A study from the University of Toronto released on Apr. 8 shows that where mothers live in Indian cities—whether in slum or non-slum neighborhoods—is linked to differences in how they breastfeed their babies.
The findings matter because early and exclusive breastfeeding is known to help protect newborns from infection, lower the risk of death, and support healthy development, especially in low- and middle-income countries. The study suggests that a one-size-fits-all approach may not be effective for improving breastfeeding practices across different urban communities.
Researchers analyzed data from more than 3,200 mothers using India's 2015–2016 National Family Health Survey. They found that while mothers living in slums are generally better at starting breastfeeding within one hour of birth, they need more support to continue exclusive breastfeeding for the recommended six months. In contrast, mothers in non-slum areas require more assistance with initiating breastfeeding immediately after delivery.
"These findings tell us that a universal or standard approach will not work for every neighborhood," said Kehinde Oluwatosin Akinwande of Lagos University Teaching Hospital. "In slum communities, mothers are doing relatively well at starting breastfeeding quickly, but need more support to continue breastfeeding only breastmilk for longer. In non‑slum areas, more help is needed right after birth to get breastfeeding started in the first hour." Akinwande also said: "India has made huge progress in getting women to give birth in facilities. The next step is to make sure every mother leaves the hospital with practical, culturally sensitive breastfeeding support that fits her living conditions."
The study found over 90% of mothers delivered their babies at health facilities—a key opportunity for hospital-based programs such as India's Mother's Absolute Affection (MAA) initiative which encourages early initiation and mother-baby contact. In non-slum areas specifically, giving birth at a health facility was strongly associated with timely initiation of breastfeeding.
Chiamaka Okonkwo of State House Medical Centre noted: "This suggests that counselling and information mothers received in the past may fade over time... Regular contact with health workers between pregnancies could help keep breastfeeding knowledge fresh." Thabani Nyoni from Dalhousie University added: "Breastfeeding decisions are shaped by social norms, caste‑based inequalities, work conditions, and how easy it is to reach services... Policies have to meet mothers where they live – whether that is in a crowded informal settlement or a more resourced urban neighborhood." Akinwande concluded: "Hospitals are a crucial starting point for breastfeeding... Strengthening post‑delivery support can turn each birth into a powerful teaching moment."
Although no strong predictors were found for exclusive breastfeeding after adjusting for other factors, researchers say differences between neighborhoods highlight the need for tailored approaches rather than uniform national messaging.
