In the present study, we tried to determine the prevalence of early ignition of breastfeeding (EIBF) and investigate the associated factors of EIBF among mothers living in Rajshahi district, Bangladesh. It was noted that the prevalence of EIBF among mothers was 88.40%. The national survey of Bangladesh (BDHS-2014) showed that 51.0% of neonates were breastfed within one hour after birth (EIBF) and 89% within one day after delivery, and 55.0% of infants under the age of 6 months were exclusively breastfed . However, more recently published key indicators of BDHS 2017-2018 showed that 65% of infants under the age of 6 months were exclusively breastfed (EB) in 2017, a level markedly higher than that found in BDHS-2014 . The prevalence of EIBF is not available in the report of BDHS 2017-2018 . BDHS-2014 found that 98% of children born during the two years of their survey were breastfed at some point in their life in Bangladesh where breastfeeding was almost universal . The rate of breastfeeding for every stage has been increasing with increase of the medical facilities in Bangladesh. Mothers can easily get advice about the benefit of breastfeeding from health providers and family planning workers. Also, the practice of providing EIBF was increasing with increasing literacy rate among women that enhanced the awareness regarding the benefit of EIBF especially among rural women in Bangladesh . BDHS-2014 conducted their survey about 6 years ago, some indicators such as mother education level, medical facilities, household wealth quintile have continued to increase during the last two decades in Bangladesh which is ultimately helping to increase the rate of EIBF.
The prevalence of EIBF among mothers in Rajshahi district was also higher than south Asian countries like India (21%) , Pakistan (8.5%) , other developing countries like Nigeria (34.7%) , Iran (32.2%)  and South Sudan (48%) . The rate of EIBF of mothers in Ethiopia was close (83.7%) to our finding .
Mothers who delivered at home were more likely to provide EIBF to their infant than mothers delivered at private hospitals. A Bangladeshi study found that mothers undergoing vaginal delivery were more likely to provide EIBF to their infants than mothers having cesarean delivery . The present finding coincided with a Chinese study . It was noted that mothers living in poor-income families were more interested to provide initial breast milk to their infants than those of middle- and high-income families, and the rate of EIBF was decreasing with increasing family income. The same results had been found in another Bangladeshi study that used BDHS-2014 data .
We found that primary or uneducated husbands’ wives had more chances to give their initial breast milk to their infants than higher educated husbands’ wives. This finding was supported by another study . They also found that the husband’s educational level was significantly associated with EIFB.
The nutritional status of mothers was an important predictor of initial breastfeeding, and it was observed that undernourished mothers were more likely to provide their breast milk to their infants than healthy and over nourished mothers. The same results had been found in our nationally representative samples . A similar observation was also mentioned by several studies [36-39, 32-34]. This study found that mothers aged 20-34 years were more likely to provide EIBF to their children than mothers aged 35 years and above. Our result was also supported by a global survey [40-41]. Again, in this study, it was found that husband’s occupation is an important factor for EIBF, i.e. farmers’ wives had a higher chance to give EIBF to their children than other professional husbands’ wives. Our result was also in line with another study in India , but disagreed with a study in Sudan .
In this study, we have found that place of delivery, family income, husbands’ education level and mothers’ nutritional status are important factors for providing initial breast milk to newborn among mothers in Rajshahi district. These four factors are very much related to each other in developing countries like Bangladesh. Most of the home delivery mothers are living in poor families. In Bangladesh, the wife is dominated by her husband, and most of the females are dependent on their husbands’ income, and income is dependent on education level. Usually, uneducated or primary educated husbands are farmers or day labors living in rural or slum areas, their income is not sufficient to maintain their family, and they cannot provide sufficient food to their family members, consequently, they suffer from under nutrition. Mothers living in poor families cannot go to hospitals/clinics for delivery, and most of them deliver at home in the presence their close relatives without proper nursing. Traditional customs and culture in the society of Bangladesh are that, after delivery, the mother immediately provides her breast milk to the newborn. It is true especially for most of the mothers having vaginal delivery. It is also mentionable that all home deliveries are vaginal. On the other hand, mothers living in middle or rich families usually deliver at hospitals/clinics under proper nursing. But now a days most of the hospital/clinic deliveries are caesarian, and after the delivery, mothers stay at the operation theatre for more than one hour, and cannot provide breast milk to their infant in time (within one hour of delivery). Mothers living in poor families are more likely to provide breast milk to their newborn than those living in rich families. A similar result was found in another Bangladeshi study . Healthy and over nourished mothers usually live in rich families, and most of them underwent caesarean section. It might create a higher risk of cephalo-pelvic disproportion and relatively poor progress due to maternal fatigue . This is one of the most important reasons for the differences seen in the practice of EIBF between undernourished and over nourished mothers. Healthy and over nourished mothers should be the focus of education on the potential benefits of EIBF. We found that mothers getting pregnant with proper planning and taking advice regarding the benefit of EIBF were more likely to provide EIBF than their counterparts. Family planning workers closely working with pregnant mothers and healthcare providers can play a good role to increase the rate of EIBF and exclusive breastfeeding in Bangladesh.
Strength and limitations of this study: Perhaps, this was the first time we attempted to investigate the early initiation of breastfeeding and its influential factors among mothers in Rajshahi district, Bangladesh. We considered two new factors; (i) getting pregnant with planning and (ii) mothers taking advice regarding the benefit of breastfeeding during their pregnancy, which were not considered in our national survey. However, there are several limitations of our present project. Firstly, in this study, we considered only Rajshahi district as our study area which is a small part of Bangladesh. Secondly, we used a quantitative study which can determine only risk factors but cannot do research in-depth. For complete study, mixed research (qualitative and quantitative) is important. Thirdly, we selected some socio-economic, demographic, anthropometric and behavioral factors as independent variables but other important factors were not considered in this study. Fourth, we did not consider the pre-lacteal feeding for calculating the prevalence of EIBF, and it would be better to ask mothers about providing EIBF immediately after delivery for getting accurate information; but we asked after 6-24 months of delivery. On the basis of our limitations, we may proclaim that further researches are required on breastfeeding among Bangladeshi mothers.