Antenatal Care Visits and Exclusive Breastfeeding Among Refugee and Host Community Women in South Sudan

The need to promote maternal and child health is a concurrent legislative agenda in many developing countries. This is particularly important in South Sudan due to protracted economic fragility. Although previous studies have examined the determinants of antenatal care (ANC) utilization and exclusive breastfeeding (EBF) among refugees and other vulnerable populations, limited empirical evidence has examined the association between ANC visits and EBF in displacement settings. Therefore, this study determined the association between ANC visits and EBF among refugees and host community members in South Sudan. The study was based on cross-sectional secondary data, which were collected in 2023 by the United Nations High Commissioner for Refugees (UNHCR), as part of the Forced Displacement Survey in South Sudan. The data were analyzed with a control function instrumental variable Poisson regression. The results showed that 61.54% of the women breastfed exclusively for six months and 8.14% did not breastfeed. Refugees reported a higher use of skilled ANC providers. The control function instrumental variable Poisson regression results confirmed the endogeneity of ANC visits, given the statistical significance of the control function parameter (p < 0.05). Also, ANC was significantly and positively associated with the number of months of EBF (p < 0.01). The results showed differences in the correlates of ANC visits and EBF duration across residence statuses. The combined analysis revealed a positive association between ANC visits and consultations with doctors and with nurses, while food problems, unchanged household income, urban residence, and some forms of delivery assistance had negative associations among some population groups. In the pooled and refugee results, civil-issued identification had a positive association with ANC visits. Also, income resilience showed different associations with EBF among host community women, and regional differences were observed among refugees. The findings highlight the need to strengthen access to adequate ANC and integrate breastfeeding counselling into maternal healthcare services delivered by skilled healthcare providers while tailoring interventions to the distinct circumstances of refugee and host community populations.