The Association Between Post Natal Care and Newborn Feeding Practices in 14 Sub-Saharan African Countries

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: The World Health Organization and the United Nations Children’s Fund recommend the promotion of post-natal care (PNC) in addition to antenatal care (ANC) and skilled birth attendance (SBA) to improve newborn outcomes. PNC includes the promotion of immediate and exclusive breastfeeding. Trials and small-scale interventions already show that PNC can improve these outcomes. Recently, PNC interventions have been scale up and introduced at the national level in many countries, though little is currently known about the association between PNC and newborn feeding.

Methods: Using data from 14 Demographic and Health Surveys (DHS), 13 of which are Countdown countries, we examine if PNC is associated with newborn feeding practices. We use separate multi-level models to examine the association between PNC and two outcomes: early initiation of breastfeeding and prelacteal feeds, and control for a number of individual and country-level variables.

Results: Results indicate that when newborns and mothers receive PNC, newborns are significantly more likely to initiate breastfeeding early compared with those who did not receive any such check (OR: 1.19, p-value: 0.016) and that mothers with previous contact with the health system through ANC and SBA have higher odds of early initiation of breastfeeding. While PNC is not associated with prelacteal feeding, ANC and SBA are, both showing reduced odds of this practice. Greater numbers of nurses is associated with higher odds of early breastfeeding (OR: 2.24, p-value: 0.009) and lower odds of prelacteal feeds (OR: 0.35, p-value: 0.006).

Conclusions: Findings suggest that PNC interventions need to strengthen maternal counseling beyond early breastfeeding to improve PNC quality and that additional investments in nurses has the potential to improve newborn feeding. Further work will present the association of PNC and neonatal mortality and if PNC is mediated by breastfeeding practices using data from the DHS and the Multiple Indicator Cluster Surveys.