Abstract
BACKGROUND: Timely breastfeeding initiation within one hour of birth is recommended to reduce neonatal and early infant mortality. However, rates of early breastfeeding remain suboptimal in India, especially among marginalized tribal communities, which continue to experience disproportionately high infant mortality. The study investigated the association between the late breastfeeding initiation and infant mortality among the tribal population in India. METHOD: The study utilized data from the fifth round if the National Family Health Survey, which provided a sample of 232,920 most recent live births in the past five years with data on breastfeeding initiation time and infant mortality. Associations between late initiation (> 1 hour) and mortality were analysed using Cox proportional hazards regression and Kaplan-Meier survival curves. RESULTS: The results showed that infants breastfed after the first hour of life had a 30% higher risk of infant mortality compared to those breastfed within an hour of birth (aHR: 1.30, 95% CI: 1.06-1.60). The Kaplan-Meier curves further highlighted the lower chances of survival when breastfeeding was delayed. CONCLUSION: These findings underscore the need for promoting early breastfeeding initiation through culturally appropriate interventions in tribal areas as a strategy to reduce persistent child survival disparities in India.