Trends and inequalities in exclusive breastfeeding among 0-5 month olds in Ghana from 1993 to 2022.

Background: Exclusive breastfeeding (EBF) during the first 6 months of life is essential for reducing infant morbidity and mortality, enhancing immunity, and supporting maternal health. Despite global and national commitments, progress remains uneven. This study examined long-term trends and inequalities in EBF among infants aged 0-5 months in Ghana between 1993 and 2022. Methods: A secondary analysis was conducted using nationally representative data from nine rounds of the Ghana Demographic and Health Surveys (GDHS) and Multiple Indicator Cluster Surveys (MICS). The outcome was EBF prevalence, defined according to WHO and UNICEF guidelines. Inequalities were examined by maternal age, education, household wealth, residence, child sex, and region, using both simple (absolute difference, ratio) and complex measures (population attributable fraction, population attributable risk, and absolute concentration index). Results: National EBF prevalence rose from 5.8% in 1993 to 53.1% in 2022, peaking at 62.8% in 2008, before stabilising. Changes in inequality patterns were observed. Earlier positive gradients by wealth and education evolved into U-shaped distributions, with the lowest and highest groups reporting higher prevalence than the middle categories. Despite these shifts, cross-sectional inequalities remained modest in magnitude relative to the considerable national increase. Wealth- and residence-related gaps narrowed over time, although regional disparities remained pronounced. Conclusion: Ghana achieved major improvements in exclusive breastfeeding over three decades, while socio-demographic inequalities were comparatively small and did not account for the recent plateau. The emergence of U-shaped patterns in wealth and education underscores the need for tailored interventions that reach middle socioeconomic groups and regions with persistently low prevalence. Strengthening equity-focused and context-specific strategies is essential for sustaining progress towards Sustainable Development Goal 3.