Three Decades of Socioeconomic Inequality in India's Breastfeeding Indicators, 1993-2021

Although existing literature heavily focuses on the health outcomes of exclusive breastfeeding (EBF) in India, studies addressing socioeconomic inequalities across a broad spectrum of breastfeeding indicators remain scarce. We utilized five waves of National Family Health Survey data (1993-2021) to analyze temporal trends and socioeconomic inequalities, proxied by maternal education (no formal schooling, 1st-5th grade, 6th-8th grade, 9th-12th grade, and above 12th grade) and household wealth (poorest, poorer, middle, richer, and richest) across six World Health Organization-recommended indicators: ever breastfed, early initiation of breastfeeding (EIBF), exclusive breastfeeding for the first 2 days after birth, EBF, mixed milk feeding (MixMF), and continued breastfeeding. We estimated absolute and relative inequalities between the lowest and highest categories of each socioeconomic marker, followed by the computation of the Annual Absolute Change to assess progress over time (1993-2021). Between 1993 and 2021, absolute inequality in EIBF remained stagnant between the two extreme maternal education levels. EBF disparities shifted significantly; the initial advantage held by mothers with no formal schooling in 1993 narrowed as the gap closed, a trend mirrored across household wealth quintiles where the poorest maintained a higher, albeit diminishing, lead in EBF prevalence. EIBF increased at an equal annualized rate across both the lowest and highest education strata, and MixMF rose more sharply among the poorest households. Addressing these shifting socioeconomic disparities is critical for achieving equitable breastfeeding outcomes across all strata, especially given the recent (2024) reported decline in EBF prevalence nationally.