title: Changes in caesarean section rates and milk feeding patterns of infants between 1986 and 2013 in the Dominican Republic.
abstract: The relationship between caesarean sections (C-sections) and infant feeding varies between different samples and indicators of feeding. The current study aimed to determine the relationship between C-sections and five indicators of infant milk feeding (breast-feeding within 1 h after delivery, at the time of the survey (current) and ever; milk-based prelacteal feeds; and current non-breast milk use) over time in a country with a rapidly rising C-section rate.
  
  
  
  Secondary data analysis on cross-sectional data from Demographic and Health Surveys from six different time points between 1986 and 2013.
  
  
  
  Dominican Republic.
  
  
  
  Infants under 6 months of age.
  
  
  
  Over 90 % of infants were ever breast-fed in each survey sample. However, non-breast milk use has expanded over time with a concomitant drop in predominant breast-feeding. C-section prevalence has increased over time reaching 63 % of sampled infants in the most recent survey. C-sections remained significantly related to three infant feeding practices - the child not put to the breast within 1 h after delivery, milk-based prelacteal feeds and current non-breast milk use - in multivariate models that included sociodemographic control variables. However, current non-breast milk use was no longer related to C-sections when milk-based prelacteal feeds were factored into the model.
  
  
  
  Reducing or avoiding milk-based prelacteal feeds, particularly among those having C-sections, may improve subsequent breast-feeding patterns. Simultaneously, efforts are needed to understand and help reduce the exceptionally high C-section rate in the Dominican Republic.
authors.affiliation: Departments of Pediatrics, Psychiatry, and Community Health Sciences,Cumming School of Medicine,University of Calgary,TRW Building,3rd Floor,3280 Hospital Drive NW,Calgary,Alberta,Canada,T2N 4Z6.
authors.forename: John D
authors.initials: JD
authors.lastname: McLennan
mesh_terms: D000818:Animals; D001942:Breast Feeding; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004293:Dominican Republic; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D008892:Milk; D011247:Pregnancy
keywords: Breast-feeding; Caesarean section; Dominican Republic; Infants; Milk