Early initiation of breastfeeding (EIBF) reduces the risk of neonatal death in both high- and low and middle-income countries (LMICs). However, less than 50% of children are put to the breast within the first hour after birth in LMICs. Conversely, prelacteal feedings are widely used in many of these countries. We investigated inequalities in the prevalence of EIBF and prelacteal feeding by household wealth and place of delivery (institutional [private or public facilities] or in-home deliveries) using data from nationally representative surveys carried out in 76 LMICs. No clear wealth-related differences were found for EIBF and WPLF; however, any prelacteal and milk-based prelacteals were significantly higher in children belonging to the richest 20% of households. Prevalence of any prelacteal was higher among institutional births in all LMICs, but especially for milk-based prelacteals in private sector deliveries in East Asia & the Pacific, Eastern Europe & Central Asia, and Latin America & the Caribbean. Water-based prelacteal feeding was more common in all African regions. EIBF was inversely correlated with any prelacteal (r = −0.59, 95% CI −0.72, −0.42), milk-based prelacteals (r = −0.41, 95% CI −0.58, −0.21), and water-based prelacteals (r = −0.34, 95% CI −0.53, −0.13). Adjustment for log GDP did not affect the magnitude and direction of the results.

These results were published in the Paediatric and Perinatal Epidemiology