Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Ideally, infants should be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.
An infant that is not exclusively breastfed could be at a substantially greater risk of death from diarrhoea or pneumonia than one who is. Moreover, breastfeeding supports infants’ immune systems and may protect them later in life from chronic conditions such as obesity and diabetes. In addition, breastfeeding protects mothers against certain types of cancer and other health conditions. Adequate feeding from 6 months onwards can prevent undernutrition and decrease the risk of infectious diseases, such as diarrhoea and pneumonia. Yet despite all the potential benefits, only about two fifths of infants 0-5 months of age worldwide are exclusively breastfed, and only around two thirds are introduced to solid foods in a timely manner.
LEVELS OF RECOMMENDED FEEDING PRACTICES
Analysis of data on feeding practices among infants and young children highlights the need for accelerated programming in this area. Globally, only 45 per cent of newborns are put to the breast within the first hour of birth, and only 2 in 5 infants less than 6 months of age are exclusively breastfed. The data show that about three quarters of children aged 12-15 months are still breastfeeding. The World Health Organization (WHO) recommends that this practice continue until age 2 and beyond, yet less than half of young children aged 20-23 months are benefitting from it.
Global estimates for feeding of children aged 6 months to 2 years indicate substantial room for improvement. Only two thirds of 6-8 month olds are receiving any solid food at all, and when considering measures of diet quantity and quality, the rates are much lower: only 1 in 2 receive a minimum meal frequency and less than 1 in 3 a minimum diet diversity.
Levels of recommended feeding practices vary widely among regions. The share of infants that are breastfed within one hour of birth ranges from around 40 per cent in West and Central Africa and South Asia to about 63 per cent in Eastern and Southern Africa. In terms of continued breastfeeding at 2 years, the range between regions is wide: only 1 in 4 children 20-23 months of age are breastfed in East Asia and the Pacific compared to more than two out of three in South Asia. When data from five indicators relating to breastfeeding are analysed regionally, children in West and Central Africa appear to be at a distinct disadvantage in contrast to their peers in Eastern and Southern Africa. For minimum diet diversity, West and Central Africa has the lowest rate at 9 per cent with the highest, among regions with data, seen in Latin America and the Caribbean at 51 per cent.
Source: UNICEF global databases, 2017, based on MICS, DHS and other nationally representative sources. Note: Data included in these global averages are the most recent for each country between 2011-2017. *Aggregates for these indicators use China, 2008.
PART ONE: FOCUS ON BREASTFEEDING
Progress to improve exclusive breastfeeding has stagnated over the past 15 years. Five out of the seven regions with trend data have current rates at around 30 per cent, and all of them have improved very little, if at all, in more than a decade. The rates of exclusive breastfeeding in Latin America and the Caribbean and in East Asia and the Pacific, for example, have remained unchanged since 2000.
Global rates have improved modestly, seeing an increase of only 7 percentage points in the last 15 years. Only two regions, Eastern and Southern Africa and West and Central Africa, have increased exclusive breastfeeding rates by ten percentage points or more during this time period.
Source UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.
Notes: Analysis is based on a subset of 78 countries with comparable trend data covering 68 per cent of the global population (excluding China and Russian Federation) for around 2000 (1997-2003) and 70 per cent for around 2015 (2010-2016). Rates around 2015 may differ from current rates presented elsewhere as trends are based on a subset of countries with baseline data. Regional estimates are presented only where adequate population coverage (≥ 50 per cent) is met. * To meet adequate population coverage, Eastern Europe and Central Asia does not include Russian Federation and East Asia and the Pacific does not include China.
PART TWO: FOCUS ON COMPLEMENTARY FEEDING PRACTICES
As infants grow, their nutrient needs grow with them. After the first six months of life, an infant’s nutrient demands start to exceed what breastmilk alone can provide. To keep up with these growing demands, WHO recommends that infants begin eating solid, semi-solid or soft foods at 6 months of age to ensure that their nutrient intake is sufficient to fuel their developing brains and bodies and thus indicators related to consumption of solid, semi-solid and soft foods become increasingly important to track.
While it is recommended that infants start eating solid foods at 6 months, globally, about one third of infants 6–8 months old are not yet eating solid foods, posing a threat to their growth and development. The situation is most troubling in South Asia, where about half of infants are being introduced to solid foods too late.
Source: UNICEF global databases, 2017, based on MICS, DHS and other nationally representative sources, 2011-2017 ( • denotes countries with older data between 2005-2010; data from these countries are not included in the regional aggregates except for China (2008) which is used for the East Asia and the Pacific and World averages).
While infants and children are the youngest members of their families – proportionally, their nutrient needs are the greatest. In fact, the nutritional needs for growth and development in children 6-23 months of age are greater per kilogram of body weight than at any other time in life. Frequent feeding of a variety of foods is therefore important to help ensure nutrient needs are met. In the graphic below, we summarize data about minimum meal frequency, minimum diet diversity and minimum acceptable diet among children 6-23 months of age (see notes on the data section for further details on these indicators) among a subset of 46 low- and middle-income countries with comparable data for each of the three indicators. Half of all children aged 6-23 months are not being fed even a minimum meal frequency and less than one third are fed a minimally diverse diet comprising at least 4 out of 7 food groups in the previous day. Together, when considering both minimum meal frequency and minimum diet diversity, only about 1 in 6 children are receiving a “minimally acceptable diet”. When considering which segments of society are affected most, disparity between richest and poorest is stark, especially for minimum diet diversity. In any case, even the richest are not doing very well when it comes to diet diversity indicating efforts are needed to improve diets of infants and young children among all segments of society.
