Assessing the causal relationship between women’s empowerment and exclusive breastfeeding practices among women of reproductive age in Bangladesh using BDHS 2022 survey data

BACKGROUND: Despite playing a significant role in the development of a child, prevalence of exclusive breastfeeding remains unsatisfactory in both global and low- and middle-income countries' context, which includes Bangladesh. Since women are the primary providers of exclusive breastfeeding, understanding their level of empowerment and autonomy over decision making is critical. This study aims to examine the effect of women's empowerment on exclusive breastfeeding in Bangladesh. METHODS: A nationally representative data from the 2022 Bangladesh Demographic and Health Survey (BDHS) was analyzed. Data on 884 women of reproductive age whose youngest child was under six months of age, and living with her were extracted. Exclusive breastfeeding was determined from children aged under six months who received only breastmilk during the 24 h preceding the interview and women's empowerment was developed following the DHS guideline. Bivariate relationships were assessed using chi-square tests, while generalized estimating equations (GEE) were used to account for clustering in multivariable analyses. For causal inference, the g-formula, inverse probability weighting (IPW), and doubly robust (DR) estimators were applied, with bootstrap confidence intervals for g-formula and DR methods. RESULTS: Among 884 mothers with infants under six months, 52% practiced exclusive breastfeeding. Multivariable GEE analysis identified mother's employment, division, child's sex, early initiation of breastfeeding, and women's empowerment as significant predictors of exclusive breastfeeding. Empowered mothers were found to have 35% higher odds of exclusively breastfeeding (OR = 1.35, 95% CI = 1.02, 1.79). Causal effect estimation using all the methods showed that women's empowerment significantly increased the odds of exclusive breastfeeding by 33%. CONCLUSION: Women's empowerment is a significant determinant of exclusive breastfeeding in Bangladesh. Women with agency to take their own decision over health, household, and mobility, awareness regarding their rights, and sense of dignity are more likely to exclusively breastfeed their infants. Therefore, interventions and policies should be designed and executed to enhance women's decision-making autonomy to improve exclusive breastfeeding rates and, consequently, child health outcomes.