Trends of inequalities in early initiation of breastfeeding in Ethiopia: Evidence from Ethiopian Demographic and Health Surveys, 2000-2016

Abstract Background Early initiation of breastfeeding (EIBF) is a cost-effective and straightforward activity with numerous neonates' survival benefits. Thus, any disparity would result in an unacceptably high rate of neonatal death at the national level, and disparities among sub-groups regarding EIBF have not been well explored in Ethiopia. Therefore, this study aimed at assessing the trends of socioeconomic inequalities in EIBF in Ethiopia. Methods The Ethiopian demographic and health survey 2000 to 2016 data and the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) were used to investigate the inequalities in early breastfeeding initiation across the wealth quantile, educational level, residence and subnational region. Difference, ratio, slope index of inequality, relative index of inequality and population attributable risk were used as equity summary measures. A 95% uncertainty interval was calculated to declare the significance of the disparity in each point estimate. Results The magnitude of EIBF practice has fluctuated over the last seventeen years, with 47.4% in 2000, 66.2% in 2005, 51.5% in 2011 and 73.3% in 2016. In 2011, a significant change in inequality was observed in wealth- and educational status, whereas in 2016, inequalities were found in the subnational regions. Furthermore, in all survey years, the simple dispersion measure indicated no inequality in EIBF based on residence differences. However, there was high dispersion both in Difference and Ratio in Ethiopia across all survey years based on Ethiopia's sub-national region. In 2016, Afar (42.0%; 95% UI: 34.7–49.7), Tigray (63.0%; 95% UI: 56.6–69.0) and Amhara (66.0%; 95% UI: 59.7–71.8) were the three least EIBF practiced regions in Ethiopia. If the regional performance disparities in 2016 were reduced to an insignificant level, the EIBF proportion at the national level would increase by 17.2% (95% UI: 2.2–32.2). Conclusion In Ethiopia, the trend of socioeconomic inequality in EIBF has increased significantly over the past seventeen years. The disparity in EIBF was observed in all measures of dispersion in 2011. In all survey years, the northern part of Ethiopia (Afar, Tigray and Amhara regions) performed worse than the rest of the country. Therefore, interventions targeting them would significantly improve the national level performance of EIBF for the subsequent reduction of neonatal mortality.