Initiating breastfeeding within the first hour of birth stands as a widely acknowledged practice endorsed by esteemed organizations such as the World Health Organization (WHO) and other professional societies. This practice holds immense value due to its manifold benefits for both newborns and mothers. Early initiation of breastfeeding (EIBF)—defined by the WHO as putting newborns to the breast within the first hour of life—ensures providing neonates with antibody-containing colostrum (i.e., the first breast milk) that safeguards them against a variety of infections 1. Evidence suggests that colostrum contains an array of protective components safeguarding neonates from mortality linked to sepsis, pneumonia, diarrhea, and hypothermia 2–5. Notably, delayed breastfeeding initiation doubles the risk of neonatal mortality 3,4. Besides the newborn, EIBF significantly contributes to the physical and psychological well-being of the mother. EIBF triggers the secretion of lactation-inducing hormones—prolactin and oxytocin—facilitating uterine contractions after birth, thus preventing postpartum haemorrhage 6. Moreover, EIBF stimulates milk production, essential for establishing exclusive breastfeeding for the first six months of age and sustaining it up to two years of age or beyond, as recommended by the WHO 2,3. The potential impact of optimal breastfeeding is profound, estimated to avert over 820,000 annual deaths among children under five and 20,000 maternal deaths attributed to breast cancer 1,2.
Despite the well-documented benefits and the relentless efforts of midwives and lactation consultants, only 42% of newborns worldwide embark on breastfeeding within the first hour of birth 7,8. The prevalence dwindles further in low-and middle-income countries, particularly in South Asia including Bangladesh 9. In Bangladesh, where cultural norms and socio-economic factors can influence health practices, the initiation of breastfeeding within the first hour remains a challenge. Previous research has shown that only 51.7% of newborns in Bangladesh are breastfed within the first hour of birth 10.
Recent studies have uncovered a wide range of factors influencing EIBF, ranging from individual and obstetric factors (e.g., complications during childbirth, cesarean delivery), and cultural influences 9,11–15. Notably, psychosocial elements— maternal beliefs, attitudes, self-efficacy, psychological well-being, and social support—have emerged as predictive determinants outweighing other factors in breastfeeding outcomes 16–18. Research revealed that higher breastfeeding self-efficacy, positive attitudes toward breastfeeding benefits, and robust social support networks are connected with higher initiation rates and longer duration of breastfeeding 17–19.
In this context, recent research has begun to explore the psychosocial factors that are potentially transformable through midwifery interventions. Intimate partner violence (IPV)—embracing physical, sexual, and emotional abuse as well as controlling behaviours against women by a current or former intimate partner—has surfaced as a crucial psychosocial predictor that could potentially influence EIBF 20,21. Although pregnancy symbolizes a period of enormous joy and excitement for most women and their families, it can also r render women susceptible to IPV, millions of women of reproductive age 22–25. In Bangladesh, like in other parts of the world, IPV during pregnancy is a concerning public health issue with implications for both maternal and offspring well-being 16,26–29. A study from Bangladesh has documented that the prevalence of physical and sexual IPV during pregnancy is respectively 39% and 26.3% 30, highlighting the urgency of understanding its impacts on various maternal and infant health outcomes, including EIBF. The association between IPV during pregnancy and EIBF remains inadequately explored within the existing literature, characterised by inconsistent findings 21,31. While some studies identify a significant association between IPV and EIBF 32,33, other do not corroborate this association 34–36. In their study of eight African countries, Misch and Yount (2014) have revealed a positive association between IPV and EIBF in some countries and a negative association in other countries 37. The intricacies of this relationship are compounded by the fact that studies have predominantly concentrated on physical IPV, overlooking the broader dimensions of sexual or psychological IPV, and have largely been confined to high-income countries 21,31. In the context of Bangladesh, the intersection of cultural norms and IPV could introduce unique dynamics that further shape this association.
The potential mechanisms between maternal exposure to IPV and EIBF are complex and warrant further exploration 21,31. IPV might directly influence EIBF through physical discomfort, fatigue, and medical complications, while indirect effects may manifest through limited social support, low self-esteem, depression, and maternal stress 18,37,38. Moreover, the well-established association between IPV around the time of pregnancy and adverse pregnancy outcomes—ranging from preterm birth to childbirth complications—adds complexity to the landscape 30,39–41. Birth-related complications and cesarean delivery, in turn, could impede breastfeeding establishment due to stress, pain, delayed initiation, maternal discomfort, and altered infant behavior 9,42,43. Given this literature, we propose a potential pathway whereby the adverse influence of IPV on EIBF could be channelled through childbirth complications, possibly serving as a mediating and moderating factor, although the empirical investigation into these associations is currently lacking.
This study aims to bridge existing knowledge gaps by investigating two pivotal aspects: 1) the link between various forms of IPV during pregnancy and EIBF in Bangladesh; and 2) the potential mediating and moderating role of complications during childbirth in this association. Given the relevance of these findings for intervention strategies, unravelling the interplay between IPV, childbirth complications and EIBF holds significant promise. By delving into the nuances of these relationships with the Bangladeshi context, we aim to contribute not only to academic discourse but also to inform policy and practice in this critical area of maternal and child health.