Factors Affecting the Breastfeeding Duration of Infants and young children in Rwanda: 2020 Demographic and Health Survey

Abstract Background: Breastfeeding is a critical component of infant and young child nutrition, providing essential nutrients, immune protection and fostering healthy growth and development. However, Insufficient understanding of the contextual determinants that affect breastfeeding duration limits the effectiveness of breastfeeding promotion programs and policies. This study determined the prevalence and factors associated with breastfeeding for at least 6, 12, and 24 months in Rwanda. Methods: This study analyzed cross-sectional data from the 2019-2020 DHS collected from November 9, 2019, to July 20, 2020, using a multi-stage sampling strategy. We used STATA 17 to analyze the data at univariable, bivariable, and multivariable levels. The logistic regression model was used to find factorsassociated with breastfeeding for at least 6, 12, and 24 months. Results: Of the 3,685 women who ever gave birth, the majority (65.0%) had attained primary education, nearly half (47.1%) were aged 25 to 34 years old, and nearly all (97.2%) were breastfeeding by the time of the study. Moreover, about 75.9% of the women breastfed their babies for at least 6 months, 54.7% for at least 12 months, while only 17.6% breastfed their babies up to 24 months or more. Firstly, a higher likelihood of breastfeeding baby for at least 6 months was among mothers aged 25-34 years [aOR: 1.4 with 95% CI: 1.1-1.7], currently working [aOR: 1.8 with 95% C.I: 1.5-2.2], catholic [aOR: 1.5 with 95% C.I: 1.1-1.9], lower number of children in a household [aOR: 1.6 with 95% C.I: 1.3-1.9] for zero or 1 child, and those receiving parenting programs in their religions [aOR: 1.4 with 95% C.I: 1.1-1.7]. Secondly, factors associated with breastfeeding up to 12 months and more include decreasing education level with mothers with 3.4 folds [aOR: 3.4 with 95% C.I: 1.2-9.7] among mothers with no education, living in other provinces other than Kigali city [aOR ranging from 1.7 to 1.8], consulted by a Nurse or Midwife during antenatal care services [aOR: 1.9 with 95% C.I: 1.0-3.4], and lower number (0 to 1) of children in household [aOR: 1.3 with 95% C.I: 1.0-1.7]. Lastly, factors associated with breastfeeding up to 24 years and more encompass increasing age of the mother with those aged 35 years+ being 1 times more than those aged 15-24 years[aOR: 2.9 with 95% C.I: 1.5-5.6], 5 years and more period of marriage or cohabitation [aOR 2.6 with 95% C.I: 1.5-4.5], currently working [aOR:1.6 with 95% C.I: 1.1-2.3], Zero to 1 children in their household [aOR: 2.0 with 95% C.I: 1.5-2.8], increasing education level of their partners [aOR ranging from 1.8 to 2.9], and history of taking iron supplements while pregnant [aOR: 1.5 with 95% C.I: 1.1-2.1]. Consequently, mothers who breastfed their children up to 24 months or more were 3.6 [aOR: 3.6 with 95% C.I: 2.4-5.4] times to have babies without anemia. Conclusion: All in all, these findings highlight the importance of promoting extended breastfeeding through targeted interventions, including parental education, workplace breastfeeding support policies, and improved maternal nutrition programs. Encouraging paternal involvement and ensuring adequate iron supplementation during pregnancy can further enhance breastfeeding outcomes.