Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh?

Abstract

Background Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are

WHO recommended practices for improving maternal and newborn health outcomes. Glob- ally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experi- enced increasing facility delivery coverage and cesarean section rates. However, the

impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent

associations between childbirth locations and mode of delivery with favorable early breast- feeding practices in four hard to reach areas of Bangladesh.

Method We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey,

were interviewed using structured questionnaires. EIBF and no prelacteal feeding were con- sidered as favorable early breastfeeding practices. The categories of childbirth locations

were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. Results The prevalence of EIBF practices were 69.6%(95% CI:67.8–71.3); 72.2%(95% CI:67.8– 71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3–75.6) mother’s in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of

EIBF (aOR = 0.51; 95%CI:0.35–0.75). Cesarean section was found to be negatively associ- ated with EIBF (aOR = 0.20; 95%CI:0.12–0.35), after adjusting for potential confounders.

We could not find any significant associations between the place of birth and mode of deliv- ery with no prelacteal feeding. Discussions This study found that facility births and cesarean deliveries were negatively associated with

EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a poten- tial solution for improving EIBF and no prelacteal feeding practices, the challenges of

reduced service availability and accessibility in HtR areas must be considered while devising

effective intervention strategies. Future studies can explore potential interventions to pro- mote early breastfeeding for facility births and cesarean deliveries in HtR areas.