The Effect of Type of Antenatal and Delivery Care Providers on Breastfeeding in South and Southeast Asia Countries

Abstract

Countries in the South and Southeast Asian region vary tremendously in their rates of breastfeeding and the region has both some of the lowest and highest rates of breastfeeding reported worldwide. For example, breastfeeding rates are 23% in Thailand, 65% in Cambodia and 82% in Sri Lanka6. These countries also vary in the type of antenatal and delivery care provider9. The objective of this study was to determine what association, if any, exists between a woman's type of antenatal care or delivery provider and her duration of breastfeeding. A secondary objective was to look at the association between type of provider and time after birth before breastfeeding was initiated. We hypothesized that having a skilled provider as the antenatal or delivery care provider will be associated with an increased duration of breastfeeding and shorter time after birth before initiation of breastfeeding. A cross-sectional analysis was performed on data from Demographic Health Surveys conducted from 2015 and 2018 in ten South and Southeast Asian countries. This included Afghanistan, Bangladesh, India, Indonesia, Cambodia, Myanmar, Maldives, Nepal, Pakistan and Timor Leste.The analysis revealed that having a doctor as an antenatal or delivery care provider was associated with statistically significant decrease in duration of breastfeeding when compared with nurse/midwife and traditional birth attendant in Bangladesh and Afghanistan. Having a nurse/midwife in Afghanistan was also associated with decreased duration of breastfeeding. In contrast, having a nurse/midwife was associated with statistically significant increase in duration of breastfeeding in Cambodia, Myanmar and Timor Leste. There was also a significant increase with use of a traditional birth attendant in Cambodia, Indonesia, Myanmar and Timor Leste. Our secondary objective analysis showed a statistically significant increase in time before initiation of breastfeeding with use of a doctor as the provider in Bangladesh and Nepal and with use of a traditional birth attendant as the provider in Afghanistan and Nepal. These findings suggest that there is a negative association in duration of breastfeeding with use of a doctor and a positive association with use of nurse/midwife or traditional birth attendant in some, but not all, countries in this region. Further investigation would be necessary to confirm these findings and determine why this negative association may exist.