Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey

OBJECTIVES: This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice. DESIGN AND SETTINGS: A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria. PARTICIPANTS: Complete responses from reproductive-age women (15–49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey. MAIN OUTCOME MEASURES: TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics. METHODS: Descriptive statistics were reported and graphically presented. Bivariate χ(2) analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors’ contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17. RESULTS: 44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR ‘AOR’=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR ‘COR’=63.9: 95% CI=28.2 to 144.9). CONCLUSIONS: CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother−child contact peculiar to CS women is critical for improved breastfeeding practice.