Peer-reviewed article
Disparities in early initiation of breast feeding and prelacteal feeding: A study of low‐ and middle‐income countries
Paulo Augusto Ribeiro Neves, Juliana dos Santos Vaz, Luiza Isnardi Cardoso Ricardo, Nancy Armenta-Paulino, Aluísio J. D. Barros et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined early breastfeeding initiation and prelacteal feeding practices across 76 low- and middle-income countries using demographic survey data from 2010-2019. The research found that early breastfeeding within the first hour after birth protects newborns but occurs in only 45% of cases globally, while prelacteal feeding (giving babies other foods or liquids before breastfeeding) is common. Disparities exist by wealth, with milk-based prelacteal feeding more common among wealthier families and in private healthcare facilities. The study confirms that early breastfeeding and prelacteal feeding are inversely related, meaning countries with higher prelacteal feeding rates have lower early breastfeeding rates.
Key points
- Only 45% of newborns globally are breastfed within the first hour after birth
- Milk-based prelacteal feeding is significantly more prevalent in the richest 20% of households
- Prelacteal feeding is more common after institutional births, especially in private sector facilities across East Asia, Eastern Europe, Central Asia, and Latin America
- Water-based prelacteal feeding is more common in African regions
- Early breastfeeding initiation is inversely correlated with all types of prelacteal feeding practices
Limitations
This is a descriptive cross-sectional analysis of survey data that identifies correlations and disparities but cannot establish causal mechanisms or explain why these patterns exist. The study does not evaluate the effectiveness of any intervention to improve breastfeeding practices.
Abstract
BACKGROUND: Early initiation of breast feeding (EIBF) reduces the risk of neonatal mortality. However, only 45% of newborns are breast-fed within the first hour after birth and prelacteal feeding (PLF) is widely prevalent in low- and middle-income countries (LMICs). OBJECTIVE: To assess within- and between-country disparities in EIBF and PLF practices by household wealth and place of birth and to investigate the national-level correlation between these feeding indicators in LMICs. METHODS: Data from Demographic Health Surveys and Multiple Indicator Cluster Surveys (2010-2019) in 76 LMICs were used to investigate within-country disparities in EIBF, any PLF, milk-based prelacteal feeding (MPLF), and water-based prelacteal feeding (WPLF) by wealth quintiles and place of childbirth (institutional [private or public sector] or in-home) for children under two years. We examined the between-country Pearson's correlation between EIBF and types of PLF, later adjusted for per capita gross domestic product (GDP). RESULTS: No clear wealth-related differences were found for EIBF and WPLF; however, any PLF and MPLF were significantly higher in children belonging to the richest 20% of households but are also prevalent among lower income groups. Prevalence of any PLF was higher among institutional births in all LMICs, but especially for MPLF in private sector deliveries in East Asia & the Pacific, Eastern Europe & Central Asia, and Latin America & the Caribbean. WPLF was more common in all African regions. EIBF was inversely correlated with any PLF (r = -0.59, 95% CI -0.72, -0.42), MPLF (r = -0.41, 95% CI -0.58, -0.21) and WPLF (r = -0.34, 95% CI -0.53, -0.13). Adjustment for log-GDP did not affect the magnitude and direction of the results. CONCLUSION: Clear prorich disparities exist in the prevalence of PLF, especially MPLF. Children born in private sector facilities are more likely to receive MPLF. EIBF is negatively associated with PLF practices in LMICs. The promotion of better early feeding practices is urgent to achieve the Sustainable Development Goal to reduce neonatal mortality to 12 deaths per 1000 live births.