Abstract
BACKGROUND: Ethiopia has had a long-standing national commitment to improving child health for the last five decades. However, evidence on trends of ever-breastfeeding and early initiation remained fragmented, and there existed a paucity of holistic evidence on the extent of the impacts of the policy and the associated factors. This study examined trends, disparities, and factors influencing ever-breastfed and early initiation in the last twenty years. METHODS: The Ethiopian Demographic and Health Surveys (EDHS 2000-2019) datasets were used and extracted for children aged 0-23 months and their mothers. Data analyses were performed using SPSS version 25. Trend and time-series analysis was used to visualize changes over time. Multivariable logistic regression was used to identify associated factors. RESULTS: Prevalence of ever-breastfeeding declined from 99.4% in 2000, to 84.01% in 2019; and early initiation showed inconsistency, increasing from 48.55% in 2000 to 69.57% in 2016 and remained unchanged (69.78%) in 2019. Maternal age, religion, and maternal healthcare utilization significantly influenced early initiation (p < 0.001). Both ever-breastfeeding and early initiation varied across regional states (< 0.001). Disparities in breastfeeding and early initiation were observed across socio-cultural settings and regional states (p < 0.05). CONCLUSION: The prevalence of ever-breastfeeding declined nationwide between 2000 and 2019, which was not uniform and early initiation showed inconsistency across socio-cultural settings and regional states. These findings highlight the need to revisit current policies and interventions. Further research is crucial to inform the development of regionally tailored and culturally sensitive strategies that promote equitable and sustained breastfeeding improvement across Ethiopia.