FEEDING PATTERNS

Item

Title: FEEDING PATTERNS
extracted text: C.HH.
SDA-RF-CH-1.48

Feeding Patterns
In developing countries, efforts to promote sound
infant and young child nutrition are based on the World
Health Assembly’s recommendation that infants should be
breastfed exclusively for the first 6 months of life and fed
■appropriate complementary foods from about the age of 6
months, with continued breastfeeding and frequent feeding
with safe and adequate amounts of local foods. Breastfeed
ing with complementary' foods should be continued from 6
months to two years (WHA. 1994). The World Health
Organization defines '‘complementary foods” as any
foods—whether manufactured or locally prepared—that are
suitable as a complement to breast milk when it becomes
insufficient to meet the nutritional needs of the infant. In
^).ther words, complementary foods are those that are
required when breast milk alone no longer sustains the
normal infant’s nutrition requirements. Complementary
foods are enriched and softened and, in most of the poorest
countries, come from the local family diet.

1

t

In this chapter, infant feeding patterns are examined
in the context of the WHO feeding recommendations.
Current feeding practices are reported by age, median age
at introduction of complementary foods, and type of foods
eaten by children.

3.1

CURRENT STATUS FEEDING
CATEGORIES

'For the purposes of this report, children were
—•—classified into one of several feeding categories based on
^kcurrent feeding practices as reported by their mothers.
^^according to age groupings that correspond to World Health
Organization (WHO) infant feeding indicators (see Appen
dix A for complete WHO definitions of infant feeding
i
categories). The groupings are shown in Tables 3.1 through
3.4, where children are classified according to whether they
I
are exclusively breastfed (breast milk only, no other
j.
liquids), given breast milk plus plain water, fully breastfed
|
(either exclusively breastfed or given breast milk plus plain
i
water only4), predominantly breastfed (given breast milk as
I
predominant source of nourishment, plus other non-milk
liquids), predominantly or fully breastfed, given milk-based
r • liquids, given complementary foods (breast milk and solid

or semisolid foods), not breastfed, or (for both breastfed and
non-breastfed children) given a bottle Tables 3.1 through
3.4 show the percentage of children less than 4 months of
age, 6 to 9 months. 12 to 15 months, and 20 to 23 months,
respectively, in each of these feeding categories.
Rates of exclusive breastfeeding among children
less than 4 months of age are shown in Figure 3.1. The
range of exclusive breastfeeding is greatest in sub-Saharan
Africa, from 1 percent in Niger to 90 percent in Rwanda.
The average rate for the sub-Saharan region is 20 percent.
In Asia, the range is also wide, from 12 percent in
Kazakhstan to 82 percent in Nepal, with an average rate for
the region of 44 percent. In Near East/North Africa,
exclusive breastfeeding ranges from 14 percent in Turkey
to 63 percent in Morocco, with the regional average similar
to that of Asia at 41 percent. In Latin America/Caribbean,
Haiti has the lowest rate of exclusive breastfeeding, at 3
percent, and Peru has the highest, at 61 percent. The
average for the region is 30 percent.
Exclusive breastfeeding rates among the aggregate
of children 0 to 4 months of age indicate that the practice is
far from ideal, yet they actually mask the true picture of
exclusive breastfeeding relative to the international recom
mendation. The true picture is that represented by the rates
at individual months up to age 6 months (Appendix G).
Exclusive breastfeeding is widely practiced in many
countries in the first month of life, but declines with each
additional month. By the time infants are 5 months of age,
exclusive breastfeeding is prevalent in only a few countries,
in the single digits in some countries, and virtually nonexis
tent in most countries.

Because exclusive breastfeeding among infants is
rare in most countries, superceded usually by predominant
breastfeeding, rates of predominant breastfeeding are
presented in Figure 3.2. In all countries, more than half of
infants under 4 months of age are predominantly or fully
breastfed, except in the Dominican Republic, Colombia,
and Haiti. Sub-Saharan Africa has the highest rates of
predominant plus full breastfeeding.

Table 3.5 presents a summary of feeding practices
among children under 4 months of age, by region.
Full breastfeeding is not included in the WHO list of infant feeding
categories. Predominantly breastfed does not include full breastfeeding.

