Changes in caesarean section rates and milk feeding patterns of infants between 1986 and 2013 in the Dominican Republic.

OBJECTIVE

The relationship between caesarean sections (C-sections) and infant feeding varies between different samples and indicators of feeding. The current study aimed to determine the relationship between C-sections and five indicators of infant milk feeding (breast-feeding within 1 h after delivery, at the time of the survey (current) and ever; milk-based prelacteal feeds; and current non-breast milk use) over time in a country with a rapidly rising C-section rate.

DESIGN

Secondary data analysis on cross-sectional data from Demographic and Health Surveys from six different time points between 1986 and 2013.

SETTING

Dominican Republic.

SUBJECTS

Infants under 6 months of age.

RESULTS

Over 90 % of infants were ever breast-fed in each survey sample. However, non-breast milk use has expanded over time with a concomitant drop in predominant breast-feeding. C-section prevalence has increased over time reaching 63 % of sampled infants in the most recent survey. C-sections remained significantly related to three infant feeding practices - the child not put to the breast within 1 h after delivery, milk-based prelacteal feeds and current non-breast milk use - in multivariate models that included sociodemographic control variables. However, current non-breast milk use was no longer related to C-sections when milk-based prelacteal feeds were factored into the model.

CONCLUSIONS

Reducing or avoiding milk-based prelacteal feeds, particularly among those having C-sections, may improve subsequent breast-feeding patterns. Simultaneously, efforts are needed to understand and help reduce the exceptionally high C-section rate in the Dominican Republic.