Early initiation of breastfeeding: Better practiced in primary healthcare facilities? Analysis of the 2019 National Demographic and Family Health Survey in Peru

Early initiation of breastfeeding (EIBF) within the first hour of life is advocated by the World Health Organization for its numerous benefits, including emotional bonding and immunological protection for the newborn. Despite global efforts, EIBF prevalence varies significantly, with reports in Peru falling below the recommended 80%. This study investigates the association between healthcare facility level and EIBF in Peru, addressing a gap in research on the influence of health facility characteristics on EIBF rates. A cross-sectional analytical study was conducted using data from the 2019 Peru Demographic and Health Survey. We included women who had uncomplicated singleton vaginal deliveries in healthcare facilities within the previous 24 months. Poisson regression adjusted for complex sampling design was used to assess the association of interest, adjusting for socio-demographic and maternal-neonatal health variables. The analysis was made using only complete cases (no missing data). Therefore, 3,389 births met the inclusion criteria, but 3,104 were included in the analysis. It revealed that births in primary healthcare (PHC) facilities had a 10% higher prevalence of EIBF compared to secondary and tertiary facilities. Covariates associated with increased EIBF prevalence included rural residency, living in the highlands or jungle, having a newborn of normal or larger size, having a midwife as highest-ranking health professional present during delivery. Conversely, higher maternal education and wealth, as well as delivery in public hospitals financed by payroll deductions (EsSalud), were associated with lower EIBF rates. This suggests that facility-level characteristics may impact EIBF practices. Recommendations include strengthening health service policies and protocols, training for health personnel across all healthcare levels to support EIBF, and exploring stakeholder perspectives through future research.