“Mother's milk”: Is there a social reversal in breastfeeding practices along with economic development?

The purpose of this article is to test the existence of a reversal in the association between household wealth and breastfeeding (BF) behavior throughout the development process of Asian countries. Our empirical investigations are based on 42 Demographic Health Surveys (DHS) conducted in 15 Asian countries with a large time window (1990-2017) aiming to capture the diversity of development levels. We construct four indicators describing adequate BF practices (early initiation of BF, exclusive BF, continued BF at one year and two years) and a harmonized asset-based composite index of household wealth allowing for comparison across DHS waves and countries. To highlight the dynamics of the wealth-BF association, we carry out econometric estimations including interaction terms between household wealth and the country's level of economic development (low, medium, and high) or time. We also perform instrumental variable estimations aiming to limit suspected endogeneity issues. Our results confirm the existence of a transition in the wealth gradient of exclusive BF and continued BF in Asian countries. More precisely, while these practices are pro-poor in the poorest countries of the sample, they progressively spread to wealthier households along with the level of economic development. For exclusive BF namely, this transition has resulted in a reversal of the wealth gradient at the end of the period (i.e., exclusive BF prevalence among the rich overpassing that of the poor). We fail, however, to observe this kind of transition for early initiation of BF, this practice remaining pro-poor, whatever the level of economic development.