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.