Spatial prevalence and its contextual determinants of early initiation of breastfeeding in cases of C-section deliveries in India: a study based on National Family Health Survey-4, 2015-2016

Koustav Ghosh, Nilam V. Panchal, Atreyee S. Chakraborty


Background: Delayed early initiation of breastfeeding (EIBF) between 2 to 23 hours has increased 1.3 times risk of neonatal and it goes up double when it crosses more than 24 hours. Babies who were born through caesarean section (C-section) were less likely to initiate early breastfeeding as compared to normal vaginal delivery.

Methods: The present study has utilized 14774 weighted samples of C-section delivered women from National Family Health Survey-4 (NFHS-4) (2015-2016). Spatial analysis software i.e. ArcGIS 10.8 and STATA 14 including logistics regression has been utilized to show the spatial prevalence and contextual determinants of EIBF on C-section birth babies in India.

Results: In India, around 31.8% of C-section mothers breastfeed their children within one hour of delivery. The prevalence of EIBF is highest in Goa and lowest in Rajasthan. The central part of India mostly from the empowered action group (EAG) states practices a very low level of EIBF practices whereas, the north-east region represents the highest prevalence for the same. The odds of logistic regression shows that mother’s higher education (OR: 1.38), everyday mass media exposure (OR: 1.66), and initiation of postnatal care (PNC) within one hour (OR: 1.79) help to increase the practices of EIBF. On the other hand, delivery in the private hospital (OR: 0.61).

Conclusions: The study shows remarkable geographical variations in EIBF and its correlates in the country. It recommends that the public health programmes need to target the states with less practice of EIBF (i.e. EAG state or central part of India) F among C-section delivery mothers. By increasing the level of mothers’ education status, mass media exposure and early PNC care can improve the EIBF practices among C-section mothers in India.


Early initiation of breastfeeding, Caesarean section, Spatial prevalence, Empowered action group

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