Data Sources:

There are two common data sources for this indicator:

1. Routinely collected administrative data
2. Population-based household surveys.

Routinely collected administrative data:

Data from routinely collected and compiled administrative data sources will provide information as recorded in medical charts/records or registers and are entered into national and/or subnational health management information systems (HMIS).

Data from health information systems may collect information on early initiation of breastfeeding among all newborns born in a health facility. Routinely collected administrative data and health facility statistics are the preferred data source in settings with a high utilization of health facility services and data are recorded in a manner that ensures good data quality for both the public and private health sectors. The compiled data in the national HMIS or District Health Information System (DHIS2) should include data from both public and private health sectors, especially when the private sector is a substantial source of service provision to the population. In settings where utilization of health facilities is not high (e.g. settings with a high prevalence of births occurring at home), data may suffer from incompleteness if information about births occurring outside facilities is not captured. In addition, there are often challenges in accurately measuring the numerator and the denominator when routine HMIS data are used to measure this indicator.

Key source of data: Administrative data sources include health facility and health services data abstracted from obstetric and neonatal medical records, including health services registers. Relevant information is recorded about early initiation of breastfeeding among all newborns delivered at health facilities and are completed by health personnel on paper forms and/or through an electronic medical record. Data from paper or electronic sources are entered or abstracted into a database or registry and are compiled and analyzed within the national and/or subnational HMIS. The ministry of health (MoH) and/or national statistical offices (NSO) are usually responsible for the reporting of this indicator.

Indicator and calculation: The indicator is calculated as the percentage of newborns breastfed within one hour of birth among live births in a health facility during a specified reference period.

Number of newborns breastfed within one hour of birth in a health facility within a specified time period / Number of total live births in a health facility in a specified time period) x 100

Frequency of measurement: The indicator can be calculated on an annual basis or may be tracked on a more frequent and ongoing basis (e.g. monthly, quarterly), depending on facility, subnational and national processes for data entry, compilation and analysis. As a guide, the recommended frequency of measurement based on reporting level is outlined below:

• Facility level: Monthly, quarterly, or as needed based on the country and/or facility need
• Subnational (first and second administrative) level: Monthly or quarterly
• National level: Annually (data can be aggregated to provide national-level data).

Disaggregation: By level of facility, location of facility and place of maternal residence (e.g. urban, rural), subnational administrative units (e.g. districts, provinces, regions), type of health personnel, intention to breastfeed, birthweight, gestational age and timing of breastfeeding.

Missing values: Missing values are usually not known or not reported.

Population-based household surveys:

The main source of data for this indicator has been through population-based household surveys collected through nationally or subnationally representative and structured questionnaires, such as:

• Demographic Health Surveys (DHS) (2)
• Multiple Indicator Cluster Surveys (MICS) (3)
• Reproductive Health Surveys (RHS)
• Other household surveys with a similar methodological design.

Population-based household survey data are the preferred data source in settings where utilization of health facility services is not very high (e.g., settings with a high prevalence of births occurring at home) or where private health sector data are excluded from routinely collected administrative data sources.

Key source of data: Eligible women of reproductive age (15–49 years) are identified in the household survey for inclusion and interviewing using an individual women’s questionnaire. Women are considered eligible for a survey interview if they are either usual residents or visitors of the household who stayed there the night before the interview.

All eligible and interviewed women (between 15 and 49 years old) who had a live birth during a specified reference period, typically 2–5 years prior to the time of interview, are asked “Did you ever breastfeed (NAME)?”, where “name” refers to the name of the live birth the individual woman had during the same reference period. The woman is to indicate whether she ever breastfed her last live birth, even if the child died very young. If the child was ever breastfed, she is then asked “How long after birth did you first put (NAME) to the breast?” For the early breastfeeding indicator calculation, the woman must report that the baby was put to the breast either immediately after birth or within the first hour after delivery.

The MoH and NSO typically conduct household surveys and compile, analyze and report the results for this indicator in collaboration with the survey program (e.g., DHS, MICS, RHS) and funding agency.

Indicator definition and calculation: Individual women of reproductive age (15–49 years old) are asked about early breastfeeding initiation irrespective of the delivery location and child’s current living status (dead or alive) and are for the most recent live birth that they had during a specified reference period, which is typically 2–5 years before the time of the survey completion.

The definition is as follows:

The percentage of newborns who were breastfed within one hour of birth in the two (or five) years prior to survey completion.

The indicator is calculated as follows:

(Number of newborns breastfed within the first hour of birth / Total number of live births) x 100

Frequency of measurement: Household surveys are typically conducted every 3–5 years.

Disaggregation at population level: Place of delivery (private or public health facility, community), mode of delivery, place of residence (e.g., urban, rural), sex of live birth, birth order, socioeconomic status (e.g., education level, wealth quintile), age of woman at the time of delivery, births attended by skilled health personnel, timing of first antenatal care, and timing (within two days) and location of postnatal health check.

Missing values: Included in the distribution as “don’t know” or missing.

Purpose:

Breastfeeding is one of the most important preventive health measures for both mother and child. Early initiation of breastfeeding within the first hour of life is associated with reduced newborn mortality and morbidity, and protects the newborn from acquired infections (4). Early initiation of breastfeeding shortly after birth also improves the likelihood that mothers will be able to successfully initiate lactation, sustain exclusive breastfeeding over the long term, encounter fewer problems breastfeeding, and maintain optimal breastfeeding behaviors (5-7). To achieve optimal maternal and newborn health, breastfeeding should begin no later than one hour after birth concomitantly with skin-to-skin contact between mother and baby for bonding and maternal–infant stimulation, which facilitates suckling and an effective latch (8).

Early initiation of breastfeeding measures the length of time after birth when the mother initiated breastfeeding, regardless of absence or presence of breast milk. Provision of mother’s breast milk, or expressed breast milk, to newborns within one hour of birth is referred to as “early initiation of breastfeeding” and ensures that the infant receives the colostrum, or “first milk”, which is rich in protective factors (6). It is an indication of the coverage of one of the essential interventions immediately after birth that can both improve maternal health and reduce newborn mortality and morbidity and protect newborns from acquiring infections (4,7).

At national and subnational levels, it is recommended to use household survey data, which will provide representative population-based coverage estimates. At the facility level, it is recommended to use HMIS data to improve quality of care among live births in health facilities. Additionally, HMIS data can be aggregated to higher levels to provide more frequent reporting.

Monitoring this indicator will demonstrate the program efforts for protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services, which is also a reflection of provisions recommended for essential interventions immediately after birth. With that, it should be noted that the early initiation of breastfeeding indicator is part of essential newborn care, but cannot be used as a proxy on its own for essential newborn care (2).

Issues:

References: