Sex inequality in early initiation of breastfeeding in 24 sub-Saharan African countries: A multi-country analysis of Demographic and Health Surveys

Obasanjo Afolabi BOLARINWA*, Bright Opoku AHINKORAH, Francis ARTHUR-HOLMES, Richard Gyan ABOAGYE, Edward Kwabena AMEYAW, Eugene BUDU, Abdul-aziz SEIDU, Uzairue Leonard IGHODALO, Sanni YAYA

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

5 Citations (Scopus)


The Sustainable Development Goal (SDG) 3 aims at reducing neonatal and under-5 mortality to below 12 per 1000 and 25 per 1000 live births, respectively, globally by 2030. Studies have found that initiation of breastfeeding within one hour of birth and continuous breastfeeding for over 12 months can positively impact neonatal and infant health. However, there is evidence that the sex of a child may influence the breastfeeding practices of a mother. Thus, we examined sex inequality in early breastfeeding initiation in sub-Saharan Africa.

Materials and methods
Data from Demographic and Health Surveys conducted in 24 sub-Saharan African countries between January 2010 and December 2019 were pooled and analysed. A total of 137,677 women of reproductive age (15–49 years) were considered in this study. Bivariate and multivariable regression analyses were performed, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) with statistical significance at a p-value less than 0.05.

The highest inequality in early initiation of breastfeeding was reported in Togo with a difference of 5.21% between the female and male children, while the lowest inequality was reported in Guinea with 0.48% difference between the female and male children. A higher odds of breastfeeding within 1 hour was observed among female children [cOR = 1.05; 95%(CI = 1.02–1.09)] compared to male children, and this persisted after controlling for the confounders included in this study [aOR = 1.05; 95%(CI = 1.02–1.08)].

We found higher odds for early breastfeeding initiation of female children compared to male children in sub-Saharan Africa. To reduce breastfeeding initiation inequalities, programmes that educate and encourage early initiation of breastfeeding irrespective of the child sex should be promoted among mothers.
Original languageEnglish
Article numbere0267703
JournalPLoS ONE
Issue number5
Early online date19 May 2022
Publication statusPublished - 19 May 2022

Bibliographical note

The authors are grateful to MEASURE DHS for granting access to the dataset used in this study.

Publisher Copyright:
© 2022 Bolarinwa et al.


  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Breast Feeding
  • Child
  • Demography
  • Female
  • Health Surveys
  • Humans
  • Infant
  • Infant, Newborn
  • Live Birth
  • Male
  • Middle Aged
  • Mothers
  • Pregnancy
  • Young Adult


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