Introduction
Methods
Participants, setting, and data
Variables
Outcome variables – breastfeeding status
Independent variables
Variable | Description |
---|---|
Conflict | |
Average casualty rate | Average conflict-related casualty rate, per 1000 population, in three years preceding survey, in governorate of household |
Pre-birth casualty rate | Average conflict-related casualty rate, per 1000 population, two years prior to birth of child, in governorate of household |
Breastfeeding | |
Child ever breastfed | Binary indicating if child has ever been breastfed |
Hours to breastfeeding | Binary indicating if the child was breastfed within one hour of birth |
Exclusive breastfeeding | Binary indicating if the child is only breastfed (=1) or receives any other liquids or solids (=0) |
Current breastfeeding | Binary indicating if child was breastfed at time of survey |
Milk or infant formula | Binary indicating if child is receiving milk or infant formula |
Health | |
Low birthweight below 2.5 kg | Binary indicating if child had low birthweight at birth, defined as being below 2.5 kg |
ANC with skilled personnel | Binary indicating if mother received antenatal care by a health professional (doctor, midwife, or nurse) or licensed birth attendant |
Childbirth with skilled personnel | Binary indicating if child was delivered by a health professional or licensed birth attendant |
Birth by caesarean section | Binary indicating if mother had a caesarean section |
Contraception | Binary indicating if mother or father is currently practicing one of the following methods of contraception: sterilization, pill, IUD, injections, implants, condom, diaphragm, foam/jelly, lactational amenorrhea method, periodic abstinence, withdrawal |
Individual/household | |
Male child | Binary indicating if the child is male |
Children ever born | Number of children ever born to the mother |
Dead children | Number of children born to mother who passed away |
Primiparous mother | Binary indicating if the child is a firstborn |
Child marriage | Binary indicating of the mother was married before 18 years |
Husband-wife age difference | Age difference between husband and wife in years |
Age of mother | Age of mother in years |
Primary education of mother | Binary indicating if mother completed primary education |
Secondary education of mother | Binary indicating if mother completed secondary education |
Mother works | Binary indicating if the mother is employed |
Female household head | Binary indicating if the household head is female |
Regional | |
Urban | Binary indicating if household resides in an urban (=1) or rural (=0) area |
Kurd | Binary indicating if household resides in a Kurd-dominant governorate, found in north-east Iraq |
Sunni | Binary indicating if household resides in a Sunni-dominant governorate, found in the middle and north-west Iraq |
Empirical design: primary interventions
Breastfeeding status – Probit regression model
Breastfeeding duration – cox proportional hazards model
