SynthesisBMJ open2019
Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa.
Synthesis in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Association between caesarean birth and childhood acute respiratory infection in low- and middle-income countries: a meta-analysis of population-based data.BMC medicine · 2026Pooled it
- Support for healthy breastfeeding mothers with healthy term babies.The Cochrane database of systematic reviews · 2022Pooled it
- Impact of cesarean section on timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis.International breastfeeding journal · 2021Pooled it
- Trial
- Association of Hospital Practices and Early Postnatal Support with Breastfeeding Outcomes in Premature and Term Infants.Children (Basel, Switzerland) · 2026Article
- Initiation of breastfeeding among mothers attending a regional referral hospital in central uganda: a cross-sectional study.Archives of public health = Archives belges de sante publique · 2025Article
- Postpartum contraceptive use after vaginal and caesarean birth in Nigeria: a nationwide population-based analysis.BMJ public health · 2025Article
- Factors associated with infant and young child feeding practices in Kaduna and Lagos States, Nigeria.PLOS global public health · 2025Article
- Article
- Article
- Effectiveness of an Early Skin-to-Skin Contact Program for Pregnant Women with Cesarean Section: A Quasi-Experimental Trial.International journal of environmental research and public health · 2023Article
- Global increased cesarean section rates and public health implications: A call to action.Health science reports · 2023Article
- Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women.International journal of environmental research and public health · 2022Article
- Cesarean section and breastfeeding outcomes in an Indigenous Qom community with high breastfeeding support.Evolution, medicine, and public health · 2022Article
- Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys.SSM - population health · 2021Article
- Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey.International breastfeeding journal · 2021Article
- Maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa.International breastfeeding journal · 2021Article
- Prevalence of Cesarean Section Among Nurses: Predictors and Effect on Exclusive Breastfeeding.SAGE open nursingArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the impact of caesarean section on breastfeeding indicators-early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)-in sub-Saharan Africa.
designSecondary analysis of Demographic and Health Surveys (DHS).
settingThirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018.
participantsWomen aged 15-49 years with a singleton live last birth during the 2 years preceding the survey.
main outcome measuresWe analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis.
resultsThe within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children.
conclusionsCaesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.
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