Socioeconomic inequalities in exclusive breastfeeding, early initiation of breastfeeding, and skin-to-skin contact between mother and newborn in Nigeria: evidence from Demographic and Health Survey

Abstract

Background The effects of breastfeeding practices on children’s health are undoubtedly of great interest worldwide. Exclusive breastfeeding (EBF), early initiation of breastfeeding (EIBF) and skin-to-skin contact (SSC) between mother and the newborn have many short-term and long-term benefits. The aim of this study was to explore state-level prevalence and examine the socioeconomic inequalities between EBF, EIBF and SSC in Nigeria. Methods Data on 2,936 children aged less than 6 months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data from 21,569 women were used for EIBF and SSC estimations. Lorenz curve and concentration index were used to examine socioeconomic inequalities in EBF, EIBF and SSC. Results The prevalence of EBF, EIBF, and SSC were 31.8%, 44.2%, and 12.1% respectively. Furthermore, Ogun State had the highest prevalence of EBF (71.4%); while Bayelsa State had the highest prevalence of SSC (67.8%) and EIBF (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and EIBF across household wealth quintile and levels of mother’s education, in contrast to their rural counterparts. We quantified the degree of wealth-related and mother’s education inequalities in EBF, SSC and EIBF. Overall, EBF, SSC and EIBF had pro-rich coverage; EBF (Conc. Index = 0.118; p < 0.001), SSC (Conc. Index = 0.152; p < 0.001) and EIBF (Conc. Index = 0.103; p = 0.002) respectively. Also, EBF was significantly more concentrated among mothers with higher educational attainment (Conc. Index = 0.157; p < 0.001), SSC (Conc. Index = 0.156; p < 0.001) and EIBF (Conc. Index = 0.091; p < 0.001). The test for differences between urban vs. rural was significant in EBF, SSC and EIBF for mother’s educational attainment. But this was only significant in EIBF for household wealth quintile. Conclusion Socioeconomic status determined breastfeeding practices and SSC in Nigeria. Breastfeeding practices interventions should target all mothers, especially low socioeconomic status mothers to ensure improvements in baby friendly initiatives.