Robustness tests: alternative interventions
Residual analysis by governorate
Alternative measures of conflict
Disaggregation by year
Wealth controls
Use of breastmilk substitutes
Results
Descriptive statistics
Entire sample | Under 6 months | 6 months- 2 years | ||||
---|---|---|---|---|---|---|
Variable | N | Mean | N | Mean | N | Mean |
Conflict | ||||||
Average casualty rate | 15,142 | 0.20 | 4497 | 0.21 | 10,318 | 0.20 |
Pre-birth casualty rate | 14,815 | 0.17 | 4497 | 0.19 | 10,318 | 0.17 |
Breastfeeding | ||||||
Child ever breastfed | 15,134 | 0.93 | 4496 | 0.95 | 10,316 | 0.93 |
Breastfed within one hour | 13,971 | 0.44 | 4236 | 0.42 | 9579 | 0.45 |
Exclusive breastfeeding | 13,834 | 0.07 | 4244 | 0.21 | 9590 | 0.01 |
Current breastfeeding | 13,834 | 0.68 | 4244 | 0.89 | 9590 | 0.58 |
Milk or infant formula | 14,815 | 0.51 | 4497 | 0.42 | 10,318 | 0.55 |
Health | ||||||
Low birthweight below 2.5 kg | 15,142 | 0.06 | 4497 | 0.05 | 10,318 | 0.06 |
ANC with skilled personnel | 15,142 | 0.76 | 4497 | 0.76 | 10,318 | 0.77 |
Childbirth with skilled personnel | 15,142 | 0.88 | 4497 | 0.87 | 10,318 | 0.88 |
Birth by caesarean section | 15,134 | 0.21 | 4497 | 0.21 | 10,315 | 0.21 |
Contraception | 15,142 | 0.52 | 4497 | 0.46 | 10,318 | 0.55 |
Individual/household | ||||||
Male child | 15,142 | 0.52 | 4497 | 0.51 | 10,318 | 0.52 |
Children ever born | 15,142 | 3.27 | 4497 | 3.17 | 10,318 | 3.31 |
Dead children | 15,142 | 0.15 | 4497 | 0.12 | 10,318 | 0.13 |
Primaparous mother | 15,142 | 0.30 | 4497 | 0.33 | 10,318 | 0.29 |
Child marriage | 15,142 | 0.35 | 4497 | 0.35 | 10,318 | 0.35 |
Husband-wife age difference | 14,692 | 4.93 | 4372 | 4.94 | 10,023 | 4.92 |
Age of mother | 15,142 | 27.80 | 4497 | 26.88 | 10,318 | 28.17 |
Primary education of mother | 15,142 | 0.50 | 4497 | 0.50 | 10,318 | 0.50 |
Secondary education of mother | 15,142 | 0.25 | 4497 | 0.23 | 10,318 | 0.26 |
Mother works | 15,142 | 0.09 | 4497 | 0.08 | 10,318 | 0.09 |
Female household head | 15,142 | 0.94 | 4497 | 0.94 | 10,318 | 0.95 |
Regional | ||||||
Urban | 15,142 | 0.58 | 4497 | 0.57 | 10,318 | 0.58 |
Kurd | 15,142 | 0.22 | 4497 | 0.21 | 10,318 | 0.22 |
Sunni | 15,142 | 0.31 | 4497 | 0.33 | 10,318 | 0.30 |
Year is 2011 | 15,142 | 0.86 | 4497 | 0.84 | 10,318 | 0.87 |
Breastfeeding status
VARIABLES | Ever breastfed | Breastfed one hour after birth | Exclusively breastfeeding (< 6 months) | Currently breastfeeding (all ages) | Currently breastfeeding (< 6 months) | Currently breastfeeding (6–24 months) |
---|---|---|---|---|---|---|
Average casualty rate | − 0.306** | − 0.209 | − 0.0973 | − 0.205* | − 0.343** | − 0.167 |
(0.126) | (0.293) | (0.306) | (0.l09) | (0.169) | (0.127) | |
[−0.0375] | [− 0.0817] | [− 0.0274] | [− 0.0730] | [− 0.0609] | [− 0.0649] | |
Health | ||||||
Low birthweight (below 2.5 kg) | − 0.228*** | − 0.0589 | − 0.0687 | − 0.186*** | − 0.124 | − 0.193*** |
(0.0605) | (0.0491) | (0.113) | (0.0468) | (0.107) | (0.0608) | |
