Socio-economic Moderators of the Association between Delayed Initiation and Place of Delivery: Insights from a Large Indian Cross-sectional Survey
Description
Background- Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, there are constraints to achieving progress in this area. Over half of the mothers in India delay breastfeeding initiation. Various factors have been pinpointed as influencing the initiation of breastfeeding, with institutional deliveries emerging as a crucial factor among them. Objective –To test the hypothesized association between institutional delivery and initiation delays and identify how various socio-economic variables moderate (weaken/strengthen/ reverse) the association between breastfeeding initiation delays and place of delivery. Methods- This cross-sectional study analyses data of 1,06,569 breastfeeding mothers drawn from data of NFHS -5 (2019-2021) for analysis. The outcome variable of the study was the timing of breastfeeding initiation for the most recent child, with the choice of delivery location serving as the explanatory variable. Additionally, socio-economic factors such as age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based Moderation analysis explored how these variables moderate the relationship between breastfeeding initiation delays and place of delivery. Statistical analysis was conducted using IBM SPSS Statistics 26. Results- The highest occurrence of delayed breastfeeding initiation was observed among mothers aged 36 and older (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and delivering their babies at home (64.1%). Institutional delivery significantly and negatively affects delayed breastfeeding initiation (OR=0.705, P<.001). Age as a moderating variable significantly affects this association. For younger mothers, delivering in institutions appears to have a mitigating effect on delayed initiation (aOR= 0.757, P<.05). Notably, education level (aOR=0.616, P<.01 for no education and aOR=0.510, P<.05 for primary education) and wealth index (aOR=0.672, P<.01) as a moderating factor have significantly strengthened the negative effect of institutional delivery on delayed initiation. Conclusion- The study offers valuable insights into the intricate moderating effects of socio-economic variables affecting breastfeeding initiation within institutional childbirth contexts in India. Outreach initiatives aimed at promoting healthcare service utilization during pregnancy and delivery and raising awareness about breastfeeding practices are essential measures to improve the adoption and implementation of early breastfeeding initiation.