Determinants of delayed initiation of breastfeeding: a community and hospital study from Guinea-Bissau

Int J Epidemiol. 1992 Oct;21(5):935-40. doi: 10.1093/ije/21.5.935.


A prospective study on the timing of breastfeeding start in Bissau was undertaken in a periurban community (n = 734), and at the Central Hospital (n = 414). Only single, full-term, healthy children born by the vaginal route were included, the purpose being to characterize mothers who delay breastfeeding start for reasons not related to disease. Multivariate failure-time analysis (Cox' regression) was used to relate the child's age at breastfeeding start to a set of independent variables. In the community, those tending to delay breastfeeding start were mothers from the largest ethnic group in the country, mothers who had given birth at times other than the evening hours (6-12 pm) and mothers who had not attended antenatal clinics. At the hospital, delayed initiation was found among young mothers and mothers from one sparsely represented ethnic group. The most important determinant of delayed breastfeeding start was negative cultural ideas about colostrum.

PIP: In Guinea-Bissau, researchers analyzed January 1984-April 1986 data on 734 mother-infant pairs registered at health centers in the periurban settlement of Bandim and March 1984-May 1986 data on 414 mother-infant pairs at the maternity ward of the Hospital Simao Mendes in Bissau to determine when mothers begin breast feeding and learn determinants of delayed breast feeding. In Bandim, the most significant determinant of delaying breast feeding among mothers in the community study was being a member of the Balanta ethnic group, the largest technic group in the country (p=.0001). This may have been because the Balanta believe the colostrum harms the infant. Membership in the Mancanha ethnic group, the country's smallest, was a determinant of delayed breast feeding among the women in the hospital study (p=.0001). The researchers could not identify a reason for this effect among Mancanha women. Community mothers who delivered anytime before 6 pm and after midnight (p=.0001)especially between midnight and 5 am (p=.0002) and noon to 5 pm (p=.0354) tended to delay breast feeding. The 3rd determinant of delaying breast feeding among the women in the community study was no prenatal care (p=.0001). Prenatal care had no effect on delayed or early breast feeding among the women in the hospital study. Young maternal age (20 years) was another determinant of delayed breast feeding among the women in the hospital study (p=.0001). Women who delivered in 1985 in the hospital were more likely to initiate breast feeding early (p=.0001) but this was not the case in 1984 and 1986, however. Public health officials planned to sue these results to design and target education about the benefits of early initiation of breast feeding.

MeSH terms

  • Adult
  • Age Factors
  • Breast Feeding / ethnology*
  • Colostrum
  • Culture
  • Female
  • Guinea-Bissau / epidemiology
  • Humans
  • Infant, Newborn
  • Male
  • Maternal Behavior / ethnology*
  • Multivariate Analysis
  • Pregnancy