This study showed that overall 7 out of 10 infants were being breastfed within the first hour of birth. Although, this prevalence has significantly improved in the five-year period from 52% in 2011 to 73.4% in 2016, it is still lower when compared to EIBF prevalence in other countries such as Malawi (95.64%), Mozambique (77.74%) and Rwanda (81.51%) . However, the overall prevalence of EIBF in Ethiopia is much higher compared to Central African countries as well as West African countries . This wide variation in the rates of EIBF within Ethiopia and between other African countries is likely due to geographic and cultural differences coupled with economic and health inequalities among different populations.
There was a statistically significant association between EIBF and the following covariates: (i) biomedical factors - type of delivery assistance, (ii) mode of delivery; socio-demographic factors - region, age, gender and birth order of child and (iii) socio-economic factor – wealth index. The predictors of EIBF of 2016 EDHS widely differs from that of the 2011 EDHS . This may be due to several factors not limited to changes in health workforce and infrastructure, changes in nutrition and feeding policies, rural-urban migration, improved education and advancements in medicine and technology .
In our study, mothers who delivered with assistance of one or more health professionals had 68% higher odds of timely breastfeeding initiation compared to mothers with no assistance at the time of delivery. This is not surprising as primary health care professionals such as midwives or other trained health professionals would readily inform and assist mothers in the process of achieving timely initiation . This finding is also consistent with findings from within and outside Ethiopia [30, 31].
Similar to existing research in Ethiopia and internationally [16, 17, 32, 33], a strong inverse association was observed between caesarean section and EIBF. Research suggest that mothers with caesarean section fail to initiate timely breastfeeding as they are often hindered by several barriers such as lengthy post-delivery hospital stays, prolonged mother-child separation, delayed skin-to-skin contact and maternal endocrinological diseases [7, 34]. Since delivery through caesarean section is becoming an increasingly common type of delivery, it is imperative to provide services that inform mothers about the importance of EIBF and its wide benefits to their newborn babies and themselves.
Distribution of EIBF rates is significantly different across the regional states in Ethiopia. Mothers from Oromiya, SNNP and Somali had significantly higher odds of EIBF whereas Affar had significantly lower odds of EIBF compared to mothers from Tigray. Other regions such as Harari, Dire Dawa, Gambella also had higher odds of EIBF but may be inconclusive given the low proportion of residents in those regions. This could be due to reasons of better access and availability of health resources in Oromiya, SNNP and Somali compared to Tigray and Afar.
In this study, female infants had higher odds of EIBF compared to male infants. This could potentially be due to the African cultural beliefs that male infants privileged enough to receive prelacteal feeds are accepted by the society as strong and healthy. The practice of prelacteal feeds in male infants is a common practice in African [35, 36] and Asian countries [37, 38].
This study also found a positive association between EIBF and child’s birth order. This is due to the fact that previous breastfeeding experience was positively associated with both intention as well as timely breastfeeding initiation . This positive experience may be due to positive changes in beliefs regarding breastfeeding, where a mother found to benefit from timely breastfeeding initiation may decide to breastfeed a subsequent child in a timely manner. This finding is also consistent with findings from Amibara district of North-Eastern Ethiopia .
As expected, mothers from wealthier households had significantly higher odds of EIBF compared to mothers from poorest households. This could be due to several reasons such as better access and availability of health resources and better intellectuality through high quality education. Similar findings have been reported elsewhere [7, 40].
Policy and practice implications
EIBF rates in Ethiopia have significantly improved in the five-year period possibly as a result of improvement in health workforce, feeding policy, maternal and child health awareness programs. However, this study shows that there are still 3 in 10 infants who are not being breastfed in a timely manner and are not benefitting from the timely initiation, thereby prone to potential health risks. Therefore, a substantial increase in EIBF practice can be achieved by better informing mothers residing regional areas with less access to health services, mothers delivering through caesarean section with less birth term intervals. In addition, primary health care services must also be aimed at mothers from a poorer economic status with adequate resources and counselling about the beneficiary impacts of timely initiation of breastfeeding.
Strengths and limitations
One of the strengths of this study is that we used data from the 2016 EDHS which is a national survey. Therefore, the study findings have profound implications at person-level, community-level as well as policy-level. However, some local areas represented in the survey had small sample sizes, and thus the results should be interpreted with caution. Since this study is a secondary data analysis of a national survey, other key variables such as traditional beliefs, psycho-social factors, partner’s preference for breastfeeding, in-depth qualitative views of the mothers are not included. This study is based on cross-sectional data and hence it is difficult to demonstrate the cause and effect relationships of the co-variates on timely initiation of breastfeeding and the survey responses may be prone to a recall bias.