Effect of Early Breastfeeding Initiation and Hospital Practices on Exclusive Breastfeeding Success: A Prospective Cross-Sectional Study.
DOI:
https://doi.org/10.51168/wp9jdj18Keywords:
Exclusive breastfeeding, breastfeeding initiation, hospital practices, formula supplementation, antenatal counselling, prelacteal feeding, Baby-Friendly Hospital InitiativeAbstract
Background
Early breastfeeding initiation and supportive hospital practices are critical determinants of exclusive breastfeeding (EBF) success. Despite recommendations for early initiation and avoidance of prelacteal and unnecessary formula feeds, EBF rates remain suboptimal.
Objective
To evaluate the association of breastfeeding initiation timing and key hospital practices, including antenatal and postnatal counselling, prelacteal feeding, and in-hospital formula supplementation, with EBF success at 2.5 and 6 months of infant age.
Methods
A prospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India, among 200 mother–newborn dyads. Participants were assessed within 48 hours of delivery and followed up at 2.5 and 6 months. Data on maternal characteristics, breastfeeding practices, hospital exposures, and barriers to EBF were collected using a structured questionnaire. Associations were assessed using chi-square tests and multivariate analysis.
Results
Breastfeeding initiation within 2 hours was significantly associated with EBF success at 2.5 months (84.0% vs. 35.5%; χ²=31.4, p=0.001) and 6 months (87.0% vs. 71.0%; χ²=5.31, p=0.021). In-hospital formula supplementation was associated with higher EBF failure at 2.5 months (51.7% vs. 10.3%; χ²=41.25, p=0.001) and 6 months (41.4% vs. 13.6%; χ²=10.62, p=0.001). Antenatal and postnatal counselling were significantly associated with improved EBF outcomes.
Conclusion
Early breastfeeding initiation, avoidance of unnecessary formula supplementation, and structured counselling were important modifiable factors associated with EBF success.
Recommendation
Hospitals should strengthen early breastfeeding support, minimize unnecessary supplementation, discourage prelacteal feeding, and provide structured antenatal and postnatal counselling and lactation support.
References
1. World Health Organization. Breastfeeding. Available from: https://www.who.int/health-topics/breastfeeding
2. World Health Organization. Breastfeeding. Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_1
3. World Health Organization. e-Library of Evidence for Nutrition Actions (eLENA): Exclusive breastfeeding. Available from: https://www.who.int/tools/elena/interventions/exclusive-breastfeeding
4. World Health Organization. Infant and young child feeding. France: WHO; 2009.
5. World Health Organization. Fact sheet on infant and young child feeding. 29 January 2016. Available from: https://www.who.int
6. Victora CG, Bahl R, Barros AJD, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490.
https://doi.org/10.1016/S0140-6736(15)01024-7
7. International Institute for Population Sciences and Macro International. National Family Health Survey (NFHS-3), India 2005-2006. Mumbai: IIPS; 2008.
8. Anderson JW, Johnstone BM, Remley DT. Breastfeeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999;70:525-535.
https://doi.org/10.1093/ajcn/70.4.525
9. Goldberg G, Prentice A, Filteau S, Simondon K, editors. Breast-Feeding: Early Influences on Later Health. Adv Exp Med Biol. Vol. 639. Dordrecht: Springer; 2009.
https://doi.org/10.1007/978-1-4020-8749-3
10. Gephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Adv Neonatal Care. 2014;14(1):44-51.
https://doi.org/10.1097/ANC.0000000000000052
11. Safari K, Saeed AA, Hasan SS, et al. The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor. Int Breastfeed J. 2018;13:32.
https://doi.org/10.1186/s13006-018-0174-9
12. Chantry CJ, Dewey KG, Peerson JM, Wagner EA, Nommsen-Rivers LA. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr. 2014;164(6):1339-45.
https://doi.org/10.1016/j.jpeds.2013.12.035
13. World Health Organization. Infant and young child feeding. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
14. Guo S, Fu X, Scherpbier RW, Wang Y, Zhou H, Wang X, Hipgrave DB. Breastfeeding rates in central and western China in 2010: implications for child and population health. Bull World Health Organ. 2013;91(5):322-31.
https://doi.org/10.2471/BLT.12.111310
15. Bernaix LW, Beaman ML, Schmidt CA, Harris JK, Miller LM. Success of an educational intervention on maternal/newborn nurses' breastfeeding knowledge and attitudes. J Obstet Gynecol Neonatal Nurs. 2010;39(6):658-66.
https://doi.org/10.1111/j.1552-6909.2010.01184.x
16. Office of the Surgeon General (US); Centers for Disease Control and Prevention (US). The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011.
17. Tarrant M, Fong DYT, Heys M, Lee ILY, Shama A, Huichoi WH. Professional breastfeeding support to increase the exclusivity and duration of breastfeeding: a randomised controlled trial. Hong Kong Med J. 2014;20(Suppl 7):34-5.
