Determinants of suboptimal breast-feeding practices in Pakistan

Objective: Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13%. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan. Design: A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007. Setting: A nationally representative sample of households. Subjects: Last-born alive children aged 0-23 months (total weighted sample size 3103). Results: The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27.3%, 32.1%, 37.1% and 18.7%, respectively. Multivariate analysis indicated that working mothers (OR = 1.48, 95% CI 1.16, 1.87; P = 0.001) and mothers who delivered by Caesarean section (OR = 1.95, 95% CI 1.30, 2.90; P = 0.001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0.37, 95% CI 0.23, 0.59; P < 0.001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1.96, 95% CI 1.18, 3.24; P = 0.009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1.93, 95% CI 1.46, 2.55; P < 0.001) and belonged to the richest wealth quintile (OR = 2.41, 95% CI 1.62, 3.58; P < 0.001). Conclusions: The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.