First 72-hours after birth: Newborn feeding practices and neonatal mortality in India
1Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India.
Insights
Early initiation of breastfeeding increased significantly in India, reducing neonatal mortality. However, progress has slowed, necessitating continued focus on breastfeeding support for newborns.
Area of Science:
- Public Health
- Neonatal Health
- Maternal Health
Background:
- Child mortality reduction is uneven, with slow progress in neonatal mortality within the first month of life.
- Early initiation of breastfeeding and avoiding pre-lacteal feeds are crucial for newborn survival by preventing infections.
- This study examines trends in early breastfeeding initiation and pre-lacteal feeding practices in India and their impact on neonatal mortality.
Purpose of the Study:
- To assess changes in the prevalence of early initiation of breastfeeding and pre-lacteal feeding in India.
- To identify factors associated with these breastfeeding practices.
- To determine the association between breastfeeding practices and neonatal mortality.
Main Methods:
- Utilized data from three rounds of the National Family Health Surveys in India (2005-06, 2015-16, 2019-21).
- Employed bivariate and multivariate analyses to examine prevalence, risk factors, and associations.
- Focused on early initiation of breastfeeding (within one hour of birth) and pre-lacteal feeding.
Main Results:
- Early breastfeeding initiation rose from 25% to 42% between 2005-06 and 2019-21.
- Pre-lacteal feeding decreased substantially from 57% to 15% during the same period.
- Early breastfeeding initiation showed an association with lower neonatal mortality; pre-lacteal feeding did not show a harmful association compared to late initiation.
Conclusions:
- Significant improvements in early breastfeeding initiation and reductions in pre-lacteal feeding were observed, coinciding with the National Rural Health Mission.
- Progress in early breastfeeding initiation has stagnated since 2015-16, and the decline in pre-lacteal feeding has slowed.
- Future programs should prioritize breastfeeding support services and personnel in health facilities to reduce adverse neonatal outcomes.
Background:
The reductions in mortality levels among children under five years are observed in most populations, including populations that were lagging the progress in the past. However, the reduction is not uniform across ages during childhood. The mortality declines within the first month have shown relatively slow progress. Early initiation of breastfeeding and discarding pre-lacteal feed protects the newborn from acquiring infection and, thereby, reduces mortality. This paper assesses the change in the prevalence of early initiation of breastfeeding and pre-lacteal feed along with their associated factors, and their association with neonatal mortality in India.
Methods:
We used data from the three rounds of National Family Health Surveys conducted during 2005-06, 2015-16 and 2019-21 in India. We used bivariate and multivariate analyses to examine prevalence rates, risk factors, and relationships between breastfeeding practices, including early initiation of breastfeeding and pre-lacteal feed, and neonatal mortality.
Results:
Early initiation of breastfeeding within one hour after birth increased rapidly from 25% in 2005-06 to 42% in 2019-21, and the pre-lacteal feeding practice declined from 57% in 2005-06 to 15% in 2019-21. Pre-lacteal feed is lower in states/districts where early breastfeeding initiation is predominant and vice versa. The role of health professionals during pregnancy and the first two days after delivery significantly improved breastfeeding practice. Further, the findings suggest that an early breastfeeding initiation is associated with lower neonatal mortality, whereas pre-lacteal feed is not harmful compared to late breastfeeding initiation.
Conclusion:
Prevalence of pre-lacteal feed reduced, and initiation of early breastfeeding increased considerably after the launch of the National Rural Health Mission in India. However, after 2015-16, early breastfeeding initiation has stagnated, and the decline in pre-lacteal feed has slowed down. The future program needs special attention to emphasize the availability and accessibility of breastfeeding advisers and observers in health facilities to help mitigate adverse neonatal outcomes.
