Timely Initiation of Breastfeeding and Associated Factors in 20 Sub-Saharan African Countries: Cross-Sectional Multilevel Analysis of Recent Demographic and Health Surveys.

BACKGROUND

An important strategy to decrease infant morbidity and mortality is timely initiation of breastfeeding (TIBF), which is defined as putting the newborn to the breast within 1 hour of delivery. Delayed initiation of breastfeeding may contribute to high neonatal and infant mortality in sub-Saharan Africa.

OBJECTIVE

This study assessed the prevalence of TIBF and associated factors using recent Demographic and Health Survey data from 20 sub-Saharan African countries.

METHODS

Using recent Demographic and Health Survey data from sub-Saharan African countries, a cross-sectional study was conducted. Data were accessed on January 27, 2026. The analysis included 177,988 children after application of sampling weights. The hierarchical structure of the data was taken into consideration by conducting a multilevel logistic regression analysis. Results were presented using adjusted odds ratios (AORs) with 95% CIs. To evaluate cluster-level variance, random-effects measures such as the median odds ratio and intraclass correlation coefficient were reported.

RESULTS

Among 177,988 weighted samples, 59.05% (95% CI 58.82%-59.28%) initiated breastfeeding within 1 hour of birth. TIBF was more likely among rural residents (AOR 1.25, 95% CI 1.21-1.28), mothers with primary (AOR 1.48, 95% CI 1.45-1.52), secondary (AOR 1.22, 95% CI 1.19-1.26), and higher education (AOR 1.22, 95% CI 1.15-1.28), institutional delivery (AOR 1.40, 95% CI 1.36-1.43), multiparous (AOR 1.19, 95% CI 1.15-1.23), and grand multiparous mothers (AOR 1.10, 95% CI 1.05-1.14). Lower odds were observed among cesarean births (AOR 0.31, 95% CI 0.30-0.33), twin births (AOR 0.87, 95% CI 0.82-0.92), delayed antenatal care initiation (AOR 0.84, 95% CI 0.82-0.85), female children (AOR 0.90, 95% CI 0.88-0.91), and mothers with a history of child death (AOR 0.90, 95% CI 0.86-0.94).

CONCLUSIONS

TIBF remains suboptimal in sub-Saharan Africa and is influenced by maternal, obstetric, and health care factors. Enhancing antenatal counseling and postnatal breastfeeding support, particularly after cesarean delivery and among vulnerable groups, may improve timely initiation practices.