A new study from the University of Toronto shows that where a mother lives in an Indian city – in a slum or non-slum area – has a bearing on how she breastfeeds her baby.
Breastfeeding within the first hour of birth helps newborns fight infections and reduces the risk of death, especially in low- and middle-income countries. For about the first six months, giving your baby only breast milk (no water or other food) protects him from diarrhea, pneumonia, stunted growth, and supports brain development.
Researchers used data from India’s 2015-2016 National Family Health Survey to compare the breastfeeding practices of more than 3,200 mothers living in urban slums and other urban peripheries across seven states.
They discovered the following splitting pattern:
- About half (50.4%) of mothers in slum areas initiated breastfeeding within 1 hour after birth, compared with just over a third (37.4%) of mothers in non-slum areas.
- However, exclusive breastfeeding during the first 5 months was more common in non-slum areas (55.8%) than in slum areas (50.0%).
These percentages are broadly consistent with national urban estimates, but also show that there is room for improvement in both settings. Both early initiation and exclusive breastfeeding need to be increased overall, but barriers and solutions vary depending on where mothers live. ”
Work Fehintola Akinwande, Faculty of Social Work, University of Toronto, First Author and PhD Student, Factor Inventory
“These findings show that no universal or standard approach will work in all regions,” Akinwande added. “In slum communities, mothers do relatively well to start breastfeeding immediately, but need more support to continue breastfeeding exclusively for longer periods of time. In non-slum areas, mothers need more support immediately after birth to start breastfeeding within the first hour of birth.”
More than 90% of mothers in both settings give birth in health facilities, which the authors say is a huge opportunity. India is already investing in hospital-based breastfeeding programs, such as the Mother’s Absolute Attachment (MAA) initiative, which encourages early breastfeeding and mother-infant contact.
“India has made great strides in allowing women to give birth in facilities,” Akinwande said. “The next step is to ensure that all mothers leave hospital with practical and culturally sensitive breastfeeding support tailored to their living conditions.
The study also found that in slums, mothers whose previous child was born two years or more early were less likely to start breastfeeding within an hour. “This suggests that the counseling and information mothers received in the past may fade over time,” said Chiamaka Okonkwo of the State House Medical Center in Abuja, Nigeria. “Regular contact with your health care provider between pregnancies may help keep your knowledge about breastfeeding fresh.”
Using a socioecological lens, the research team looked beyond individual mothers to the broader environment, including family support, community norms, and health services.
“The decision to breastfeed is driven by social norms, caste-based inequalities, working conditions, and the availability of services,” said co-author Thabani Nyoni, a faculty member in Dalhousie University’s School of Social Work. “Policies must meet mothers where they live, whether in crowded informal settlements or resource-rich urban areas.”
In non-slum areas, births in health facilities are strongly associated with initiation of breastfeeding within the first hour, highlighting the importance of bedside support from nurses and counselors. “Hospitals are an important starting point for breastfeeding,” says Kehinde Oluwatosin Akinwande of the University of Lagos Teaching Hospital. “By increasing support after birth, we can turn each birth into a powerful teaching moment.”
Although the study did not find strong predictors of exclusive breastfeeding even after controlling for other factors, the authors say the clear differences between slum and non-slum areas point to the need for targeted programs rather than a single national message.
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Reference magazines:
Akinwande, SF, others. (2026). Prevalence and social determinants of breastfeeding in urban slums and urban non-slum areas of India: A comparative analysis. pro swan. DOI: 10.1371/journal.pone.0323861. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323861
