title: Inequities in milk-based prelacteal feedings in Latin America and the Caribbean: the role of cesarean section delivery.
abstract: BACKGROUND
  Prelacteal feeds (ie, foods other than breast milk offered before the milk comes in) have been identified as a risk factor for shorter breastfeeding duration and neonatal mortality.
  
  
  OBJECTIVE
  This study aimed to test for socioeconomic inequities on the risk of milk-based prelacteal feeding associated with cesarean section delivery.
  
  
  METHODS
  We conducted secondary cross-sectional data analyses of 7 Demographic and Health Surveys conducted in Latin American and Caribbean countries between 2005 and 2010 (N = 49 253 women with children younger than 3 years of age). Multivariate logistic regression was used to test the association between cesarean section delivery and the risk of milk-based prelacteal feeding in the total samples as well as within the lowest and highest wealth quintile subsamples by country and in the pooled sample.
  
  
  RESULTS
  Almost one-third of newborns received milk-based (22.9%) prelacteal feeds. Prelacteal feeding prevalence varied from 17.6% in Guiana to 55% in Dominican Republic. Cesarean section delivery was associated with significantly higher odds of introduction of milk-based prelacteals in all countries (adjusted odds ratio [AOR] range, 2.34 in Bolivia to 4.50 in Peru). The association between cesarean section delivery and risk of milk-based prelacteal feeds was stronger among the poorest than wealthiest women (AOR [95% confidence interval], 2.94 [2.58-3.67] vs 2.17 [1.85-2.54]).
  
  
  CONCLUSIONS
  Women of lower socioeconomic status may need additional breastfeeding support after cesarean section delivery to prevent the introduction of milk-based prelacteals. Reducing the rates of cesarean section deliveries is likely to reduce the prevalence of prelacteal feeding.
authors.affiliation: Social Nutrition Department, Rio de Janeiro State University, Rio de Janeiro/RJ, Brazil cristianoboccolini@gmail.com.
authors.forename: Cristiano Siqueira
authors.initials: CS
authors.lastname: Boccolini
authors.affiliation: Yale School of Public Health, New Haven, CT, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.affiliation: Rio Grande do Sul Federal University, Porto Alegre/RS, Brazil.
authors.forename: Elsa Regina Justo
authors.initials: ER
authors.lastname: Giugliani
authors.affiliation: Rio de Janeiro Federal University, Rio de Janeiro/RJ, Brazil.
authors.forename: Patricia de Moraes Mello
authors.initials: Pde M
authors.lastname: Boccolini
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002585:Cesarean Section; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011181:Postnatal Care; D012044:Regression Analysis; D013020:South America / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014900:West Indies / Q000453:epidemiology; D055815:Young Adult
keywords: Caribbean; Latin America; breastfeeding; cesarean section; prelacteal feeds