Descriptive statistics of breastfeeding practice by some characteristics
The median duration of breastfeeding was 22 ± 0.50 months (95% CI 21.01–22.99), while that of mean duration was 28.92 ± 0.32 months (95% CI 28.29–29.56). Table 1 shows that the percentage of early initiation of breastfeeding was lower in the Affar region (54.7%) followed by the Amhara (75.1%) and the Tigray regions (78.9%), respectively, while the highest percentage was observed in Dire Dawa (95.4%) and Harari (93.7%) regions.
The percentage of exclusive breastfeeding was low in the Somali region (27.7%) and the Affar region (30.5%). More than three-quarters (83.5%) of the mothers were from rural areas. About 80.6% of rural newborns initiate breastfeeding within 1 h of birth compared to 87.8% of urban newborns. The percentage exclusive breastfeeding was almost uniform in both rural and urban residents, 47.2 and 46.7%, respectively.
More than two-thirds (68.7%) of the mothers had no formal education at all. The percentage of early initiating of breastfeeding (80.3%) and exclusive breastfeeding (46.6%) was lowest among uneducated mothers. Similarly, more than half (52.2%) of fathers were illiterate. Nearly half (48.9%) of the children included were females. Male babies had a higher proportion of exclusive breastfeeding (47.5%) than that of females. Table 1 also shows that 65.3% of the mothers delivered outside of health facilities. Babies born outside of health facilities had a smaller percentage (79.4%) of early initiation of breastfeeding.
Only 8.5% of babies had a postnatal check-up. And 62.4% of mothers had attended antenatal care at least once. About 71.6% of mothers were unemployed. More than half (53.1%) were from a poor economic level. Moreover, children born from unemployed women and poor wealth indices had a lower percentage of early initiation of breastfeeding and exclusive breastfeeding practices 80.3 and 75.3%, respectively. Similarly, children with a small birthweight, cesarean birth, and being born of a large family (7 or higher), had a lower percentage of early initiation of breastfeeding, i.e. 79, 76.9 and 56.2%, respectively (Table 1).
Trends of breastfeeding practices are presented in Figs. 2 and 3. The percentage of early initiation of breastfeeding within increases from 51% in 2000 to 69% in 2005, then it fell to 52% after 5 years in 2011 and rose to 73% in 2016. Similarly, percentages of exclusive breastfeeding increase significantly from 38% in 2000 to 58% in 2016. Both initiations of breastfeeding and exclusive breastfeeding show a decreasing trend from 2005 to 2011. Overall, this shows that the percentages of both early initiations of breastfeeding and exclusive breastfeeding increased from 2000 to 2016. The median duration of breastfeeding in Ethiopia decreased from 25.20 months in 2000 to 23.90 months in 2016. See Fig. 2.
The two outstanding stages, three and 5 months in Fig. 3 indicate that the period when a child terminated exclusive breastfeeding.
The Kaplan-Meier survival functions presented in Figs. 4, 5, 6 and 7 indicate a consistently falling time to cessation of breastfeeding. The Kaplan-Meier survival function of rural women on Fig. 5 was above that of urban women, indicating that, on average, rural women breastfed for a longer time compared to urban women. Similarly, the survival function of females on Fig. 6 lies below that of male children. On the other hand, Fig. 7 shows mothers with secondary or higher education level have a longer time to cessation of breastfeeding, i.e., educated mothers breastfed for a longer time compared to that of illiterate mothers.
Factors associated with early initiation of breastfeeding
Multivariate logistic regression analysis to examine factors associated with early initiation of breastfeeding is presented in Table 2. The goodness of fit was also checked using the likelihood ratio tests (LRT). Consequently, the result of likelihood ratio test, provided 1521.32 (p - value < 0.0001), would imply good fit for the model. Thus, the null hypothesis, there is no difference between the model with no predictor variables and the model with explanatory variables was rejected. Accordingly, regions of residence, place of residence, religion of mother, sex of a child, place of delivery, mode of delivery, birthweight of a child, baby postnatal checkup and parity, were covariates significantly correlated with early initiation of breastfeeding.
