Publications Summary

Document Type
Working Papers
Publication Topic(s)
Maternal Health, Nutrition
Albania, Armenia, Egypt, Jordan, Maldives, Tajikistan, Bangladesh, Cambodia, India, Indonesia, Myanmar, Nepal, Pakistan, Philippines, Timor-Leste, Angola, Benin, Burundi, Chad, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Senegal, South Africa, Tanzania, Uganda, Zimbabwe, Guatemala, Haiti
Recommended Citation
Mallick, Lindsay, Wenjuan Wang, Shiza Farid, and Thomas W. Pullum. 2020. Initiation of Breastfeeding in Low- and Middle-Income Countries: A Time-to-Event Analysis. DHS Working Paper No. 163. Rockville, Maryland, USA: ICF.
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Publication Date
June 2020
Publication ID

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Objective: Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). There is a need for research on the time to initiation of breastfeeding by hour and quantification of the relationships between initiation and predictive factors. Methods: With data from 31 countries that had a Demographic and Health Survey since 2015, we describe breastfeeding initiation among women age 15-49 with the most recent birth in the past 2 years. With a subset of 21 countries, we conducted survival analysis with multivariable Weibull regressions to examine factors associated with time to initiation of breastfeeding. Findings: Babies in most countries began breastfeeding within the first few hours after birth. Mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. The median time was 0.5 hours in 24 countries. The mean and median time to initiation was much greater for births delivered by cesarean section compared with births delivered vaginally at home or at health facilities. Weibull regressions, controlling for socioeconomic, demographic, and health-related characteristics of mothers and babies, showed significantly greater delays (reduced hazard ratios) in time to initiation of breastfeeding for cesarean section versus vaginal delivery at facilities and small versus normal birth size. Immediate skin-to-skin contact and higher parity were significantly associated with shorter time to initiation.


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