Breastfeeding patterns in India differ between slum and non-slum neighborhoods
· News-MedicalA new study from the University of Toronto shows that where a mother lives in an Indian city – in a slum or a non‑slum neighborhood – is linked to how she breastfeeds her baby.
Breastfeeding within one hour of birth helps newborns fight infection and lowers the risk of death, especially in low‑ and middle‑income countries. Giving babies only breastmilk (no water or other foods) for about the first six months protects them from diarrhea, pneumonia, and poor growth and supports their brain development.
Using data from India's 2015–2016 National Family Health Survey, the researchers compared breastfeeding practices among more than 3,200 mothers living in urban slums and in other urban neighborhoods across seven states.
They found a split pattern:
- About half of mothers in slums (50.4%) started breastfeeding within one hour of birth, compared to just over a third of mothers in non‑slum areas (37.4%).
- However, exclusive breastfeeding in the first five months was more common in non‑slum areas (55.8%) than in slums (50.0%).
Suliat Fehintola Akinwande, lead author and PhD student, Factor‑Inwentash Faculty of Social Work, University of TorontoWhile these percentages are broadly consistent with national urban estimates, they also show that there is room for improvement in both settings. Both early initiation and exclusive breastfeeding need to increase overall, but the barriers and the solutions will differ depending on where mothers live."
"These findings tell us that a universal or standard approach will not work for every neighborhood," added Akinwande. "In slum communities, mothers are doing relatively well at starting breastfeeding quickly, but need more support to continue breastfeeding only breastmilk for longer. In non‑slum areas, more help is needed right after birth to get breastfeeding started in the first hour."
More than 90% of mothers in both settings delivered in health facilities, which the authors say is a major opportunity. India has already invested in hospital‑based breastfeeding programs such as the Mother's Absolute Affection (MAA) initiative, which encourages early breastfeeding and mother‑baby contact.
"India has made huge progress in getting women to give birth in facilities," said Akinwande. "The next step is to make sure every mother leaves the hospital with practical, culturally sensitive breastfeeding support that fits her living conditions.
The study also found that in slum areas, mothers whose previous child was born more than two years earlier were less likely to start breastfeeding within an hour. "This suggests that counselling and information mothers received in the past may fade over time," said Chiamaka Okonkwo of the State House Medical Centre in Abuja, Nigeria. "Regular contact with health workers between pregnancies could help keep breastfeeding knowledge fresh."
The research team used a social–ecological lens to look beyond individual mothers to the wider environment, including family support, community norms, and health services.
"Breastfeeding decisions are shaped by social norms, caste‑based inequalities, work conditions, and how easy it is to reach services," said Thabani Nyoni, co‑author and faculty member at the School of Social Work, Dalhousie University. "Policies have to meet mothers where they live – whether that is in a crowded informal settlement or a more resourced urban neighborhood."
In non‑slum areas, giving birth in a health facility was strongly linked to starting breastfeeding within the first hour, underlining the importance of bedside support from nurses and counsellors. "Hospitals are a crucial starting point for breastfeeding," said Kehinde Oluwatosin Akinwande of Lagos University Teaching Hospital. "Strengthening post‑delivery support can turn each birth into a powerful teaching moment."
Although the study did not find strong predictors of exclusive breastfeeding after adjusting for other factors, the authors say the clear differences between slum and non‑slum areas point to the need for targeted programming rather than a single national message.
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