Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa

Engida Yisma*, Ben W. Mol, John W. Lynch, Lisa G. Smithers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
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Abstract

Objective 

To examine the impact of caesarean section on breastfeeding indicators - early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once) - in sub-Saharan Africa. 

Design 

Secondary analysis of Demographic and Health Surveys (DHS). 

Setting

 Thirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018. 

Participants

 Women aged 15-49 years with a singleton live last birth during the 2 years preceding the survey. 

Main outcome measures

 We analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis. 

Results

 The within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children. 

Conclusions

 Caesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.

Original languageEnglish
Article numbere027497
Number of pages12
JournalBMJ Open
Volume9
Issue number9
DOIs
Publication statusPublished - 4 Sept 2019

Bibliographical note

Funding
The first author is fully supported by an Australian Government Research Training Programme (RTP) Scholarship.

Acknowledgments
The authors are grateful to The DHS Program for providing the data sets used for this analysis. BWM is supported by an NHMRC Practitioner Fellowship (GNT1082548) and also reports consultancy for ObsEva, Merck Merck KGaA, and Guerbet. JWL is supported by an NHMRC Centre of Research Excellence (GNT1099422).

Data Availability Statement

Supplemental material
[bmjopen-2018-027497supp001.pdf]

Keywords

  • epidemiology
  • maternal medicine
  • paediatrics
  • public health

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