Trends and inequalities in early breastfeeding initiation in Ghana

Early breastfeeding initiation is a critical practice for improving neonatal health outcomes, yet little is known about its inequalities. This study examines trends and inequalities in early breastfeeding initiation among women in Ghana. We employed an ecological time-trends study design among women of reproductive age, using six waves data from the Ghana Demographic and Health Surveys conducted in 1993, 1998, 2003, 2008, 2014, and 2022. The World Health Organization’s Health Equity Assessment Toolkit (HEAT) was used to compute inequality measures difference (D), prevalence ratio (PR), population attributable fraction (PAF), and population attributable risk (PAR) across six stratifiers: maternal age, child’s sex, household wealth, maternal education, place of residence, and subnational regions. Nationally, the prevalence of early breastfeeding initiation rose significantly from 15.2% in 1993 to 58.1% in 2022. All subgroups recorded improvements, with marginalized populations showing the largest gains. For instance, women in the lowest wealth quintile increased from 13.4% in 1993 to 60.2% in 2022, compared with women in the highest quintile who increased from 16.5% to 49.7% within the same period. Regionally, Bono East recorded the highest early breastfeeding initiation prevalence in 2022 (70.3%), while Greater Accra had the lowest (45%). Inequality assessments showed mixed patterns: wealth- and education-related disparities narrowed over time, with a 2022 prevalence ratio of 0.9, suggesting disadvantaged groups were more likely to adopt early breastfeeding initiation. Similarly, place of residence and child’s sex also narrowed overtime. However, age-related inequalities widened. Regional inequalities also persisted, with a prevalence ratio of 1.6 in 2022, indicating women in underserved regions were still more likely to practice early breastfeeding initiation compared with women in more advanced regions. Early breastfeeding initiation rates in Ghana have improved steadily over the past three decades, yet socioeconomic and regional disparities remain. Targeted strategies are needed to sustain gains and close gaps, including policy reforms to expand maternity leave and workplace breastfeeding support, as well as community-based initiatives such as awareness campaigns to promote equitable breastfeeding practices. Addressing these inequities will be vital for advancing maternal and child health outcomes in Ghana.