[−0.0326] | [− 0.0230] | [− 0.0188] | [− 0.0686] | [− 0.0237] | [− 0.0763] | |
ANC with skilled personnel | 0.163*** | − 0.0939 | − 0.128** | − 0.0340 | 0.0212 | − 0.0304 |
(0.0425) | (0.0660) | (0.0547) | (0.0321) | (0.0719) | (0.0267) | |
[0.0214] | [− 0.0369] | [− 0.0370] | [− 0.120] | [0.00380] | [− 0.0118] | |
Childbirth with skilled personnel | − 0.0610 | − 0.115 | 0.0390 | − 0.0733* | − 0.0153 | − 0.104** |
(0.0544) | (0.0798) | (0.0792) | (0.0392) | (0.109) | (0.0459) | |
[−0.00722] | [−0.0454] | [0.0108] | [−0.0257] | [− 0.00270] | [− 0.0400] | |
C-section birth | − 0.256*** | − 0.902*** | − 0.181*** | − 0.0597 | − 0.174** | −0.0939** |
(0.0316) | (0.104) | (0.0640) | (0.0410) | (0.0772) | (0.0386) | |
[−0.0353] | [− 0.315] | [− 0.0487] | [−0.0214] | [− 0.0329] | [− 0.0368] | |
Contraception | − 0.0475 | 0.00789 | − 0.187*** | 0.0351 | − 0.268*** | 0.207*** |
(0.0302) | (0.0392) | (0.0528) | (0.0304) | (0.0535) | (0.0431) | |
[−0.00581] | [0.00309] | [−0.0525] | [0.0125] | [−0.0482] | [0.0808] | |
Individual/household | ||||||
Male child | −0.0324 | − 0.00191 | 0.0981*** | 0.0567** | 0.0695** | 0.0714** |
(0.0268) | (0.0191) | (0.0361) | (0.0236) | (0.0310) | (0.0316) | |
[− 0.00398] | [−0.000750] | [0.0276] | [0.0202] | [0.0124] | [0.0278] | |
Children ever born | 0.0607*** | 0.0124 | 0.0264 | 0.0596*** | −0.00164 | 0.0511*** |
(0.0100) | (0.00921) | (0.0180) | (0.0104) | (0.0395) | (0.0111) | |
[0.00744] | [0.00487] | [0.00744] | [0.0212] | [−0.000292] | [0.0199] | |
Dead children | −0.447*** | 0.0294 | 0.00151 | −0.114*** | − 0.103 | − 0.103*** |
(0.0325) | (0.0236) | (0.0724) | (0.0319) | (0.0865) | (0.0390) | |
[−0.0549] | [0.0115] | [0.000424] | [− 0.0407] | [− 0.0184] | [− 0.0403] | |
Primaparous mother | −0.0969* | − 0.109** | − 0.0966* | 0.0692 | − 0.0725 | 0.126*** |
(0.0501) | (0.0447) | (0.0571) | (0.0485) | (0.115) | (0.0487) | |
[−0.0122] | [− 0.0426] | [− 0.0268] | [0.0244] | [− 0.0131] | [0.0487] | |
Child marriage | −0.0897 | 0.00241 | −0.112* | − 0.0336 | 0.00170 | 0.0294 |
(0.0568) | (0.0287) | (0.0652) | (0.0272) | (0.0805) | (0.0335) | |
[−0.0112] | [0.000945] | [−0.0311] | [− 0.0120] | [0.000302] | [0.0114] | |
Husband-wife age difference | 0.00647 | −4.71e-05 | − 0.00569 | − 0.00180 | − 0.00264 | − 0.00102 |
(0.00421) | (0.00221) | (0.00363) | (0.00263) | (0.00692) | (0.00273) | |
[0.000794] | [−1.84e-05] | [−0.00160] | [− 0.000640] | [− 0.000469] | [− 0.000398] | |
Age of mother | − 0.0144*** | − 0.00117 | − 0.0134*** | − 0.00989*** | 0.00372 | − 0.000320 |
(0.00352) | (0.00289) | (0.00431) | (0.00299) | (0.00861) | (0.00404) | |
[−0.00176] | [− 0.000457] | [− 0.00377] | [− 0.00352] | [0.000661] | [− 0.000125] | |
Primary education of mother | − 0.0285 | − 0.107** | − 0.0464 | −0.111*** | − 0.0998 | − 0.0903** |
(0.0404) | (0.0448) | (0.0782) | (0.0270) | (0.0714) | (0.0380) | |
[−0.00350] | [− 0.0420] | [− 0.0131] | [− 0.0393] | [−0.0177] | [− 0.0352] | |
