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

• Type of Material: Article
• Authors: Melissa Young, Emory University; Nguyen Phuong, International Food Policy Research Institute; Shivani Kachwaha, International Food Policy Research Institute; Lan Tran Mai, FHI360; Sebanti Ghosh, FHI360; Rajeev Agrawal, FHI360; Jessica Escobar-Alegria, FHI360; Purnima Menon, International Food Policy Research Institute; Rasmi Avula, International Food Policy Research Institute
• Language: English
• Date: 2019-11-26
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/mcn.12892
• Title of Journal or Parent Work: Maternal & Child Nutrition
• Volume: 16
• Issue: 2
• Start Page: e12892
• End Page: e12892
• Grant/Funding Information: The Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.
• Keywords: Life Sciences & Biomedicine; Science & Technology; exclusive breastfeeding; Bangladesh; Interventions; Nutrition & Dietetics; breastfeeding initiation; India; Uttar Pradesh; programme; prelacteal feed; Pediatrics; Violence; Determinants; Rates

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.