In this study, we investigated the determinants of early initiation of breastfeeding among women aged 15–49 years in Ethiopia using secondary data from the EMDHS 2019, the overall prevalence of early initiation of breast feeding was 73.7%. According to the WHO classification, the reported EIBF prevalence in this study is categorized as good . It is
still lower when compared to the previous studies of EIBF prevalence in other countries such as Zimbabwe (78%) , Angola (98.4%), Cuba (89.2%) and Sir Lanka (85.5%) , and also lower than the national 92% EIBF targeted by the health sector development program of Ethiopia . However, the overall prevalence of EIBF in Ethiopia is much higher compared to economic community of west Africa state (ECOWAS) (43%) , Ghana (55.7%) , Tanzania (71.4%) , kingdom of Saudi Arabia (43.6%) , India (41.5%) , Indonesia (57%)  and Middle East (34.3%) . The reason for the higher prevalence of EIBF in the current study compared to the previous study might be due to the successful health extension program implementation in Ethiopian primary health care system. The health extension workers identify pregnant mothers and refer them to the nearby health facilities for delivery this might enable the mothers to obtain information on the importance of EIBF from health care providers .
Mode of delivery was significantly associated with early initiation of breast feeding in the present study. A mother who delivered by vaginal delivery was around 3.9 times more likely to initiate breastfeeding within one hour than those who gave birth via a cesarean section. This finding is supported by similar studies done in Ethiopia, a secondary analysis of EDHS 2016 [11, 16], different region in Ethiopia [30–33] and different countries such as Saudi Arabia , Sudan ,Tanzania [35, 36], Uganda [37, 38], Ghana , Nigeria , Namibia , West Africa state , Nepal [40, 41], India , Indonesia [8, 27, 42], Bangladesh [43, 44], South Asia , Middle East , Turkey , Romania . A secondary analysis of the WHO Global survey published in 2017 also showed EIBF to be significantly lower among women with caesarean section delivery . This may be due to the procedure taking longer, pain after procedure, effects of anesthesia and tiredness that make it difficult to initiate breastfeeding early and the time of postoperative care which delays mother-baby contact .
Place of delivery was also significantly associated with early initiation of breastfeeding in the current study. A mother who gave birth at a health facility was 1.6 times more likely to initiate early breastfeeding than those delivered at home. This finding is similar with previous study reported in Ethiopia [11, 30, 31, 48], multiple African countries [18, 36, 37, 39], India [26, 49, 50], Nepal [41, 51], Bangladeshi , Rumania  and WHO global survey . Mothers who delivered at a health facility may be supported and get information about the importance of early initiation of breastfeeding, and also health professionals tend to facilitate early initiation of breastfeeding compared to those who gave birth at home [29, 55].
Parity is also one of the associated factors of early initiation of breast feeding. We found positive relationship between greater parity and EIBF in the first hour after giving birth, mothers who had three or more children had higher odds of EIBF within one hour of birth compared to first time mothers. This is consistent with previous studies in Ethiopia  and different countries [21, 28, 39, 44, 45, 53, 54]. This may be lack of experience and knowledge about the importance of EIBF and the first pregnancy tend to have higher incidence of delivery complications which results in separation of the mother baby pair .
In this study, we observed the distribution of EIBF rate to be different among regional states in Ethiopia. Mother from Oromiya region had significantly higher odds of EIBF compared to mothers from Tigray region. This is supported by similar study done in Ethiopia, a secondary analysis of EDHS 2016 . These regional variations could possibly be explained by the fact that there could be variations in health care utilization, culture and socioeconomic status of the study participants between regions.
One of the strengths of this study is that we used data from the 2019 EMDHS which is a national survey, Therefore, the study findings have great implications at person-level, community-level as well as policy-level. The major limitations were the study was subject to recall bias. The other weakness of the study was that some important possible factors that could affect the practice are missed due to incompleteness of information since we used a secondary data source .