Secondary education of mother | −0.0682 | − 0.0845 | − 0.172*** | − 0.241*** | − 0.240*** | − 0.228*** |
(0.0471) | (0.0661) | (0.0652) | (0.0355) | (0.0814) | (0.0427) | |
[−0.00756] | [− 0.0330] | [− 0.0464] | [− 0.0878] | [− 0.0462] | [− 0.0894] | |
Mother works | 0.0291 | 0.0180 | 0.0209 | 4.71e-05 | −0.0653 | 0.0148 |
(0.0663) | (0.0883) | (0.0620) | (0.0489) | (0.113) | (0.0611) | |
[0.00351] | [0.00707] | [0.00592] | [1.67e-05] | [−0.0120] | [0.00574] | |
Female household head | 0.116 | 0.00323 | 0.239** | −0.128* | − 0.0631 | − 0.139* |
(0.0702) | (0.0399) | (0.111) | (0.0669) | (0.128) | (0.0764) | |
[0.0154] | [0.00127] | [0.0611] | [−0.0422] | [− 0.0108] | [− 0.0531] | |
Regional | ||||||
Urban | −0.186*** | 0.00626 | −0.00783 | − 0.0945** | − 0.130** | − 0.112** |
(0.0433) | (0.0634) | (0.0533) | (0.0385) | (0.0545) | (0.0456) | |
[−0.0224] | [0.00245] | [−0.00220] | [− 0.0335] | [− 0.0230] | [− 0.0436] | |
Kurd | 0.0307 | − 0.359* | − 0.00890 | − 0.407*** | − 0.403*** | − 0.471*** |
(0.0820) | (0.184) | (0.136) | (0.0409) | (0.0470) | (0.0445) | |
[0.00372] | [−0.136] | [− 0.00250] | [− 0.151] | [− 0.0825] | [− 0.186] | |
Sunni | −0.126 | − 0.238 | −0.119 | − 0.102 | −0.0565 | − 0.165* |
(0.0956) | (0.212) | (0.156) | (0.0771) | (0.134) | (0.0897) | |
[−0.0160] | [−0.0919] | [− 0.0329] | [− 0.0367] | [−0.0102] | [− 0.0648] | |
Year is 2011 | −0.309 | 0.264* | −0.335*** | − 0.257*** | −0.186 | − 0.267*** |
(0.0827) | (0.139) | (0.0927) | (0.0852) | (0.117) | (0.0810) | |
[−0.0319] | [0.101] | [−0.103] | [−0.0868] | [− 0.0306] | [− 0.101] | |
Constant | 2.251*** | 0.219 | −0.138 | 1.312*** | 1.930*** | 0.741*** |
(0.125) | (0.205) | (0.239) | (0.0998) | (0.327) | (0.136) | |
Observations | 14,701 | 13,562 | 4126 | 13,434 | 4126 | 9308 |
VARIABLES | Ever breastfed | Breastfed one hour after birth | Exclusively breastfeeding (< 6 months) | Currently breastfeeding (all ages) | Currently breastfeeding (< 6 months) | Currently breastfeeding (6–24 months) |
---|---|---|---|---|---|---|
Average casualty rate in 3 years prior to survey in governorate of household | ||||||
2006 and 2011 merged | ||||||
Casualty rate | −0.306** | − 0.209 | − 0.0973 | −0.205* | − 0.343** | −0.167 |
(0.126) | (0.293) | (0.306) | (0.l09) | (0.169) | (0.127) | |
[−0.0375] | [− 0.0817] | [− 0.0274] | [− 0.0730] | [− 0.0609] | [− 0.0649] | |
2011 only | ||||||
Casualty rate | − 0.430** | − 0.267 | − 0.674 | −0.416*** | − 0.640*** | −0.446*** |
(0.197) | (0.486) | (0.582) | (0.0905) | (0.234) | (0.112) | |
[− 0.0545] | [− 0.106] | [− 0.183] | [0.150] | [− 0.117] | [− 0.175] | |
2006 only | ||||||
Casualty rate | −0.201 | − 0.186 | 0.144 | 0.00535 | −0.287** | 0.139 |
(0.140) | (0.274) | (0.280) | (0.0761) | (0.137) | (0.0934) | |
[−0.0184] | [−0.0625] | [0.0460] | [0.00168] | [−0.0445] | [0.0508] | |
Average casualty rate in 2 years prior to birth of child in governorate of household | ||||||
2006 and 2011 merged | ||||||
Casualty rate | −0.198** | − 0.127 | − 0.223 | −0.242** | − 0.0892 | −0.405** |
