%0 Journal Article %A Lindsay Mallick %A Wenjuan Wang %A Shiza Farid %A Thomas Pullum %T Initiation of Breastfeeding in Low- and Middle-Income Countries: A Time-to-Event Analysis %D 2021 %R 10.9745/GHSP-D-20-00361 %J Global Health: Science and Practice %P 308-317 %V 9 %N 2 %X Key FindingsWe calculated a continuous measure of time to initiation of breastfeeding in low- and middle-income countries using recent Demographic and Health Surveys Program data and found that although the average time ranged from 1.7 hours in Burundi to 40 hours in Chad, the median time to initiation met the benchmark of within 1 hour in most countries.In nearly all countries studied and after controlling for confounding factors, cesarean delivery was associated with a significant delay in median time to initiation of breastfeeding, ranging from 30% to 830% longer time compared with vaginal deliveries in facilities. Conversely, immediate skin-to-skin contact was associated with an earlier time to initiation in almost all countries (10%–80% earlier).Key ImplicationsProgram managers and hospital administrators should consider adopting facility-based programs that encourage early breastfeeding, such as the Baby-Friendly Hospital Initiative, particularly in places where breastfeeding is substantially delayed.Government officials should endorse health facility-based policies that promote breastfeeding practices such as skin-to-skin and provide health care worker training opportunities to build awareness of these practices.Objective:Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). Although delays are associated with cesarean delivery and skin-to-skin contact may facilitate early breastfeeding, a more nuanced understanding of these relationships is needed.Methods:With data from 31 countries that had a Demographic and Health Survey since 2015, we described breastfeeding initiation among babies most recently born in the last 2 years to women aged 15–49 years. In a subset of 21 countries, we conducted survival analysis with multivariable log-logistic accelerated failure time (AFT) regressions to examine factors associated with time to initiation of breastfeeding, specifically the mode of delivery and skin-to-skin contact, controlling for receipt of health care as well as socioeconomic and demographic characteristics of mothers and babies.Findings:Babies in most countries began breastfeeding within a few hours after birth. The mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. In most countries (24 of 31), the median time was 0.5 hours. Median time to initiation was greater for births by cesarean delivery compared with vaginal births at health facilities. After controlling for covariates, AFT models showed significant delays in breastfeeding among cesarean deliveries in most countries, with as much as a 9-fold delay in Senegal. Immediate skin-to-skin contact was significantly associated with a shorter time to initiation.Conclusion:Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries. %U https://www.ghspjournal.org/content/ghsp/9/2/308.full.pdf