Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study
Bibliographic record
Abstract
BACKGROUND: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. OBJECTIVE: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. METHODS: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. RESULTS: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ≥36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. CONCLUSIONS: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".