AN ANALYSIS OF THE DETERMINANTS OF EXCLUSIVE BREASTFEEDING IN INDIA

Abstract

Exclusive breastfeeding (EBF) is an infant feeding practice in which infants are fed only breast milk for the first 6 months of their life. Compared to other breastfeeding practices, EBF has significant protective health benefits for mothers and children. In India, raising awareness on EBF is a critical public health strategy to combat high levels of maternal and child mortality. Most national policies on maternal and child health in India have at best generated mass awareness on EBF. Mother’s Absolute Affection (MAA) is a unique policy in this regard. Rather than generating mass awareness, MAA will target selected groups of mothers to provide awareness on EBF through counseling sessions. Currently, MAA is mostly in the planning phase for the selection of mothers to target for counseling. There is much debate on whether targeted interventions such as MAA are justified in the Indian context since mass awareness approaches have been successful in improving EBF outcomes in several countries. Furthermore, even if targeted interventions such as MAA can be justified, there is controversy as to which groups of mothers should be targeted for counseling. Considering these policy debates, this study asked the following research question: What are the determinants of EBF, and how have these changed over time? The answer to the first part of the question will help guide MAA on which mothers to target for counseling. The answer to the second part of the question will determine whether MAA was justified, or mass awareness approaches are adequate to raise awareness on EBF in India. This study utilized a dataset that is nationally representative of households in India. Based on a literature review and interviews with faculty members of the International Institute for Population Sciences (IIPS), 21 potential determinants of EBF were selected. After controlling for relevant covariates, multivariable logistic regressions were run and determinants of EBF were identified. Notably, the groups of mothers most at risk of not practicing EBF were the following: mothers with female children, mothers not belonging to a marginalized caste, mothers with no or low levels of education, employed mothers, mothers who had a cesarean delivery, mothers who made no or few postnatal care visits, mothers who did not initiate breastfeeding early, mothers from urban regions, mothers from households with relatively high wealth indices, and mothers from states with a lack of state-specific community health programs. Across time, the risk of not practicing EBF increased for most of these groups of mothers. Based on these findings, this study concludes that targeted interventions such as MAA are justified, primarily because mass awareness approaches have been unable to reduce or eliminate the risk of not practicing EBF for most groups of mothers. The findings of this study identify which groups of mothers are at risk of not practicing EBF and should thus be targeted for counseling on EBF. This study suggests that improved monitoring of EBF outcomes is necessary to enable evidence based policymaking related to EBF. Ultimately, raising awareness on EBF through targeted interventions such as MAA is critical to tackle high maternal and child mortality in India.