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 roughly the same proportion of 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 only about half of young children aged 20-23 months are benefitting from it.

Global estimates for appropriate feeding of children aged 6 months to 2 years are currently limited to the timely introduction of solid, semi-solid or soft foods at 6 to 8 months. However, only two thirds of children are benefiting from this practice. This indicates substantial room for improvement, especially since the timely introduction of solid food represents only one of eight guiding principles for age-appropriate feeding.[1] Moreover, data from a limited set of nationally representative surveys suggest that the diet of this age group is only minimally acceptable in terms of food quality and frequency of feeding.[2]

Levels of recommended breastfeeding 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 60 per cent in Eastern and Southern Africa. In terms of continued breastfeeding at 2 years, the range between regions is wide: only one in four children 20-23 months of age are breastfed in  East Asia and 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.

Across the continuum, too few children are getting the nutrition they need to survive, grow and develop

Per cent of children: put to the breast within one hour of birth, exclusively breastfed (0-5 months); receiving solid, semi-solid or soft foods (6-8 months), with a minimum meal frequency, minimum diet diversity and minimum acceptable diet (6-23 months) and continued breastfeeding at 1 year (12-15 months) and 2 years (20-23 months), global, 2015*.

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. Note: Data included in these global averages are the most recent for each country between 2010-2016. *Aggregates for these indicators use China, 2008; **Aggregates for these indicators do not include China due to lack of data and while >50% of the global population coverage was met, almost all of the data for these indicators are from low and lower middle income countries.

Click here to download this graph by region

Across the continuum, too few children are getting the nutrition they need to survive, grow and develop

Per cent of children: put to the breast within one hour of birth, exclusively breastfed (0-5 months); receiving solid, semi-solid or soft foods (6-8 months), with a minimum meal frequency, minimum diet diversity and minimum acceptable diet (6-23 months) and continued breastfeeding at 1 year (12-15 months) and 2 years (20-23 months), global, 2015*.

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. Note: Data included in these global averages are the most recent for each country between 2010-2016. *Aggregates for these indicators use China, 2008; **Aggregates for these indicators do not include China due to lack of data and while >50% of the global population coverage was met, almost all of the data for these indicators are from low and lower middle income countries.

Click here to download this graph by region

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 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, with change driven almost entirely by South Asia, where exclusive breastfeeding rates increased by 17 percentage points between 2000 and 2015. While this is an important achievement, still fewer than two in three infants benefit from exclusive breastfeeding in the region.

South Asia has made the greatest strides in exclusive breastfeeding of all regions

Trends in percentage of infants aged 0-5 months exclusively breastfed, by region, around 2000 and around 2015

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, CEECIS does not include Russian Federation and East Asia and the Pacific does not include China. **Other refers to mainly high-income countries not included within UNICEF programme regions.

South Asia has made the greatest strides in exclusive breastfeeding of all regions

Trends in percentage of infants aged 0-5 months exclusively breastfed, by region, around 2000 and around 2015

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, CEECIS does not include Russian Federation and East Asia and the Pacific does not include China. **Other refers to mainly high-income countries not included within UNICEF programme regions.

INFANT FEEDING PATTERNS

In every region of the world, rates of exclusive breastfeeding decline steadily from birth to 5 months of age. Milk-based liquids are hindering exclusive breastfeeding to at least some degree in all regions. Where common, milk-based liquids are even fed to large proportions of infants as young as 0–1 months of age. In West and Central Africa, the greatest obstacle to exclusive breastfeeding is plain water. Significant numbers of infants are being introduced to complementary foods too early in all regions, particularly in Latin America and the Caribbean. Many infants in this region are also not receiving any breastmilk at all.

The rate of exclusive breastfeeding declines steadily throughout the 0-5 month period in all regions

Percentage of infants aged 0-5 months receiving breastmilk only, breastmilk and plain water, breastmilk and non-milk liquids, breastmilk and other milk/formula, breastmilk and complementary foods and no breastmilk, by region, 2016

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

Notes: Analysis is based on a subset of 75 countries with available raw data for the development of area graphs covering 43 per cent of the global population. Regional estimates are presented only where adequate population coverage (50 per cent) is met. *To meet adequate population coverage, South Asia does not include India, CEECIS does not include Russian Federation, East Asia and the Pacific does not include China and Latin America and the Caribbean does not include Brazil. The “Total” is not labelled as a Global figure as data were available for <50% of the global population. **Other refers to mainly high-income countries not included within UNICEF programme regions.

