ArticleInternational breastfeeding journal2025
Progress and inequalities in early initiation of breastfeeding among women in Sierra Leone, 2008-2019.
Article in International breastfeeding journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly initiation of breastfeeding, defined as placing a newborn to the breast within the first hour of birth, is vital for improving neonatal survival, strengthening the mother-child bond, and ensuring the delivery of essential nutrients and antibodies. This study examines progress and socioeconomic inequalities in the early initiation of breastfeeding among women in Sierra Leone from 2008 to 2019.
methodsWe used data from the three rounds of the Sierra Leone Demographic and Health Survey conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate the inequality measures among women 15-49 years, which include simple difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). The inequality assessment was conducted based on six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national region.
resultsIn Sierra Leone, the early initiation of breastfeeding rate increased from 48.7% in 2008 to 75.2% in 2019. Higher rates of early initiation of breastfeeding were observed among mothers (15-19 years), women from the lowest wealth quintile, those without formal education, and those residing in rural areas. However, regional inequalities persisted, with the Eastern region showing the lowest rates. The inequality (D) in age increased from - 0.2 in 2008 to -1.6 in 2019. The economic status disparity increased from - 8.7% in 2008 to -18.4% in 2019. Inequality for education decreased from - 10.6 in 2008 to -4.7 in 2019. The increase in place of residence inequality was from -2.6% in 2008 to -13.4% in 2019. For the sex of the child, the disparity increased from - 1.5% to -3.6% in 2019. Regional disparity increased from 19.7 in 2008 to 28.6 in 2019. PAR also rose from 8.9 to 11.1 percentage points.
conclusionEarly initiation of breastfeeding has shown substantial improvement in Sierra Leone, highlighting the effectiveness of recent public health interventions. However, inequalities accross economic status, level of education, sex of the child, and sub-national region still persist. To sustain these gains and ensure equitable progress, continued policy attention and targeted strategies are essential to address persistent socio-economic and regional inequalities disparities.
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