University of Maryland School of Public Health, College Park, MD, USA.
Avenir Health, Glastonbury, CT, USA.
Glob Health Sci Pract. 2021 Jun 30;9(2):308-317. doi: 10.9745/GHSP-D-20-00361.
Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). Although delays are associated with cesarean delivery and skin-to-skin contact may facilitate early breastfeeding, a more nuanced understanding of these relationships is needed.
With data from 31 countries that had a Demographic and Health Survey since 2015, we described breastfeeding initiation among babies most recently born in the last 2 years to women aged 15-49 years. In a subset of 21 countries, we conducted survival analysis with multivariable log-logistic accelerated failure time (AFT) regressions to examine factors associated with time to initiation of breastfeeding, specifically the mode of delivery and skin-to-skin contact, controlling for receipt of health care as well as socioeconomic and demographic characteristics of mothers and babies.
Babies in most countries began breastfeeding within a few hours after birth. The mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. In most countries (24 of 31), the median time was 0.5 hours. Median time to initiation was greater for births by cesarean delivery compared with vaginal births at health facilities. After controlling for covariates, AFT models showed significant delays in breastfeeding among cesarean deliveries in most countries, with as much as a 9-fold delay in Senegal. Immediate skin-to-skin contact was significantly associated with a shorter time to initiation.
Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries.
早期母乳喂养对母亲和婴儿都有诸多益处。既往研究通常将母乳喂养启动分析为二分类变量（在分娩后 1 小时或 1 天内）。虽然剖宫产分娩和皮肤接触会延迟母乳喂养启动，但需要更细致地了解这些关系。
利用 2015 年以来有国家人口与健康调查数据的 31 个国家的数据，我们描述了最近 2 年内 15-49 岁产妇所生婴儿的母乳喂养启动情况。在 21 个国家的子集中，我们采用多变量对数-logistic 加速失效时间（AFT）回归进行生存分析，以检查与母乳喂养启动时间相关的因素，特别是分娩方式和皮肤接触，同时控制了卫生保健的获得情况以及母亲和婴儿的社会经济和人口统计学特征。
大多数国家的婴儿在出生后数小时内开始母乳喂养。母乳喂养启动的平均时间范围从布隆迪的 1.7 小时到巴基斯坦的 32 小时和乍得的 40 小时。在大多数国家（31 个中的 24 个），中位数时间为 0.5 小时。与在医疗机构经阴道分娩相比，剖宫产分娩的母乳喂养中位启动时间更长。在控制了协变量后，AFT 模型显示，在大多数国家剖宫产分娩的母乳喂养启动时间明显延迟，塞内加尔的延迟高达 9 倍。立即进行皮肤接触与母乳喂养启动时间更短显著相关。
促进早期母乳喂养的努力应鼓励进行皮肤接触，并针对剖宫产分娩。
