Factors influencing early initiation of breastfeeding in Afghanistan: secondary analysis of the Afghanistan MICS 2022-23.

Background: Initiating breastfeeding immediately within the first hour following birth has positive effects on the mother's and newborn's health and wellbeing. Little is known about the early initiation of breastfeeding and associated factors in Afghanistan. In this study, we addressed this research gap.

Methods: We used data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022-23. Data were analysed from 11,992 ever-married women, aged 15-49 years, who delivered a live child in the last 2 years before the survey. The outcome was early initiation of breastfeeding and defined as initiating breastfeeding within the first hour of birth. A logistic regression model was used to identify factors associated with early initiation of breastfeeding.

Results: Out of 11,992 women, 46.9% initiated breastfeeding within the first hour of birth. The likelihood of early initiation of breastfeeding was greater in women with secondary or higher education (AOR 1.44 [95% CI 1.26, 1.63]), in women belonging to the second wealth quintile (AOR 1.17 [95% CI 1.04, 1.31]), in women who had access to media (AOR 1.15 [95% CI 1.03, 1.29]), and in women who had mobile phones (AOR 1.25 [95% CI 1.15, 1.37]). The likelihood was lower in women who gave birth at home (AOR 0.60 [95% CI 0.55, 0.66]), at private hospitals or clinics (AOR 0.65 [95% CI 0.56, 0.76]), as compared to women who gave birth at public clinics or hospitals, and in women living in rural areas (AOR 0.88 [95% CI 0.78, 0.95]). Women who had C-section for their latest live birth (AOR 0.26 [95% CI 0.21, 0.32]), and women who had very small-sized babies (AOR 0.89 [95% CI 0.79, 0.99]) were less likely to report early initiation of breastfeeding.

Conclusion: With nearly half of Afghan women delaying breastfeeding beyond the first hour of birth, targeted health policies and interventions are crucial. Addressing key socioeconomic and healthcare disparities through education, equitable access to maternal care, and community-based awareness programs can promote early breastfeeding practices and improve neonatal health outcomes in Afghanistan.