Determinants and Facilitators of Exclusive Breastfeeding in Haryana, India Open Access

Hendrix, Sara Elizabeth (Summer 2023)

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Background: Exclusive breastfeeding throughout the first six months of life is recommended to ensure optimal infant growth and development. However, despite strong evidence and existing programs exclusive breastfeeding in Haryana, India remains suboptimal. 


Objective: The purpose of this study is to determine key determinants of exclusive breastfeeding practices among mothers with an infant aged 2-4 months in Haryana, India.


Methods: Household surveys were administered 232 mother-infant dyads from Haryana, India with infants 2-4 months of age. A multivariate logistic regression was used to identify associations between potential determinants and three primary outcome variables: exclusive breastfeeding as determined by dose-to-mother (EBF DTM) stable isotope technique, exclusive breastfeeding (EBF) determined by the mother’s recall of feeding practices in last 24 hrs, and early initiation of breastfeeding (within first hour of birth). We examined the role of key sociodemographic, mother-infant dyad characteristics, and breastfeeding experience/perception/support covariates, such as family type, maternal age, and perception of low milk volume.


Results: In the EBF DTM model, negative associations were found with maternal perceived low milk volume (OR 0.17, CI 0.07, 0.41), breastfeeding support from family and/or friends compared to no support (OR 0.32, CI 0.13, 0.74) as well as having ever experienced breastfeeding difficulty (OR 0.24, CI 0.06, 0.95). In the recall EBF model, mothers who were married at a young age (less than 18 years old) (OR 0.43, CI 0.22, 0.83) and mothers with perceived low milk volume (OR 0.35, CI 0.15, 0.78) had lower rates of exclusive breastfeeding. In addition, infants receiving prelacteal feeds was negatively associated with early initiation of breastfeeding (OR 0.24, CI 0.13, 0.37).


Conclusion: Maternal perceptions of low milk volume in addition to breastfeeding difficulties were significant barriers to the practice of exclusive breastfeeding in this context. Further research to design lactation support programs to address these barriers may be merited.


Table of Contents

Chapter 1: Introduction 1

1.1 Introduction and rationale 1

1.2 Problem Statement 2

1.3 Purpose Statement 3

1.4 Significance Statement 3

Chapter 2: Review of the Literature 4

2.1 Nutrition in the First 1000 Days 4

2.2 Exclusive Breastfeeding 5

2.3 Exclusive Breastfeeding in LMICs 9

2.4 Exclusive Breastfeeding in India 10

Chapter 3: Project Content 13

3.1 Methods 13

3.1.1 Subjects 13

3.1.2 Data Collection 13

3.1.3 Data Analyses 14

3.1.4 Ethics 17

3.2 Results 17

Appendices 20

Chapter 4: Discussion, Conclusion and Recommendations 25

4.1 Discussion 25

4.2 Conclusions and Recommendations 29

Bibliography 32

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