The Moderating Effect of Urban Versus Rural Residence on the Relationship Between Type of Birth Attendant and Early Initiation of Breastfeeding in Ghana

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© The Author(s) 2017. Background: Early initiation of breastfeeding increases the likelihood of longer duration of breastfeeding. Factors associated with breastfeeding include maternal sociodemographic, behavioral and health-related characteristics, infant health characteristics, and perinatal factors. Research aim: This study aimed to determine the association between type of birth attendant and early initiation of breastfeeding among women in Ghana. Methods: A cross-sectional study was conducted using women (N = 3,087) who participated in the 2014 Ghana Demographic and Health Survey. The main outcome of interest was early initiation of breastfeeding, defined as provision of mother’s milk to the infant within 1 hr of birth. Chi-square tests and multivariable logistic regression modeling were performed. Results: Breastfeeding was initiated within 1 hr of birth by 58.3% of women. In the multivariable model, there was a significant interaction between type of birth attendant and place of residence on early initiation of breastfeeding. For rural areas, compared with women who had a nurse or midwife as their birth attendant, the multivariable odds ratios [95% confidence intervals] for early initiation of breastfeeding were lower among women whose birth attendant was a relative or other, 0.20 [0.07, 0.55], p =.002; village health volunteer or traditional health practitioner, 0.21 [0.07, 0.62], p =.005; none, 0.34 [0.12, 0.93], p =.035; community health officer, 0.42 [0.21, 0.85], p =.016; and doctor, 0.48 [0.24, 0.96], p =.037. For urban areas, no significant association was detected between type of birth attendant and early initiation of breastfeeding. Conclusion: Findings from the study highlight the need for focused, context-specific, early initiation of breastfeeding promotion and intervention, especially for women and their birth attendants in rural areas.