 

The rate of exclusive breastfeeding declines steadily throughout the 0-5 month period in all regions

Percentage of infants aged 0-5 months receiving breastmilk only, breastmilk and plain water, breastmilk and non-milk liquids, breastmilk and other milk/formula, breastmilk and complementary foods and no breastmilk, by region, 2016

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

Notes: Analysis is based on a subset of 75 countries with available raw data for the development of area graphs covering 43 per cent of the global population. Regional estimates are presented only where adequate population coverage (50 per cent) is met. *To meet adequate population coverage, South Asia does not include India, CEECIS does not include Russian Federation, East Asia and the Pacific does not include China and Latin America and the Caribbean does not include Brazil. The “Total” is not labelled as a Global figure as data were available for <50% of the global population. **Other refers to mainly high-income countries not included within UNICEF programme regions.

 

DISPARITIES

Breastfeeding is one of the few positive health behaviors that is more prevalent in poor than in rich countries; and within low- and middle-income-countries themselves, poor women breastfeed longer than rich women.[3]  Across nearly all regions, more women from the poorest households continue to breastfeed after the first year of life when compared with women from the wealthiest households. This is particularly true in Latin America and the Caribbean, where the continued breastfeeding rate among women in the poorest households is nearly double that of their wealthier counterparts. Similarly, in West and Central Africa and East Asia and the Pacific, the rates among women from the poorest quintile are 1.6 times higher than women in the richest quintile. The difference between richest and poorest is negligible among countries studied in CEE/CIS.

Continued breastfeeding rates are highest amongst women from the poorest households

Percentage of 12-23 month olds that are breastfed, by wealth quintile and region, 2015

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

Note: Analysis is based on a subset of 75 countries with disaggregated data for continued breastfeeding at 12-23 months covering 76 per cent of the global population (excluding China and Russian Federation). Regional estimates are presented only where adequate population coverage (≥50 per cent) is met. *To meet adequate population coverage, East Asia and the Pacific does not include China, Latin America and the Caribbean does not include Brazil, and CEECIS does not include Russian Federation. **Other refers to countries outside of the UNICEF programme regions; representing mainly high income countries not included within UNICEF programme regions.

 

Continued breastfeeding rates are highest amongst women from the poorest households

Percentage of 12-23 month olds that are breastfed, by wealth quintile and region, 2015

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

Note: Analysis is based on a subset of 75 countries with disaggregated data for continued breastfeeding at 12-23 months covering 76 per cent of the global population (excluding China and Russian Federation). Regional estimates are presented only where adequate population coverage (≥50 per cent) is met. *To meet adequate population coverage, East Asia and the Pacific does not include China, Latin America and the Caribbean does not include Brazil, and CEECIS does not include Russian Federation. **Other refers to countries outside of the UNICEF programme regions; representing mainly high income countries not included within UNICEF programme regions.

 

PART TWO: FOCUS ON COMPLEMENTARY FEEDING

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.

One out of every three infants is waiting too long for his or her first foods

Percentage of infants 6-8 months of age fed solid, semi-solid or soft foods, 2015

Note: These maps are stylized and not to scale and do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined. The final status of the Abyei area has not yet been determined.

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources, 2010-2016 ( • denotes countries with older data between 2005-2009; 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).

 

One out of every three infants is waiting too long for his or her first foods

Percentage of infants 6-8 months of age fed solid, semi-solid or soft foods, 2015

Note: These maps are stylized and not to scale and do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined. The final status of the Abyei area has not yet been determined.

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources, 2010-2016 ( • denotes countries with older data between 2005-2009; 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 one in 6 children are receiving a “minimally acceptable diet”.  When considering which segments of society are affected most, there are no differences between boys and girls for any of these indicators, but 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.

Too few are receiving even a minimum meal frequency or minimum diet diversity

Per cent of children 6-23 months of age receiving a minimum meal frequency, minimum diet diversity and minimum acceptable diet, total and by sex, area of residence and wealth quintile, 2015

Note: Analysis is based on a subset of 46 countries with comparable data for each of the 3 indicators from 2010-2016, comprising 52 per cent of the global population.