Note: Analysis is based on a subset of 66 countries with comparable data for each of the 3 indicators from 2010-2017, comprising 59 per cent of the global population. * Population coverage for the 3 indicators in urban areas is 47%; interpret with caution.
Source: UNICEF Global databases 2017, based on MICS, DHS and other national surveys.
The report summarizes the proceedings of a technical consultation convened by UNICEF, FANTA, USAID, and WHO in June 2017 with the aim of understanding issues related to the use and operationalization of the infant and young child feeing (IYCF) indicators released in 2008. The report highlights discussions related to the modification of IYCF indicators for minimum diet diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). It also highlights issues presented around collecting and operationalizing these indicators in the field through DHS, MICS and other surveys. Lastly, the report presents the discussions on additional issues and way forward for feeding and nutrition indicators in three main age groups: 0-5 months, 24-59 months, and school-age children.
This special issue of Maternal and Child Nutrition includes the invited papers from presentations made during a global meeting in Mumbai, India, on the theme: First Foods: A Global Meeting to Accelerate Progress on Complementary Feeding for Young Children (November 17–18, 2015). The Conference provided a platform that aimed to (a) synthesize the biological and implementation science on complementary feeding; (b) review the practice and experience in improving access to nutritious complementary foods and good complementary feeding practices in children aged 6–23 months; and (c) consolidate a strong evidence base that can inform the development of strategies and approaches to improve complementary feeding that are fit to context. The papers in this special issue provide the most up to date thinking on a variety of topics related to young child feeding discussed at the 2015 meeting.
A new global report from UNICEF, From the First Hour of Life: Making the case for improved infant and young child feeding everywhere, provides a global status update on infant and young child feeding practices and puts forth recommendations for improving them. The report is divided into two parts: Part I focuses on breastfeeding and Part II looks at complementary feeding practices. Each part reviews the most recent evidence on infant and young child feeding practices and provides updated global and regional estimates and trends, where available, as well as disaggregated analyses.
With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe. The paper describes past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.
The standard indicators for infant and young child feeding practices were developed in alignment with WHO’s Guiding Principles on feeding the breastfed and non-breastfed child. The aim is to use the guidelines to assess infant and young child feeding practices within and across countries and to evaluate progress in this programme area. While it is not possible to develop standard indicators for all desirable and recommended practices, 15 indicators (8 core and 7 optional) were developed and are presented in WHO’s 2008 publication, Indicators for Assessing Infant and Young Child Feeding Practices. Part 1: Definitions. These indicators are a culmination of six years of inter-agency work and are used to assess a subset of practices.
This set of indicators provides i) an update of the 1991 WHO and UNICEF indicators on breastfeeding practices and ii) a broad set of indicators to assess, for the first time, feeding practices in children aged 6 to 23 months.
Core indicators for infant and young child feeding practices
|Early initiation of breastfeeding||Children born in the last 24 months who were put to the breast within one hour of birth||Children born in the last 24 months|
|Exclusive breastfeeding||Infants 0─5 months of age who received only breast milk during the previous day||Infants 0─5 months of age|
|Continued breastfeeding at 1 year||Children 12─15 months of age who received breast milk during the previous day||Children 12─15 months of age|
|Introduction of solid, semi-solid or soft foods||Infants 6─8 months of age who received solid, semi-solid and soft foods during the previous day||Infants 6─8 months of age|
|Minimum dietary diversity||Children 6─23 months of age who received foods from ≥ 4 food groups during the previous day||Children 6─23 months of age|
|Minimum meal frequency||Breastfed children 6─23 months of age who received solid, semi-solid and soft foods the minimum number of times or more during the previous day||Breastfed children 6─23 months of age|
|Non-breastfed children 6─23 months of age who received solid, semi-solid and soft foods or milk feeds the minimum number of times or more during the previous day||Non-breastfed children 6─23 months of age|
|Minimum acceptable diet||Breastfed children 6─23 months of age who had at least the minimum dietary diversity and the minimum meal frequency during the previous day||Breastfed children 6─23 months of age|
|Non-breastfed children 6─23 months of age who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day||Non-breastfed children 6─23 months of age|
|Consumption of iron-rich or iron-fortified foods||Children 6─23 months of age who received an iron-rich food or a food that was specially designed for infants and young children and was fortified with iron, or a food that was fortified in the home with a product that included iron during the previous day||Children 6─23 months of age|
DATA COLLECTION AND REPORTING
Data for these indicators are collected through household surveys. With the exception of early initiation of breastfeeding, they are based on questions about liquid and food intake of children aged 0─23 months in the 24 hours preceding the survey. Standard questions and other practical methodological instructions for the core and optional indicators are available in the WHO document, Indicators for Assessing Infant and Young Child Feeding Practices. Part 2: Measurement. Large household survey programmes, such as MICS and DHS, are major sources of country-level estimates for seven of the core indicators as well as a subset of the optional indicators. Other national household surveys, such as national nutrition surveys, often include questions used to report on these indicators as well.
 These dimensions include continued breastfeeding or minimum milk feeds, appropriate timing of introduction of solid, semi-solid and soft foods, as well as optimum quantity and quality of foods consumed.
 Note that continued breastfeeding at 2 years (20─23 months) is an optional indicator, but is included in UNICEF’s global database.