering effect for finding the impact of socio-economic and demographic factors on EIBF.

The prevalence of EIBF among Bangladeshi mothers was 51.4% (urban: 47.1% and rural: 53.4%). A two -level logistic regression model showed that mothers living in the Sylhet division (p<0.01) and rural environment (p<0.05) were more likely to practice EIBF. Mothers who were obese or overweight (p<0.01), had secondary (p<0.05) or higher education (p<0.01) were less likely to provide early breastfeeding to their newborn babies compared to their counterparts. Those who delivered by caesarian-section (p<0.01) were less likely to perform EIBF while those who attended an antenatal care clinic more than 3 times (p<0.05) were more likely to do so. About half of the Bangladeshi mothers did not start breast-feeding within one hour after birth. This study identified several geographical and socio-demographic factors that were associated with EIBF, and hope that this information will help the government to focus their resources to promote early breastfeeding.

Partial Text

The World Health Organization (WHO) considers breastfeeding as the normal way to provide young infants with all the nutrients that they need for healthy growth and development especially in the first six months of life [1]. It has been shown that breast milk contains essential nutrients with immunological and anti-inflammatory properties that protect both mothers and children against various infections and diseases [2–4]. Early initiation of breastfeeding (EIBF) or timely initiation of breastfeeding refers to providing breast milk to the newborn babies within one hour of birth, which ensures that they receive essential nutrients including the colostrums [5]. Colostrum, the “first milk” produced by the mother first few days after delivery is endowed with protective antibodies that act as the first line of defense in the form of passive immunization for the infant. The colostrum fortifies their immune system and contributes towards the lowering of the mortality rate in neonates [6]. It also contains at least ninety known nutritional components including amino acids, minerals and vitamins essential for the growth and development of newborns [7]. EIBF increases skin-to-skin contact between mother and infant, and helps to prevent hypothermia of the baby, establishes bonding between mother and child, and increases the potential for exclusive breastfeeding practices [8].

The 2014 BDHS received ethics approval from Bangladesh Medical Research Council. The 2014 BDHS also received written consent from each individual in the study. The data used in the present study was extracted from the large scale of dataset collected by the Bangladesh Demographic and Health Survey (BDHS-2014). This is a nationally representative survey, which covered all administrative regions (or divisions) of Bangladesh. Thus, Bangladesh is divided into eight administrative divisions, of which Mymensinghm is a new division. During the BDHS-2014, Bangladesh was divided into seven administrative divisions, and Mymensinghm was considered as a district under the Dhaka division. The BDHS-2014 survey collected socio-demographic, health, anthropometric and lifestyle information from 17,863 Bangladeshi married women over the reproductive age (15 to 49 years). The data was collected from March 24, 2014 to August 11, 2014. The sampling technique, survey design, survey instruments, measuring system and quality control have been described elsewhere [23].

A frequency distribution (percentage) was used to determine the prevalence of EIBF among Bangladeshi mothers. Chi-square (χ2) tests were performed to evaluate the association between independent variables and the EIBF. BDHS-2014 collected data using two-stage stratified cluster sampling. Since the observations were derived from several levels of hierarchy, it was possible to obtain a clustering effect in outcome variable. A single-level statistical model would not be appropriate for analyzing this type of data set [29]. To remove the clustering effect, two levels of multiple logistic regression analysis were used to detect the impact of socioeconomic, demographic and nutritional factors on EIBF among Bangladeshi mothers. The median odds ratio (MOR) was used to check the existence of clustering effect in outcome variable. The MOR is defined as
where σu2 is the cluster variance. The value of MOR is always greater than or equal to 1. If MOR = 1, it means there is no cluster variation, but if MOR>1, there is cluster variation of the outcome variable, and the effect needs to be removed [30].

EIBF is one of the most effective practices for providing balanced nutrition for newborn babies, and to reduce the rate of child mortality and morbidity. The overall prevalence of the EIBF practice among Bangladeshi mothers as based on the BDHS survey taken in 2014, which was 51.4%, indicating some improvement when compared to the rate of 47% reported in the survey conducted in 2011 [23]. This rate was lower than that for the neighboring country of Nepal (66.4%) [28], as well as for other developing countries such as Ethiopia (83.7%) [14]. However, the rate was higher than other South Asian countries like India (21%), Pakistan (8.5%), and other developing countries like Nigeria (34.7%), Iran (32.2%), and South Sudan (48%) [32–36].

This study showed that almost half of all Bangladeshi mothers do not practice EIBF. Mothers from specific geographical regions like the Sylhet division, and those from rural areas were more likely to practice EIBF. Uneducated, healthy (normal weight) and vaginally delivered mothers were more likely to provide their initial breast milk to their newborns. It was also noted that mothers who attended ANCs more than 3 times were more likely to perform EIBF. Thus, providing information on the benefits of EIBF among educated women in urban areas may also be an effective way to promote EIBF, with a special focus on expecting mothers attending the ANC clinics.