The region of residence of mothers was associated with early initiation of breastfeeding. The odds of early initiation of breastfeeding was lower among women residing in all regions except Harari compared to that of Dire Dawa (p - value < 0.01). Urban residents were 29% more likely to initiate breastfeeding early than mothers in the rural areas (OR 0.71, 95% CI 0.51, 0.99). The odds of delayed initiation of breastfeeding among Coptic orthodox was 1.89 (OR 1.89, 95% CI 1.02, 3.50) times higher than traditional/others. The male newborn was 1.18 times more likely to initiate breastfeeding late than a female (OR 1.18, 95% CI 1.01, 1.37). Regarding the place of delivery, mothers who delivered outside the health facility had higher odds of not initiating breastfeeding within 1 h of birth (OR 1.55, 95% CI 1.25, 1.91). The odds of delaying initiation of breastfeeding was lower among normal deliveries compared to cesarean birth (OR 0.10, 95% CI 0.06, 0.15), as were average size at birth compared to small birthweight (OR 0.80, 95% CI 0.66, 0.96) and newborn from small family size compared to those of seven and higher family size (OR 0.69, 95% CI 0.49, 0.97).
Factors associated with exclusive breastfeeding
In multivariate logistic regression analysis, the independent variables region, mother’s age, father’s educational level, place of delivery, baby postnatal checkup, antenatal care during pregnancy, mode of delivery, and weight of the child at birth were significantly associated with exclusive breastfeeding. Mothers that lived in Affar (OR 0.17, 95% CI 0.10, 0.28), Somali (OR 0.16, 95% CI 0.09, 0.26), and Harari regions (OR 0.28, 95% CI 0.16, 0.49) were less likely to exclusively breastfeed compared to mothers living in the Dire Dawa region, whereas those from Tigray, Oromia, Benishangul-Gumuz regions and the Addis Ababa city had a higher odds of exclusive breastfeeding compared to Dire Dawa. A woman that had primary education was less likely to practice exclusive breastfeeding (OR 0.62, 95% CI 0.40, 0.96) compared to a secondary or higher education. Moreover, the odds of exclusive breastfeeding among babies born outside of health facilities, and mothers with no breastfeeding counseling during antenatal following up was lower (OR 1.56, 95% CI 1.22, 1.99) and (OR 1.50, 95% CI 1.15, 1.95), respectively, as compared to being born in health facilities and at least four antenatal follows up, respectively. Furthermore, a baby receiving a postnatal check (OR 0.53, 95% CI 0.39, 0.73) and children born of a medium sized at birth (OR 0.80, 95% CI 0.65, 0.99) were more likely to be exclusively breastfed (Table 2).
Factors associated with duration of breastfeeding
From the multivariate Cox’s proportional hazard model analysis presented in Table 3, region, mother’s age, religion, wealth index, place of delivery, professional antenatal care, type of birth, baby weight at birth, employment status of mothers and parity were significantly associated with the duration of breastfeeding. Mothers who were living in Amhara (HR 1.31, 95% CI 1.05, 1.64), Oromia (HR 1.27, 95% CI 1.04, 1.54), and Benishangul-Gumuz (HR 1.34, 95% CI 1.09, 1.65) had a longer duration of breastfeeding than those who were residing in Dire Dawa.
Younger age mothers had a shorter duration of breastfeeding compared those 40 years and older. The average duration of breastfeeding were short (HR 0.76, 95% CI 0.60, 0.96) for mothers who were Muslims compared to that of traditional/others. Mothers who gave birth outside of health facilities had a shorter duration of breastfeeding compared to their counterparts who delivered in the health center. Furthermore, mothers who were not working, with poor wealth index and a single child had a longer duration of breastfeeding. Moreover, babies with a larger or average birthweight had a shorter duration of breastfeeding. Being born in a small family size also had a significant risk of early termination of breastfeeding (p - values < 0.001) (Table 3).