Antenatal care Contacts beyond 4 to 7 years fails to enhance immediate or exclusive breastfeeding rates: Study

Recent study investigates breastfeeding practices in sub-Saharan Africa following the 2016 World Health Organization (WHO) antenatal care (ANC) policy update, which recommends a minimum of eight ANC contacts during pregnancy. It examines trends in immediate and exclusive breastfeeding (IEBF) and explores the relationship between ANC uptake (specifically comparing 4-7 contacts versus 8+ contacts) and breastfeeding practices.

Analysis of DHS Data in Sub-Saharan Africa

Data from Demographic and Health Surveys (DHS) conducted between 2018 and 2023 across 19 sub-Saharan African countries were analyzed. The analysis included 25,669 individuals and focused on immediate breastfeeding (IBF), defined as breastfeeding within one hour of birth, and exclusive breastfeeding (EBF) for infants aged zero to six months. Several health service, clinical, social and contextual factors available in DHS surveys for eligible countries were also considered.

Variations in Breastfeeding Rates Across Countries

The study found substantial variations in breastfeeding rates across countries. IBF ranged from 24.4% in Senegal to 86.7% in Rwanda, while EBF ranged from 17.6% in Gabon to 74.2% in Kenya. Most countries' IBF rates were higher than EBF rates. Only a small fraction of women, 8.6% on average, reported attending eight or more ANC contacts.

Association Between ANC Contacts and Breastfeeding Practices

Pooled analysis across all countries showed that having 8+ ANC contacts, compared to 4-7 contacts, was not significantly associated with either IBF or EBF. However, results did indicate that there was a relationship between health service, clinical, demographic, and contextual factors and IBF and EBF.

Implications for Promoting Optimal Breastfeeding Practices

The findings suggest limited additional benefits of 8+ ANC contacts over 4-7 contacts in promoting IEBF, despite the WHO's recommendation. It emphasizes the need for comprehensive strategies to promote ANC uptake and improve the quality of ANC contacts through behavior change interventions and complementary health service delivery. The results highlight the need to focus on improved quality of care, tailored interventions, and addressing misconceptions to improve both ANC attendance and breastfeeding outcomes in sub-Saharan Africa.

Key Points

* The study analyzes data from Demographic and Health Surveys (DHS) conducted between 2018 and 2023 in 19 sub-Saharan African countries, involving 25,669 individuals, to assess breastfeeding practices following the 2016 WHO antenatal care (ANC) policy update.

\* Immediate breastfeeding (IBF) rates varied significantly across countries, ranging from 24.4% in Senegal to 86.7% in Rwanda, while exclusive breastfeeding (EBF) rates ranged from 17.6% in Gabon to 74.2% in Kenya.

\* Across the surveyed countries, a small percentage of women (8.6% on average) reported attending eight or more ANC contacts, as recommended by the WHO.

\* Pooled analysis revealed that attending 8+ ANC contacts, compared to 4-7 contacts, did not show a significant association with either immediate or exclusive breastfeeding practices.

\* Health service, clinical, demographic, and contextual factors were found to have a relationship with immediate breastfeeding and exclusive breastfeeding practices.

\* The findings suggest that increasing ANC contacts beyond 4-7 may not significantly improve immediate and exclusive breastfeeding rates, highlighting the importance of comprehensive strategies focusing on the quality of ANC contacts, behavior change interventions, and complementary health service delivery.

Reference –

Bolanle Olapeju et al. (2025). Antenatal Care And Breastfeeding Practices In Sub-Saharan Africa: An Analysis Of Demographic And Health Surveys. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07188-w.