Inequalities in Delayed Initiation of Breastfeeding: Evidence from Health Surveys in 58 Low- and Middle-Income Countries (2012-2017)

Background: Delay in breastfeeding initiation beyond 1 hour of birth increases the risk of neonatal deaths and illnesses. Despite ample evidence highlighting its importance, wealth-related inequalities exist in delayed breastfeeding initiation rates in many low- and middle-income countries (LMICs). Our goal was to examine the magnitude and trend of socio-economic inequalities in delayed breastfeeding initiation rates in LMICs.Methods: We used data from 58 low- and middle-income countries from their most recent Demographic and Health Survey and Multiple Indicator Cluster Survey to present delayed breastfeeding initiation rates across wealth quintile and area of residence. To assess the wealth-related inequalities in delayed breastfeeding initiation rates, we calculated two indicators- the difference, in percentage points, between the rates recorded for the poorest and wealthiest quintiles and the ratio of the same two values. To present the change over time, we calculated- the annual absolute change and annual absolute excess change. Results: Within countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest quintile (median 47.4%) and lower in the poorest quintile (median 42.6%). In 37 study countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest than among the poorest. The highest prevalence of delayed breastfeeding initiation was in South Asia, and the largest levels of pro-rich inequality were in Latin America and Caribbean. Pro-poor inequality was more common in Sub-Saharan Africa. Delayed breastfeeding initiation rates decreased faster in the poorest quintile (median -1.3 percent-points per year) compared to the wealthiest quintile (median -0.8 percent-points per year), indicating an increase in pro-poor inequality over time.Conclusions: There is no distinguishable global pattern for wealth-related inequality in the prevalence of delayed breastfeeding initiation. The prevailing inequality may be due to a combination of sociodemographic factors and is largely preventable by incorporating adequate infrastructure towards creating a pro-breastfeeding environment.