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Table 3.5 Regional summary of current status feeding practices for last-born children less than 4 months of age
Percentage of last-bom children less than 4 months of age in specific feeding categories, by region. Demographic and Health Surveys, 1990-1996

Breastfeeding

Exclusive
breast
feeding1

Breast
milk and
plain
water

Fully
breastfed2

Sub-Saharan Africa

20.1

37.8

Near East/North Africa

40 7

9.5

Asia

43.5

Latin America/Caribbean

30.3

Region

Not
breastfeeding

Predom
inantly
breastfed3

Predom
inantly
or fully
breastfed’

57.8

16.7

74.5

9.7

14.8

9.1

1.0

50.2

23.4

73.6

15.6

5 8

21.2

5.0

0.3
4.4

11.2

54.7

13.6

68 3

18.9

7.2

18.1

5.6

4.8

77

38.0

15.1

53.1

23.1

14.2

41.6

7.5

6.7

Received
comple
Received mentary
foods*’
milk

Used
bottle

Total

Used
bottle

1 Breast milk only
2 Exclusive breastfeeding or breast milk and plain water
3 Breast milk predominantly, with other non-milk liquids
4 Combines full and predominant breastfeeding
5 Receive breast milk plus other milks or formula
6 Breast milk plus solid or semisolid foods

Feeding practices for infants 6 to 9 months of age
are shown in Table 3.2. Among infants that age, the most
relevant feeding indicator is the proportion given comple* mentary foods in addition to breast milk, as is recommended
. from the age of 6 months onward. The prevalence of this
. indicator is shown in Figure 3.3. In sub-Saharan Africa,
,.fewer than half of all infants 6 to 9 months are given
‘ complementary' foods in Mali, Ghana, and Burkina Faso. In
fcgjAsia, the same is true of infants in India, Bangladesh, and
Pakistan. where only a third of infants are fed with comple
te mentary foods. In Near East/North Africa, fewer than half
L-lthe infants in Jordan, Turkey, and Morocco are fed comple&Linentary foods. In Latin America/Caribbean, only 23
^Ppercent and 12 percent of infants in the Dominican Repuby. lie and Brazil, respectively, are fed complementary foods.

A summary of feeding practices for children 6 to 9
onths of age, by region, including the proportion receiving
'tnplementary foods, is presented in Table 3.6.
For children 12 to 15 months of age, the indicator
main interest is the proportion of children still breast“■ding, also known as the first-year breastfeeding continu°nrate. The percentage of children 12 to 15 months of
lln specific feeding categories is shown in Table 3.3, and
Proportion of children this age still breastfeeding is
iWn in Figure 2.14 (page 28). In sub-Saharan Africa,
^feeding through the first year is quite common in all

countries, with the exception of Namibia, which has a
relatively low rate (for sub-Saharan Africa), at 68 percent.
The sub-Saharan countries have the highest first-year
continuation rates compared with countries in other regions.
In Asia, Bangladesh and Nepal have the highest first-year
rates, at 96 and 97 percent, respectively. Latin Amer
ica/Caribbean, in general, has some of the lowest rates,
including 29 percent in the Dominican Republic and 33
percent in Brazil. A regional summary of feeding practices
for children 12 to 15 months of age, including the percent
age of children still breastfeeding, is shown in Table 3.7.
Among children 20 to 23 months old, the propor
tion still breastfeeding provides the second-year breastfeed
ing continuation rate. The percentage of children 20 to 23
months of age in specific feeding categories is shown in
Table 3.4, and the proportion of children this age still
breastfeeding is shown in Figure 2.15 (page 28). SubSaharan Africa and Asia have the highest second-year
continuation rates, specifically in Burkina Faso, Rwanda,
Bangladesh, and Nepal, where 80 percent or more of
children 20 to 23 months of age are still breastfeeding.
Fewer than half the children this age in Latin Amer
ica/Caribbean and Near East/North Africa are still breast
feeding, and in the Dominican Republic and Paraguay, only
7 and 8 percent, respectively, continue to breastfeed. The
regional summary of feeding practices, including the
second-year continuation rates, is shown in Table 3.8.

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