Initiation of breastfeeding within one hour of birth and its determinants among normal vaginal deliveries at primary and secondary health facilities in Bangladesh: A case- observation study

Abstract

Background

Initiation of breastfeeding within one hour of birth can avert 22% of newborn mortality. Sev- eral factors influence breastfeeding practice including mothers’ socio-demographic and

obstetric characteristics, and factors related to time around child birth. This study explores

breastfeeding initiation practices and associated influencing factors for initiating breastfeed- ing within one hour of birth in public health facilities of Bangladesh.

Methods In this study, normal deliveries were observed in 15 public health facilities from 3 districts in Bangladesh. Study participants were selected by convenient sampling i.e. delivery cases attending health facilities during the study period were selected excluding caesarean section

deliveries. Among 249 mothers, time of initiation of breastfeeding was observed and its asso- ciation was measured with type of health facility, privacy in delivery room, presence of sepa- rate staff for newborn, spontaneous breathing, skin-to-skin contact and postnatal contact of

mother or newborn with health care providers within one hour after delivery. Data was col- lected during August-September, 2016. Kruskal-Wallis test was used to measure equality of

median duration of breastfeeding initiation time among two or more categories of indepen- dent variables. Series of simple logistic regressions were conducted followed by multiple

logistic regression to identify the determinants for breastfeeding initiation within one hour. Results Among 249 mothers observed, 67% initiated breastfeeding within one hour of birth at health facilities and median time to initiate breastfeeding was 38 minutes (Inter-quartile range: 20–56 minutes). After controlling for maternal age as potential confounder, the odds of initiating breastfeeding within one hour of birth was significantly higher if mothers gave birth in district hospitals (AOR 3.5: 95% CI 1.5, 6.4), visual privacy was well-maintained in delivery room (AOR 2.6: 95% CI 1.2, 4.8), newborns cried spontaneously (AOR 4.9: 95% CI 3.4, 17.2), were put to skin-to-skin contact with mothers (AOR 3.4: 95% CI 1.9, 10.4) or were examined by health care providers in the facilities (AOR 2.4: 95% CI 1.3, 12.9). Conclusions In health facilities, initiation of breastfeeding within one hour is associated with some critical practices and events around the time of birth. With the global push toward facility-based deliveries, it is very important to identify those key factors, within the landscape of maternal and newborn care, which significantly enable health care providers and parents to engage in the evidence-based newborn care activities including early initiation of breastfeeding that will, in turn, reduce global rates of newborn mortality.