(0.0995) | (0.160) | (0.103) | (0.110) | (0.0760) | (0.171) | |
[−0.0225] | [− 0.0499] | [− 0.00626] | [− 0.0861] | [− 0.0159] | [− 0.158] | |
2011 only | ||||||
Casualty rate | −0.391 | −0.558 | − 0.785 | −1.652*** | −1.039 | − 1.364*** |
(0.325) | (0.551) | (1.232) | (0.364) | (0.648) | (0.260) | |
[−0.0457] | [−0.221] | [− 0.213] | [− 0.595] | [−0.190] | [− 0.533] | |
2006 only | ||||||
Casualty rate | −0.200*** | −0.0534 | − 0.113 | 0.121 | − 0.119 | 0.0835 |
(0.0603) | (0.199) | (0.0894) | (0.101) | (0.0810) | (0.0814) | |
[−0.0173] | [− 0.0180] | [− 0.0361] | [0.0378] | [− 0.0184] | [0.0304] |
VARIABLES | Ever breastfed | Breastfed one hour after birth | Exclusively breastfeeding (< 6 months) | Currently breastfeeding (all ages) | Currently breastfeeding (< 6 months) | Currently breastfeeding (6–24 months) |
---|---|---|---|---|---|---|
Average casualty rate | −0.429** | − 0.260 | − 0.663 | − 0.420*** | −0.515** | − 0.434*** |
(0.206) | (0.501) | (0.495) | (0.0955) | (0.221) | (0.115) | |
[−0.0544] | [−0.103] | [− 0.179] | [− 0.152] | [−0.0927] | [− 0.170] | |
Wealth | ||||||
Quintile 1 | −0.0480 | 0.190* | 0.0227 | 0.102* | 0.121 | 0.137** |
(0.0837) | (0.0987) | (0.140) | (0.0539) | (0.107) | (0.0594) | |
[−0.00615] | [0.0752] | [0.00616] | [0.0365] | [0.0213] | [0.0533] | |
Quintile 2 | 0.0177 | 0.0590 | 0.150 | 0.0847 | 0.109 | 0.0738 |
(0.0863) | (0.0668) | (0.118) | (0.0532) | (0.109) | (0.0503) | |
[0.00223] | [0.0234] | [0.0419] | [0.0302] | [0.0189] | [0.0288] | |
Quintile 3 | 0.00291 | 0.0325 | 0.0334 | 0.0105 | 0.00765 | 0.0237 |
(0.0885) | (0.0858) | (0.119) | (0.0396) | (0.0800) | (0.0447) | |
[0.000368] | [0.0129] | [0.00912] | [0.00377] | [0.00137] | [0.00926] | |
Quintile 4 | 0.0364 | −0.0434 | 0.0356 | −0.00290 | 0.0272 | − 0.0213 |
(0.0618) | (0.0426) | (0.122) | (0.0542) | (0.109) | (0.0469) | |
[0.00453] | [−0.0171] | [0.00973] | [−0.00105] | [0.00483] | [−0.00835] | |
Other controls | ||||||
Health | Yes | Yes | Yes | Yes | Yes | Yes |
Individual / Household | Yes | Yes | Yes | Yes | Yes | Yes |
Regional | Yes | Yes | Yes | Yes | Yes | Yes |
Constant | 2.019*** | 0.276 | −0.732*** | 0.999*** | 1.588*** | 0.394** |
(0.126) | (0.169) | (0.279) | (0.112) | (0.330) | (0.157) | |
Observations | 12,653 | 11,646 | 3437 | 11,525 | 3437 | 8093 |
Dependent variable: Child given milk or infant formula | |||||
---|---|---|---|---|---|
VARIABLES | (1) | (2) | (3) | (4) | (5) |
Average casualty rate | 0.394 | 0.288 | 0.294 | 0.156 | 0.245 |
(0.367) | (0.298) | (0.271) | (0.280) | (0.507) | |
[0.155] | [0.114] | [0.116] | [0.0616] | [0.0967] | |
Casualty*Quintile 1 | −0.285 | −0.147 | |||
(0.355) | (0.521) | ||||
[−0.112] | [−0.0579] | ||||
Casualty*Quintile 2 | −0.0558 | −0.0193 | |||
(0.243) | (0.338) | ||||
[−0.0220] | [−0.00760] | ||||
Casualty*Quintile 3 | −0.135 | −0.0830 | |||
(0.293) | (0.425) | ||||
[−0.0530] | [− 0.0327] | ||||
Casualty*Quintile 4 | 0.850** | 0.764 | |||
(0.380) | (0.493) | ||||
[0.335**] | [0.301] | ||||
