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OP101 The impact of caesarean section on breastfeeding indicators in sub-saharan africa: a meta-analysis of demographic and health surveys
  1. E Yisma1,
  2. B Mol2,
  3. J Lynch1,
  4. L Smithers1
  1. 1School of Public Health, The University of Adelaide, Adelaide, Australia
  2. 2Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia


Background The association between caesarean section and breastfeeding is poorly understood in sub-Saharan Africa. We aimed to examine the impact of caesarean section on breastfeeding indicators—early initiation of breastfeeding, exclusive breastfeeding, and ever breastfeeding—in sub-Saharan Africa.

Methods We used the most recent data from 32 Demographic and Health Surveys (DHS) completed in sub-Saharan Africa. We analysed the data to examine the impact of caesarean section on breastfeeding indicators using log-Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios were pooled in random effects meta-analysis.

Results The within-country adjusted analyses showed, compared with vaginal birth, caesarean section was associated with adjusted prevalence ratios (aPR) for early initiation of breastfeeding that ranged from 0·23 (95%CI, 0·16, 0·31) in Tanzania to 0·81 (95%CI, 0·64, 1·02) in Cameroon. Similarly, the aPR for exclusive breastfeeding ranged from 0·57 (95%CI; 0·33, 0·99) in Senegal to 1·60 (95%CI; 1·07, 2·39) in Mali, while the aPR for ever breastfeeding ranged from 0·90 (95%CI, 0·82, 0·99) in Liberia to 1·02 (95%CI, 0·98, 1·06) in Guinea. Meta-analysis combining the adjusted effects from 32 countries showed that caesarean section was associated with a 47% lower prevalence of early initiation of breastfeeding (pooled PR, 0·53 (95%CI, 0·48, 0·58)), but not with exclusive breastfeeding (pooled PR, 0·93 (95%CI; 0·86, 0·99)) nor ever breastfeeding (pooled PR, 0·98 (95%CI; 0·98, 0·99)).

Conclusion Caesarean section had a negative influence on early initiation of breastfeeding, but showed little difference in exclusive- and ever-breastfeeding between infants born by caesarean versus vaginal birth in sub-Saharan Africa.

  • Epidemiology
  • Breastfeeding
  • Neonatal Health

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