Delayed Breastfeeding Initiation and Associated Factors in Tanzania: A Cross-Sectional Study

Delayed initiation of breastfeeding is associated with poor child development outcomes and increased risk of infant mortality, which remains a major public health challenge in low- and middle-income countries. Despite global and national efforts to promote optimal breastfeeding, early initiation remains suboptimal in much of Sub-Saharan Africa. This study examined the prevalence and factors associated with delayed initiation of breastfeeding in Tanzania.

We analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey, a nationally representative cross-sectional survey. The study population comprised children under 24 months. The outcome variable was delayed breastfeeding initiation, defined as not initiating breastfeeding within 1 h of life. Weighted data were analyzed using multilevel mixed-effects logistic regression to identify associated factors.

A total of 4478 children were included, with a mean (±SD) age of 11.5 ± 6.9 months. The prevalence of delayed initiation was 24.4%. Child-related factors included first (aPR = 1.32; 95% CI: 1.13-1.55) and second birth order (aPR = 1.21; 95% CI: 1.06-1.39). Maternal age 35-49 years was also associated (aPR = 1.16; 95% CI: 1.02-1.32). Health-related factors included absence of immediate skin-to-skin contact (aPR = 1.85; 95% CI: 1.64-2.09), cesarean delivery (aPR = 2.45; 95% CI: 2.17-2.78), lack of birth assistance (aPR = 1.63; 95% CI: 1.16-2.28), and assistance from non-skilled provider (aPR = 1.42; 95% CI: 1.09-1.84). Geographically, delayed initiation was more prevalent in Zanzibar (aPR = 1.62; 95% CI: 1.33-1.98) and less prevalent in the Southern zone (aPR = 0.54; 95% CI: 0.36-0.80).

Nearly one in four newborns in Tanzania experience delayed breastfeeding initiation. Delayed initiation was associated with child, maternal, health-related, and geographical factors. Strengthening skin-to-skin contact, skilled birth attendance, cesarean support, counseling for first-time and older mothers, and addressing geographical disparities may improve early initiation and support progress toward Sustainable Development Goal target 3.2.