Prevalence and determinants of breastfeeding duration among women of reproductive age in a fragile setting: A survival analysis using Demographic and Health Survey data.

BACKGROUND

Breastfeeding is vital for infant survival and maternal health, yet national empirical evidence on lactation duration in fragile settings remains scarce. This study aims to identify the individual- and community-level determinants of breastfeeding duration among mothers.

METHODS

We analyzed secondary data from a nationally representative Demographic and Health Survey (DHS), utilizing a final analytical sample of 4226 mother-child pairs. Kaplan-Meier survival curves and multivariable Cox proportional hazards regression models were used to analyze the continuous time-to-event duration of breastfeeding up to 24 months.

RESULTS

The median duration of breastfeeding was 12 months. Multivariable regression revealed that older maternal age of 35-49 years (adjusted Hazard Ratio [aHR] = 0.74, 95% CI: 0.61-0.89) and being widowed (aHR = 0.70, 95% CI: 0.55-0.89) significantly decreased the hazard of early weaning. Similarly, a birth order of 3-4 (aHR = 0.57, 95% CI: 0.46-0.70) and long birth intervals of ≥24 months (aHR = 0.92, 95% CI: 0.85-1.00) were associated with a lower hazard of cessation. Conversely, multiple births significantly accelerated breastfeeding discontinuation (aHR = 1.32, 95% CI: 1.07-1.64). Substantial subnational regional variations in duration were also observed, whereas maternal education and household wealth were not statistically significant predictors.

CONCLUSION

Breastfeeding duration falls considerably short of the recommended two years. Public health policies should prioritize young mothers, support birth spacing through integrated family planning, and provide targeted clinical assistance to mothers of multiples, adjusting for subnational regional disparities to improve lactation outcomes.