Antenatal and perinatal service delivery associations with breastfeeding outcomes in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey.

Infant and Young Child Feeding (IYCF) breastfeeding guidelines of the World Health Organization (WHO) have been promoted in Nepal since the early 1990s. This study investigated whether antenatal and perinatal service delivery in Nepal are associated with early initiation of breastfeeding and age-appropriate feeding practice (exclusive breastfeeding to six months; introduction of complementary foods at six months with continued breastfeeding to two years). Data from the 2016 Nepal Demographic and Health Survey (NDHS) were analysed using multivariable logistic regression. The unit of analysis was an interviewed woman and her last-born child aged 0-23 months. We examined number of antenatal visits, place and type of delivery, infant-mother skin-to-skin contact post-delivery, and breastfeeding observation and counselling by a healthcare provider within two days post-delivery. Of 1938 mother-infant dyads, 1073 (55.4%) commenced breastfeeding within one hour of delivery and 1665 (85.9%) were engaged in age-appropriate feeding. Breastfeeding within one hour of delivery was associated with infants delivered vaginally (aOR: 4.76, 95% CI: 2.96-7.65), infant-mother skin-to-skin contact post-delivery (aOR:2.10, 95% CI: 1.63-2.72) and observation of breastfeeding by a healthcare provider within two days post-delivery (aOR: 1.58, 95% CI: 1.20-2.08). Age-appropriate feeding was lowest amongst mothers with infants aged 4-5 months (40.8%) compared to those with infants aged 0-1 month (aOR: 0.158, 95% CI: 0.083-0.302). Antenatal and perinatal service delivery were not significantly associated with age-appropriate feeding. Further promotion of infant-mother skin-to-skin contact post-delivery (including after caesarean delivery) and observation of early breastfeeding may increase the rate of breastfeeding within one hour of delivery. Promotion of exclusive breastfeeding in antenatal and perinatal services and additional postnatal support should be considered to increase exclusive breastfeeding of infants to six months. These improvements may be achieved through enhanced implementation of the Baby Friendly Hospitals Initiative and effective training and sufficient practice for skilled birth attendants.