This study disclosed the rural-urban difference in the factors associated with EIBF. A previous study in Ethiopia(29) has focused on the whole nation using the pooled data. On the contrary, this study has analyzed by disaggregating the dataset into Rural versus urban to identify the factors of EIBF respective the residence. Based on this, maternal age, current working status of mothers, numbers of under-five children, regions, women participation in making health care decisions, birth sizes, and mode of delivery were determinants of EIBF in rural populations. Whereas in the urban population, only antenatal care visits and mode of delivery were found to be determinants of early initiation of breastfeeding of infants.
In agreement with studies (31, 32), in rural populations, the odds of EIBF were higher among younger mothers as compared to older mothers. The possible justification might be due to the improvement of health education regarding optimal breastfeeding practice, girl education, and women's empowerment in making health care decisions (33).
In rural residency, the odds of EIBF were higher among mothers who are not working as compared to their counterparts. The finding is supported by a study conducted in Nigeria (34). The possible explanation might be that the mothers who had works are more likely have financial access which enables them to purchase a meal for newborns which in turn leads to formula feeding and that contributes to the late initiation of breastfeeding. In addition, mothers who had work may afford to pay the requested fee for cesarean section and they may choose cesarean section as the mode of delivery, which is the known contributing factor for the late initiation of breastfeeding of newborns(22). Furthermore, mothers who have no works more likely to stay at home and may only focus on the care of their baby, including optimal breastfeeding.
Irrespective of the residence, in both Rural and Urban populations, the rate of EIBF was higher among newborns who are delivered vaginally as compared to newborns delivered by cesarean section. Similar results have been reported from studies (17–20, 22–24, 29, 34–38). The possible explanation might be due that the newborn may be exhausted and stressed during surgical extraction from the maternal abdomen and the newborn may be depressed due to the effect of anesthesia, and later on, it contributes to the late initiation of breastfeeding. In addition, in cesarean section, the time gap for repairing the surgical incision and responsiveness of mothers following the procedure may delay breastfeeding initiation.
In the rural population, mothers who have autonomy in making health care decisions were associated with higher odds of EIBF as compared to their counterparts. The result is contrary to a study conducted in Niger(39). The possible explanation might be that those mothers may know the importance of EIBF to their babies. In addition, those mothers may be empowered to reject any cultural constraint or practice regarding the prelacteal feeding of the newborn(33).
In the urban population, mothers who have antenatal care were associated with higher odds of EIBF as compared to mothers who didn’t have antenatal care. The finding is supported by studies(19, 24, 31, 32, 38). The possible explanation might be that having antenatal visits was an opportunity for health professionals for giving health education regarding optimal breastfeeding and the importance of EIBF for the newborn.
The other finding of this study was that in rural populations, babies reported as large birth sizes were associated with a higher odds of EIBF as compared to babies reported as small-sized. The finding is supported by studies conducted in Nigeria and Nepal (34, 40). The possible justification might be the mothers and health professionals perceived that the large-sized babies are healthy, therefore, they may put the baby to breast milk early in the first hours. In addition, the small-sized babies may they are preterm and immature which needs special care immediately after birth to adapt to the extrauterine environment. Thus, the time gaps may contribute to the late initiation of breastfeeding.
On the contrary to the previous study(20), In rural population, the numbers of children in the households were positively associated with EIBF, such that, the mothers who have ≤2 children in the household were less likely practiced EIBF as compared to mothers who have >2 children. The possible justification might be due that the mothers may have previous experience regarding optimal breastfeeding or may the mothers have information regarding the importance of EIBF during the previous births.
Similar to the previous study (17), this study revealed that rural mothers who are living in large to center and small to peripheral regions were less likely to practice EIBF as compared to mothers who are living in Metropolitan. The possible justification might be differences in sociocultural practices/beliefs or it may be differences in awareness regarding the importance of EIBF to newborns.
The clinical and public health implication of this study is to take prompt intervention on the determinate factors and respond to increasing the proportion of EIBF of newborns. Therefore, In rural residences, considering and taking special attention to older mothers, small-sized newborns, women empowerment, to mothers living in large to center regions and small peripheral could increase the rate of EIBF. In urban residences, strengthening maternal and child health services utilization. Irrespective of residence, giving special attention to newborns delivered through cesarean section could increase the rate of EIBF.