Current prevalence, changes, and determinants of breastfeeding practice in China: data from cross-sectional national household health services surveys in 2013 and 2018.

Background: The World Health Organization and the government of China have made many efforts to improve breastfeeding practices. The evidence of breastfeeding practices over the past decade in China is limited. The current study aimed to describe the current prevalence, variation trends, and determinants of breastfeeding practices in China using data from the National Household Health Service Surveys (NHHSS) in 2013 and 2018.

Methods: Women who had at least one live birth in the five years from the 2013 NHHSS numbered 10,544, and 12,766 women from the 2018 NHHSS were included in the current study. The rates of breastfeeding, early initiation of breastfeeding within the first hour after birth, exclusive breastfeeding for at least six months since birth, and continued breastfeeding accompanied by adequate complementary feeding for over two years were measured. Logistic regressions were performed to study the associations between breastfeeding practices and maternal-based, healthcare-based, and infant-based characteristics.

Results: In the 2018 survey, the rates of practiced any breastfeeding, early initiation of breastfeeding within the first hour after birth, exclusive breastfeeding for at least six months, and continued breastfeeding for over two years were 91.50%, 28.16%, 47.90%, and 4.78%, respectively, showing significant improvements compared to the 2013 survey period. Women who received high education, were from a household with high incomes, had more than one child, and had more antenatal and postnatal visits, were more likely to practice breastfeeding and initiate it within the first hour, but they were less likely to breastfeed the infants for two years. Births by caesarean section and low birthweight were associated with worse breastfeeding practices.

Conclusions: The rates of practicing breastfeeding and exclusive breastfeeding for six months or more in China improved over the past decades, suggesting improved awareness and knowledge of breastfeeding among women. However, individual and social factors may impact practices of early initiation and continued breastfeeding. Strengthening breastfeeding support from family, community, and health professionals (e.g., family member engagement, friendly work environment, and professional consultation, etc.) during the postpartum and infant period may improve women's confidence in breastfeeding practices.