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UNICEF STATISTICS
  UNICEF Data: Monitoring the Situation of Children and Women
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Adopting optimal feeding practices is fundamental to a child’s survival, growth and development, but too few children benefit

 

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 diarrhea 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 worldwide are exclusively breastfed for the first six months of life, 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 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
Percentage of children worldwide put to the breast within one hour of birth; exclusively breastfed (0–5 months); receiving solid, semi-solid or soft foods (6–8 months) and continued breastfeeding at 1 year (12-15 months) and 2 years (20-23 months), 2015

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. Data included in these global averages are the most recent for each country between 2010-2016 (*exception: China, 2008).

 

TRENDS   

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.

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.

 

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 beastfed, 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.

 

Starting at 6 months of age, when infants increasingly start to rely on nutrients in other food for their optimal growth and development, the diversity of their diet becomes a key measure of how well they are eating and acts as a proxy for their micronutrient intake. Using available data from 38 countries, an analysis between low-income, lower-middle-income and upper-middle-income countries indicates large disparities in diversity of diet between country incomes as well as wealth quintiles within these country groupings. When it comes to dietary diversity, just over one third of the wealthiest are meeting the minimum requirement in low-income countries.

Even young children from the richest households in low-income countries are not getting a diverse enough diet
Percentage of children aged 6–23 months who receive food from four or more food groups, median values by income group and by household wealth quintile

Notes: Data are presented as medians for countries with comparable data. The values in brackets represent the number of countries included in the analysis for each income group.

Source: UNICEF global databases, 2015, based on MICS, DHS and other nationally representative sources, 2010–2014.

REFERENCES

UNICEF, Improving Child Nutrition: The achievable imperative for global progress, UNICEF, New York, 2013.

 

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

[3] Victoria, C. et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. Breastfeeding Series, 2016; 387: 475–90.

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Infant and Young Child Feeding
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Publication

Improving Child Nutrition: The achievable imperative for global progress

This report builds on earlier findings on the impact of undernutrition by highlighting new developments and demonstrating that efforts to scale up nutrition programmes are working, benefiting children in many countries.

 

Journal Article

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

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.

 

 

Publication

From the First Hour of Life

From the first hour of life: Making the case for improved infant and young child feeding everywhere, reviews the most recent evidence on breastfeeding and provides updated global and regional estimates on early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding. The report concludes with recommendations to guide policy action on breastfeeding at the national level.

 

Notes on the Data

THE INDICATORS

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[2] to assess, for the first time, feeding practices in children aged 6 to 23 months.

Core indicators for infant and young child feeding practices

Indicator name

Definition

UNICEF global database exists?

Numerator

Denominator

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

Yes

Exclusive breastfeeding

Infants 0─5 months of age who received only breast milk during the previous day

Infants 0─5 months of age

Yes

Continued breastfeeding at 1 year[3]

Children 12─15 months of age who received breast milk during the previous day

Children 12─15 months of age

Yes

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

Yes

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

Coming in the State of the World’s Children 2015 report

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

Coming in the State of the World’s Children 2015 report

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

Coming in the State of the World’s Children 2015 report

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

No

 

DATA COLLECTION AND REPORTING

Data for these indicators are collected though 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. 

 

[2] 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.

[3] Note that continued breastfeeding at 2 years (20─23 months) is an optional indicator, but is included in UNICEF’s global database.