Does caesarean section have an impact on exclusive breastfeeding? Evidence from four Southeast Asian countries.

Background: The effect of caesarean section (CS) on breastfeeding initiation has been extensively studied, but its influence on exclusive breastfeeding practices remains inconclusive. Therefore, this study aims to investigate the impact of CS on exclusive breastfeeding using evidence from four countries in the Southeast Asian region.

Methods: This cross-sectional study used secondary data obtained from the Demographic and Health Surveys (DHS) conducted between 2016 and 2022 in four countries within the Southeast Asian Region. We included information on the youngest children aged 0-5 months living with their mothers within the DHS datasets. The association between CS and exclusive breastfeeding was determined using a simple and multiple logistic regression models. Weight factors were taken into account in all analyses for the two-stage stratified cluster sampling design.

Results: Among 3420 children, nearly half (49.1%, 95%CI: 47.0, 51.2) were exclusively breastfed. Children born by CS had lower odds of being exclusively breastfed, compared to children born vaginally (aOR = 0.68, 95%CI: 0.53, 0.88). Women who were married or living with a partner (aOR = 2.19, 95%CI: 1.33, 3.60), children born at a health facility (aOR = 1.31, 95%CI: 1.00, 1.71), and girl babies (aOR = 1.24, 95%CI: 1.05, 1.48) had higher odds of exclusive breastfeeding. Furthermore, residing in rural areas was associated with an increased likelihood of exclusive breastfeeding (aOR = 1.47, 95%CI: 1.20, 1.80). Maternal age, mother's education, parity, antenatal and postnatal care taken, and mass media exposure were not associated with exclusive breastfeeding.

Conclusion: This study highlights a significant association between CS and reduced exclusive breastfeeding practices. The findings underscore the importance of providing adequate support and interventions to mothers who deliver by CS and their family members to ensure they can successfully achieve exclusive breastfeeding, particularly in a global context where CS rates are rising.