Other Controls | |||||
Health | Yes | Yes | Yes | Yes | Yes |
Individual/household | Yes | Yes | Yes | Yes | Yes |
Regional | Yes | Yes | Yes | Yes | Yes |
Constant | −0.497** | −0.466** | −0.463** | −0.442** | −0.463* |
(0.208) | (0.206) | (0.205) | (0.204) | (0.248) | |
Observations | 2945 | 2945 | 2945 | 2945 | 2945 |
Breastfeeding duration
All years | Year 2006 | Year 2011 | ||||
---|---|---|---|---|---|---|
Variables | Coefficient | Hazard ratio | Coefficient | Hazard ratio | Coefficient | Hazard ratio |
Average casualty rate | 0.119 | 1.1737 | −0.270*** | 0.7633 | 0.463*** | 1.7221 |
(0.175) | (0.0949) | (0.142) | ||||
Health | ||||||
Low birthweight (below 2.5 kg) | 0.137** | 1.1613 | 0.0861 | 1.0900 | 0.144** | 1.1785 |
(0.0557) | (0.141) | (0.0583) | ||||
ANC with skilled personnel | 0.0745** | 1.0918 | 0.141 | 1.1509 | 0.0747** | 1.0929 |
(0.0333) | (0.228) | (0.0361) | ||||
Childbirth with skilled personnel | 0.146*** | 1.1804 | 0.0859 | 1.0897 | 0.163*** | 1.2044 |
(0.0397) | (0.210) | (0.0397) | ||||
C-section birth | 0.119** | 1.1178 | −0.0558 | 0.9457 | 0.140** | 1.1403 |
(0.0532) | (0.0930) | (0.0614) | ||||
Contraception | −0.105*** | 0.9146 | −0.327*** | 0.7214 | −0.0916*** | 0.9166 |
(0.0335) | (0.114) | (0.0334) | ||||
Individual/household | ||||||
Male child | −0.0996*** | 0.9125 | −0.118* | 0.8888 | −0.0971*** | 0.9160 |
(0.0270) | (0.0611) | (0.0298) | ||||
Children ever born | 0.0273* | 1.0312 | 0.644*** | 1.9049 | 0.0341*** | 1.0391 |
(0.0145) | (0.172) | (0.0118) | ||||
Dead children | 0.0177 | 1.0162 | −0.706** | 0.4934 | 0.0235 | 1.0219 |
(0.0326) | (0.294) | (0.0340) | ||||
Primaparous mother | 0.0417 | 1.0344 | 0.272 | 1.3132 | 0.0431 | 1.0355 |
(0.0572) | (0.193) | (0.0608) | ||||
Child marriage | −0.224*** | 0.7999 | −0.223 | 0.8001 | −0.219*** | 0.8035 |
(0.0380) | (0.161) | (0.0369) | ||||
Husband-wife age difference | −0.00383 | 0.9961 | 0.00264 | 1.0026 | −0.00488* | 0.9949 |
(0.00239) | (0.0108) | (0.00277) | ||||
Age of mother | −0.0371*** | 0.9623 | −0.0151 | 0.9850 | −0.0414*** | 0.9578 |
(0.00483) | (0.0158) | (0.00434) | ||||
Primary education of mother | 0.0565 | 1.0678 | −0.134 | 1.8746 | 0.0799** | 1.0948 |
(0.0345) | (0.102) | (0.0353) | ||||
Secondary education of mother | 0.171*** | 1.1876 | −0.0867 | 0.9070 | 0.204*** | 1.2283 |
(0.0480) | (0.112) | (0.0552) | ||||
Mother works | 0.0254 | 1.0352 | −0.130 | 0.8780 | 0.0216 | 1.0305 |
(0.0746) | (0.109) | (0.0772) | ||||
Female household head | 0.00116 | 1.0242 | −0.149 | 0.8615 | 0.0460 | 1.0813 |
(0.0929) | (0.151) | (0.113) | ||||
Regional | ||||||
Urban | 0.0450 | 1.0537 | 0.133 | 1.1420 | 0.0406 | 1.0497 |
(0.0444) | (0.107) | (0.0460) | ||||
Kurd | 0.405*** | 1.5240 | 0.383*** | 1.4668 | 0.410*** | 1.5363 |
(0.0442) | (0.128) | (0.0491) | ||||
Sunni | 0.216** | 1.2249 | 0.173 | 1.1888 | 0.118 | 1.0976 |
(0.108) | (0.180) | (0.113) | ||||
Year is 2011 | 0.0240 | 1.0233 | ||||
(0.0177) | ||||||
Observations | 13,812 | 1924 | 11,888 |