Breast-feeding initiation time and neonatal mortality risk among newborns in South India

C. R. Garcia, L. C. Mullany, L. Rahmathullah, J. Katz, R. D. Thulasiraj, S. Sheeladevi, C. Coles, J. M. Tielsch

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Objective: To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region. Study Design: Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h. Result: Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 12 h after birth. Conclusion: Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

Original languageEnglish (US)
Pages (from-to)397-403
Number of pages7
JournalJournal of Perinatology
Issue number6
StatePublished - Jun 2011


  • Breast-feeding
  • India
  • care practices
  • mortality
  • neonatal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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