Early Initiation of Breastfeeding

Outcome

% of children born in the last 24 months who were put to the breast within one hour of birth

Early initiation of breastfeeding is a recommended newborn-care and feeding practice associated with improved breastfeeding outcomes and newborn health and survival. This indicator measures the percentage of live births in the previous 24 months for which the newborn was put to the breast within one hour of birth.

Collect the following data through individual interviews with all women of reproductive age in sampled households who had a live birth in the 24 months preceding the survey. Identify eligible respondents through household screening or a birth history, not by selecting households because a living child aged 0–23 months is present.

      

RECOMMENDED SURVEY QUESTION (Q) AND POSSIBLE ANSWERS (A)

Q1: Was [baby's name] ever breastfed?

A1: yes / no / does not know

_ye

Ask the following question only if the previous answer is "yes".

fn

Q2: How long after birth was [baby's name] first put to the breast?

A2: _

1) immediately

2) less than one hour

3) ________ completed hours

4) ________ completed days

5) does not know

Interviewer instruction: If the respondent says ‘immediately’, select option 1. If the interval was less than one hour, select option 2. Otherwise, record completed hours if the interval was less than 24 hours, or completed days.

Ask the questions for every live birth in the 24 months preceding the survey, including children who have died since birth. Do not include stillbirths.

 

To calculate the indicator’s value, divide the number of live births in the past 24 months where the child was put to the breast within one hour of birth by the total number of live births in the same period. Include all live births, whether the child is living or deceased at the time of interview. Include children who were never breastfed and births with ‘does not know’, missing or inconsistent timing responses in the denominator but not in the numerator. Multiply the result by 100 to convert it to a percentage.

This data can be disaggregated by the child’s sex, and, if feasible, also by place of delivery, mode of birth, geographical area and household wealth.

1) Early initiation of breastfeeding means that the baby was put to the breast within the first hour after birth. It does not require that the baby suckled or that milk was transferred. Translate and pre-test ‘put to the breast’ carefully so that it is understood as placing the baby at the breast, rather than skin-to-skin contact alone.

2) Do not interpret the result only as a measure of mothers’ knowledge, motivation or choice. Clinical condition, caesarean birth, mother–newborn separation, facility routines and access to skilled support can affect whether the newborn is put to the breast within one hour. Interpret the result alongside place and mode of birth and, where available, relevant service-quality data.

 

3) Do not calculate this population indicator from records or exit interviews at supported health facilities alone. Such data exclude births occurring elsewhere and should be reported as a facility-specific measure.

4) This indicator relies on retrospective recall and accurate classification of births within the 24-month reference period. Confirm the date of birth from available records where appropriate. If the exact date is unknown, use a standardised age-estimation procedure, supported by a local events calendar where useful. Consider recall and date uncertainty when interpreting small differences over time. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.

5) Because the standard denominator also includes children who have died, train interviewers to ask relevant questions sensitively and in private, without pressuring bereaved respondents.

Also consider using the following indicators:

• Skin-To-Skin Contact (measures a closely related immediate newborn-care practice that can enable early initiation)

• Exclusively Breastfed for the First Two Days After Birth (assesses whether breastfeeding was protected from other foods and liquids during the period immediately following initiation)

• Pre-Lacteal Feeding (identifies early feeding practices that may delay or interfere with breastfeeding establishment)

• Exclusive Breastfeeding Under Six Months (measures the subsequent breastfeeding outcome that early initiation is intended to help support)