Source: UNICEF Global databases 2016, based on MICS, DHS and other national surveys.

Too few are receiving even a minimum meal frequency or minimum diet diversity

Per cent of children 6-23 months of age receiving a minimum meal frequency, minimum diet diversity and minimum acceptable diet, total and by sex, area of residence and wealth quintile, 2015

Note: Analysis is based on a subset of 46 countries with comparable data for each of the 3 indicators from 2010-2016, comprising 52 per cent of the global population.

Source: UNICEF Global databases 2016, based on MICS, DHS and other national surveys.

Infants and young children have extremely high nutrient needs – and getting enough good nutrition into each mouthful is no easy task. Children need foods that pack a nutrient-dense punch. The needs for zinc and iron, minerals essential for optimal growth, immune function and development, are particularly high early in life. Flesh foods, eggs and dairy products are particularly effective at providing these essential nutrients, as well as vitamin A and calcium, between the ages of 6 months and 23 months.  To understand the contribution of animal source foods to the diets of infants and young children, we present below the proportion of children receiving animal source foods in the previous day. Based on this analysis, it is clear that vast differences in the consumption of animal-source foods across regions exist, but one thing remains consistent: fewer children are eating animal-source foods between 6 months and 11 months of age than between 12 months and 23 months in every region. Despite improvements in animal source food consumption as children age, the fact that a third of these nearly 2-year-old children are still not consuming any animal-source foods at all requires programmatic action.

Globally, the vast majority of children are eating only one type of animal source food in the previous day – or none at all

Percentage of children 6-23 months of age in each animal source food group category, by age and by region, 2015

Note: Analysis is based on a subset of 55 countries with data on types of animal source foods consumed between 2010-2014 covering 67 per cent of the global population excluding China and Russian Federation. Regional estimates are presented only where adequate population coverage (˜ 50 per cent) is met. *To meet adequate population coverage, Latin America and the Caribbean does not include Brazil, CEE/CIS does not include Russian Federation and East Asia and the Pacific does not include China. **Even after exclusion of Russian Federation from the analysis, CEE/CIS only met 45 per cent population coverage.  ***Other refers to mainly high-income countries not included within UNICEF programme regions. **** The animal source foods were grouped into the three following types (i) flesh foods; (ii) eggs; and (iii) dairy (e.g. milk and milk products).

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

Globally, the vast majority of children are eating only one type of animal source food in the previous day – or none at all

Percentage of children 6-23 months of age in each animal source food group category, by age and by region, 2015

Note: Analysis is based on a subset of 55 countries with data on types of animal source foods consumed between 2010-2014 covering 67 per cent of the global population excluding China and Russian Federation. Regional estimates are presented only where adequate population coverage (˜ 50 per cent) is met. *To meet adequate population coverage, Latin America and the Caribbean does not include Brazil, CEE/CIS does not include Russian Federation and East Asia and the Pacific does not include China. **Even after exclusion of Russian Federation from the analysis, CEE/CIS only met 45 per cent population coverage.  ***Other refers to mainly high-income countries not included within UNICEF programme regions. **** The animal source foods were grouped into the three following types (i) flesh foods; (ii) eggs; and (iii) dairy (e.g. milk and milk products).

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.

REFERENCES

[1] See WHO (2005) Guiding principles for feeding non-breastfed children 6-24 months of age and WHO (2003)Guiding principles for complementary feeding of the breastfed child.

[2] WHO, Indicators for Assessing Infant and Young Child Feeding Practices, Part 3: Country profiles, WHO, Geneva, 2010.

[3] Victora, C.G., Bahl, R., Barros, A.J.D., França, G.V.A., Horton S,., Krasevec, J., Murch, S., Sankar, M.J., Walker, N., Rollins, N.G.,Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016. 387(10017): p. 475-90.

[4] Rollins, N.C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C.K., Martines, J.C., Piwoz, E.G., Richter, L.M., Victora, C.G.; Lancet Breastfeeding Series Group., Why invest, and what it will take to improve breastfeeding practices? The Lancet, 2016. 387(10017): p. 491-504.