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Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study
  1. Laura Oakley1,
  2. Christopher P Baker1,
  3. Srivalli Addanki2,
  4. Vipin Gupta3,
  5. Gagandeep Kaur Walia4,
  6. Aastha Aggarwal4,
  7. Santhi Bhogadi2,
  8. Bharati Kulkarni5,
  9. Robin T Wilson6,
  10. Dorairaj Prabhakaran4,
  11. Yoav Ben-Shlomo7,
  12. George Davey Smith7,
  13. K V Radha Krishna5,
  14. Sanjay Kinra1
  1. 1 Department of Non-communicable Disease Epidemiology, London School of Hygiene, London, UK
  2. 2 Indian Institute of Public Health, Hyderabad, India
  3. 3 Department of Anthropology, University of Delhi, New Delhi, India
  4. 4 Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
  5. 5 National Institute of Nutrition, Hyderabad, India
  6. 6 Department of Geography and Environment, University of Southampton, Southampton, UK
  7. 7 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Laura Oakley; laura.oakley{at}


Objective To investigate whether village-level urbanicity and lower level socioeconomic factors are associated with breastfeeding practices in transitioning rural communities in India.

Setting 29 villages in Ranga Reddy district, southern India between 2011 and 2014.

Participants 7848 children under 6 years identified via a cross-sectional household survey conducted as part of the Andhra Pradesh Children and Parents Study.

Outcome measures Two key indicators of optimal breastfeeding: termination of exclusive breastfeeding before 6 months and discontinuation of breastfeeding by 24 months. Village urbanicity was classified as low, medium or high according to satellite assessed night-light intensity.

Results Breastfeeding initiation was almost universal, and approximately two in three children were exclusively breastfed to 6 months and a similar proportion breastfed to 24 months. Using multilevel logistic regression, increasing urbanicity was associated with breastfeeding discontinuation before 24 months (medium urbanicity OR 1.45, 95% CI 0.71 to 2.96; high urbanicity OR 2.96, 95% CI 1.45 to 6.05) but not with early (<6 months) termination of exclusive breastfeeding. Increased maternal education was independently associated with both measures of suboptimal breastfeeding, and higher household socioeconomic position was associated with early termination of exclusive breastfeeding.

Conclusion In this transitional Indian rural community, early stage urbanicity was associated with a shorter duration of breastfeeding. Closer surveillance of changes in breastfeeding practices alongside appropriate intervention strategies are recommended for emerging economies.

  • social medicine
  • nutrition & dietetics
  • public health

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  • Contributors The study was conceived and designed by Shah Ebrahim (SE) and VG, and overall study management was by VG, GKW, KVRK and SK. Study tools were developed by VG, GKW and AA, and the study implemented by VG and GKW. Data management was provided by AA, GKW, SB and CB. SB was in charge of field management, SA and CB contributed to data collection and processing. RTW obtained and processed the NTLI data. LO, CB, SA and SK designed the analysis reported here. LO performed the statistical analysis, SK helped interpret the results and provided crucial input on manuscript preparation. LO, CB and SK were responsible for the initial draft of the manuscript. All authors contributed to the revision of the manuscript and reviewed and approved the final version.

  • Funding The APCAPS household survey was funded by a Wellcome Trust Strategic Award (Grant: 084674/Z, principal investigator Shah Ebrahim).

  • Competing interests None declared.

  • Patient consent Not needed.

  • Ethics approval Ethics committees at the National Institute of Nutrition (Hyderabad, India) and London School of Hygiene and Tropical Medicine (London, UK).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement For details on how to access APCAPS data, please visit

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