Intra-household Power Dynamics and Early Initiation of Breastfeeding among a National Sample of Tanzanian Women

Background: This study assesses the relationship between intra-household power dynamics, including household decision-making, age at marriage, and intimate partner violence, and early initiation of breastfeeding (EIB).  EIB has been associated with improved infant and child nutrition and health outcomes, including reduced neonatal mortality, in many contexts.  Despite a growing emphasis of the importance intra-household power dynamics to child health, little is known about their effects on EIB.  Methods: Data from the Tanzania Demographic and Health Survey data were used for this study.  The sample consisted of 4,219 mothers of at least one child under 59 months of age. Multivariate logistic regression was conducted to examine the relationship between EIB and intra-household power dynamics, while controlling for potential confounding variables.  Results:  Nearly 64% of Tanzanian mothers of children under 59 months old reported EIB. Multivariate analysis demonstrated that the odds for EIB were negatively associated with marriage before 18 years of age (child marriage) and experiencing emotional intimate partner violence.  The odds of EIB were positively associated with the number of household decisions made jointly by the mother and her partner (out of 3).  There was no association between experiencing physical or sexual intimate partner violence and EIB.   Conclusion: While controlling for potential confounding factors, household power dynamics in Tanzania affected the odds of initiating breastfeeding within the first 24 hours of birth.  These partnership characteristics should be considered when designing programming aimed at promoting EIB.  Tools are needed for practitioners to assess these factors systematically for program design and evaluation.