It takes a village: An empirical analysis of how husbands, mothers‐in‐law, health workers, and mothers influence breastfeeding practices in Uttar Pradesh, India

Abstract

Evidence on strategies to improve infant and young child feeding in India, a country that carries the world's largest burden of undernutrition, is limited. In the context of a programme evaluation in two districts in Uttar Pradesh, we sought to understand the multiple influences on breastfeeding practices and to model potential programme influence on improving breastfeeding. A cross‐sectional survey was conducted among 1,838 recently delivered women, 1,194 husbands, and 1,353 mothers/mothers‐in‐law. We used bivariate and multivariable logistic regression models to examine the association between key determinants (maternal, household, community, and health services) and breastfeeding outcomes [early initiation of breastfeeding (EIBF)], prelacteal feed, and exclusive breastfeeding (EBF). We used population attributable risk analysis to estimate potential improvement in breastfeeding practices. Breastfeeding practices were suboptimal: EIBF (26.3%), EBF (54%), and prelacteal feeding (33%). EIBF was positively associated with maternal knowledge, counselling during pregnancy/delivery, and vaginal delivery at a health facility. Prelacteal feeds were less likely to be given when mothers had higher knowledge, beliefs and self‐efficacy, delivered at health facility, and mothers/mothers‐in‐law had attended school. EBF was positively associated with maternal knowledge, beliefs and self‐efficacy, parity, and socio‐economic status. High maternal stress and domestic violence contributed to lower EBF. Under optimal programme implementation, we estimate EIBF can be improved by 25%, prelacteal feeding can be reduced by 25%, and EBF can be increased by 23%. A multifactorial approach, including maternal‐, health service‐, family‐, and community‐level interventions has the potential to lead to significant improvements in breastfeeding practices in Uttar Pradesh.

Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India

“…11 The husband's knowledge about ANC practices and delivering in a health facility and the MIL's knowledge about early initiation of breastfeeding (EIBF) practices are associated with whether the household performs these practices. 12,13 Our qualitative work suggests men are most likely to be involved when decisions have financial repercussions, such as whether to deliver in a facility, whereas the MIL is deferred to for decisions around home care, such as breastfeeding or cord care (unpublished results). Social norms further impinge on these decisions, with norms themselves constantly evolving.…”

Breastfeeding and Child Oral Health Promotion: Perspectives of Nursing Mothers and Dentists

“…However, the feeling of insu cient milk production may be related to a lack of con dence and inadequate practice than to a real inability to produce milk. Therefore, the timely support of health teams could solve this barrier 11,20 by investing in maternal and family knowledge and by improving BF advice 33 .…”

“…Women's assistance during pregnancy can minimize anxiety and increase the number of pregnant women to breastfeeding their babies 7,34 . Multidisciplinary actions developed during the prenatal and postpartum periods strengthen bonds between teams and users, facilitate the care line's implementation, and promote integrality 33 . In keeping with previous studies 26,35 , most of the interviewees reported not having received information about BF during the prenatal period.…”

Impact of maternal factors and socio-demographic determinants on early initiation of breastfeeding practices in Alwar district, Rajasthan, India

“…9 In India, EIBF nearly doubled from 23% to 42%, between 2005-2006 and 2015-2016, and India reports 41.6% as current rate of early initiation within 1 hour of birth. 1,10 In Rajasthan, breastfeeding rates are much lower as compared with the national average with EIBF at only 13.3% in national family health survey (NFHS)-3 and increasing to 28.4% in NFHS 4 (2015NFHS 4 ( -2016. The data reveals that 37.7% new-born were not breastfed within 1 hour of birth while they were delivered in the health facilities.…”

“…India has developed a comprehensive infant and young child feeding policies and operational guidelines that are well aligned with global policies. 1 In view of IYCF guidelines and current practices of early initiation of breastfeeding, this study explores underlying causes and factors that influence breastfeeding practices, especially EIBF.…”