18. Tarrant M, Fong DYT, Heys M, et al. Professional breastfeeding support to increase the exclusivity and duration of breastfeeding: a randomised controlled trial. Hong Kong Med J. 2014;20(Suppl 7):34-5.
19. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Martines JC, Piwoz EG, et al. Why invest, and what it will take to improve breastfeeding practices. Lancet. 2016;387(10017):491-504.
https://doi.org/10.1016/S0140-6736(15)01044-2
20. International Institute for Population Sciences and Macro International. National Family Health Survey (NFHS-3), India 2005-2006. Mumbai: IIPS; 2008.
21. Shaili V, Paru S, Kandapal DS, Jayanti S, Anurag S, Vipul N. A community-based study on breastfeeding practices in a rural area of Uttarakhand. Natl J Community Med. 2012;3(2):283-287.
22. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):3-13.
https://doi.org/10.1111/apa.13147
23. Yotebieng M, Labbok M, Soeters HM, Chalachala JL, Lapika B, Vitta BS, Behets F. Ten Steps to Successful Breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: a cluster-randomised controlled trial. Lancet Glob Health. 2015;3(9):e546-555.
https://doi.org/10.1016/S2214-109X(15)00012-1
24. Boskabadi H, Bagheri S. Comparison between infants receiving traditional supplements and exclusively breastfed infants. Avicenna J Phytomed. 2015;5(6):479-484.
25. Gephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Adv Neonatal Care. 2014;14(1):44-51.
https://doi.org/10.1097/ANC.0000000000000052
26. Safari K, Saeed AA, Hasan SS, et al. The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor. Int Breastfeed J. 2018;13:32.
https://doi.org/10.1186/s13006-018-0174-9
27. Chantry CJ, Dewey KG, Peerson JM, Wagner EA, Nommsen-Rivers LA. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr. 2014;164(6):1339-45.
https://doi.org/10.1016/j.jpeds.2013.12.035
28. Sankar MJ, Sinha B, Chowdhury R, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):3-13.
https://doi.org/10.1111/apa.13147
29. Rathaur VK, Pathania M, Pannu C, Jain A, Dhar M, Pathania N, et al. Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India. J Family Med Prim Care. 2018;7(1):45.
https://doi.org/10.4103/jfmpc.jfmpc_413_16
30. Retrospective study of breastfeeding practices in the first six months of lactation among mothers in a metropolitan city. J Matern Soc Health. Available from: https://jmsh.ac.in/articles
31. Bhanderi DJ, Pandya YP, Sharma DB. Barriers to exclusive breastfeeding in rural community of central Gujarat, India. J Family Med Prim Care. 2019;8(1):54.
https://doi.org/10.4103/jfmpc.jfmpc_329_18
32. Bhanderi DJ, Pandya YP, Sharma DB. Barriers to exclusive breastfeeding in rural community of central Gujarat, India. J Family Med Prim Care. 2019;8(1):54.
https://doi.org/10.4103/jfmpc.jfmpc_329_18
33. Shaili V, Paru S, Kandapal DS, Jayanti S, Anurag S, Vipul N. A community-based study on breastfeeding practices in a rural area of Uttarakhand. Natl J Community Med. 2012;3(2):283-287.
34. Descriptive study to assess breastfeeding knowledge levels of perinatal period mothers admitted at a tertiary care centre, Dehradun, Uttarakhand. Available from: https://acrobat.adobe.com/id/urn:aaid:sc:AP:b8850cfc-e331-4985-ad40-392e6835afe5
35. Khanal V, Adhikari M, Sauer K, Zhao Y. Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011. Int Breastfeed J. 2013;8(1):9.
https://doi.org/10.1186/1746-4358-8-9
36. Dawal S, Inamdar IF, Saleem T, Priyanka S, Doibale MK. Study of prelacteal feeding practices and its determinants in rural areas of Maharashtra. Sch J Appl Med Sci. 2014;2(4D):1422-1427.
37. Madhu K, Chowdary S, Masthi R. Breastfeeding practices and newborn care in rural areas: a descriptive cross sectional study. Indian J Community Med. 2009;34(3):243-246.
https://doi.org/10.4103/0970-0218.55292
38. Suresh S, Sharma KK, Saksena M, Thukral A, Agarwal R, Vatsa M. Predictors of breastfeeding problems in the first postnatal week and its effect on exclusive breastfeeding rate at six months: experience in a tertiary care centre in Northern India. Indian J Public Health. 2014;58(4):270.
https://doi.org/10.4103/0019-557X.146292
39. Early initiation and exclusive breastfeeding: experience from a tertiary care centre in Puducherry. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8990951/
40. Tarrant M, Fong DYT, Heys M, et al. Professional breastfeeding support to increase the exclusivity and duration of breastfeeding: a randomised controlled trial. Hong Kong Med J. 2014;20(Suppl 7):34-5.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Monika Kashyap, Ragini Singh, Vishal Kaushik, Priyanka Gandhi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
