Over the last decade, infant and young child feeding (IYCF) indicators in India have improved [1]. However, poor IYCF practices are still apparent, associated with pervasive high rates of child under-nutrition. In India, IYCF practices have improved substantially over the past decade, but still remain sub-optimal [2]. The following article examines the key breast-feeding practices over a 10-year period based on eight key breast feeding indicators viz early initiation of breast feeding, exclusive breast feeding, introduction of solid, semi-solid or soft foods, continued breastfeeding at 1 year, continued breastfeeding at 2 years, minimum dietary diversity, minimal meal frequency, and minimum acceptable diet.                

Indicator 1: Early Initiation of Breastfeeding

The prevalence of early initiation of breastfeeding increased by nearly 18.4% in both boys and girls from 2006 to 2015 which further increased by 14.6% within one year (2017). Overall the prevalence of early initiation of breastfeeding was found to be slightly higher in boys in 2017 (57.1% against 56.1% in girls). In the urban areas, the decadal prevalence of early initiation of breast feeding increased from 28.4% to 54.7%, while that in rural area, an increase in the prevalence was seen from 21.4% to 57.2%. The 10-year prevalence of early initiation of breast feeding among the mothers having secondary or higher education observed an increase from 32.1% to 44.1%, whereas that among the mothers having primary or no education increased from 17.6% to 37.7% in ten years. In the survey done in 2006, the prevalence of early initiation of breast feeding varied from 16.7% to 30.3% which rose consistently over time to reach levels between 55% and 60% in 2017 across different wealth quintiles.

Indicator 2: Exclusive Breastfeeding

The percentage of exclusive breastfeeding rose consistently over time from 46% (2006) to reach levels of around 58% in 2017. The trend was similar across both the genders examined. Compared with the infants 4-5 months of age, the proportion of exclusively breastfed children who were 0–1 month old remained consistently high (around 70%), while that of children aged 2-3 months increased from around 50% in 2003 to nearly 60% in 2017 survey. In the urban areas, the decadal prevalence of exclusive breast feeding increased from nearly 40% to 60%, while that in rural areas, an increase in the prevalence was seen from 48.3% to 57.5%.Over a period of 10 years, the prevalence of exclusive breast feeding among the mothers having secondary or higher education observed an increase from 43% to 56%, whereas that among the mothers having primary or no education increased from 48% to 53% from 2006 to 2017.Across the different wealth quintiles, the prevalence of exclusive breast feeding varied with the lowest being among the highest quintile (36.3%) while highest being in the lowest wealth quintile (53.3%) which increased consistently over time and reduced the gap to reach levels between 54% and 61% in 2017 across different wealth quintiles.

Indicator 3: Introduction Of Solid, Semi-Solid or Soft Foods

Survey done in 2006 revealed that nearly 56% of boys and girls were introduced to complementary food that included solid, semi-solid or soft foods after 6 months of exclusive breast feeding which reduced to around 40% in 2015 and later increased to 53% in 2017. Mothers living in the urban area were more likely to introduce complementary food than their counterparts residing in the rural area. While the overall prevalence of introduction of solid, semi-solid or soft food reduced from 67% to 60% in urban area, the percentage remained quite consistent in the rural area over the 10-year time span. At any point of time, the prevalence of complementary food uptake was higher in mothers who had attained secondary or higher education (67% in 2006 v/s 50% in 2015) as compared to those mothers who had received primary or no education at all (48% in 2006 v/s 40% in 2015). Variation in introduction of complementary food was observed among the different household quintiles with the highest uptake of complementary food in the highest household quintile (76%) while the lowest being in the second lowest household wealth quintile (46.4%) in 2006. The only change was observed in the second highest quintile where the prevalence of complementary feeding increased by only 3.1% over a time span of 10 years, while the rest household wealth quintiles remained consistent.

Indicator 4: Continued Breastfeeding at 1 year

The percentage of children who continued to breastfeed at 1 year of age was high at around 88%–90% across both genders in 2006, with a substantial decline in these levels over the period of time under examination. While in the urban area, the percentage of continued breastfeeding reduced from 82.7% in 2005 to around 80% in 2015, likewise, the mothers residing in the rural area also witnessed a drop in continued breastfeeding at 1 year by nearly 3% from 2005 to 2015. However, the 10-year prevalence of continued breastfeeding was more in rural areas compared to urban areas. The mothers with higher education level seemed less likely to continue breastfeeding at 1 year as compared to those who had attained either primary education or no education at all. The overall prevalence of continued breastfeeding at one year was observed to be declining irrespective of the educational status of the mothers. There was no change in the percentage of continued breastfeeding at 1 year among the different household wealth quintiles except for the 10% drop that was witnessed in the highest wealth quintile after 2015.

Indicator 5: Continued breastfeeding at 2 years

An overall declining trend was observed in the prevalence of continued breastfeeding at 2 years across both genders. The 10-year survey suggests that percentage of children continuing to breastfeed up to 2 years of age merely reduced by 1% in both male as well as female children. Although the overall prevalence of continued breastfeeding up to 2 years was higher in rural areas as compared to urban areas, a slight decline in the proportion of breastfeeding at 2 years was observed in both regions from 2005 to 2015. Surprisingly, the trend of continuing breastfeeding at 2 years was on the rise for more educated women while the opposite trend was seen for those breastfeeding women who were less educated. Although, the 10-year prevalence of continued breastfeeding at 2 years of age was higher among those who were less educated at any point of time under examination. The overall decadal prevalence of continued breastfeeding at 2 years remained low in the highest household wealth quintile group as compared to the other household quintiles, but it was worth noting that there was a 5% rise in continued breastfeeding at 2 years in the same group.

Indicator 6: Minimum Dietary Diversity (MDD)

An overall uprising trend was observed in the children receiving a diversified diet across both genders and all age groups ranging from 6-23 months. At the end of the survey period, the decadal-prevalence of MDD was more in the urban areas (19.8%) compared to rural areas (15.3%). The trend based on location was, nevertheless, seen to be rising at the end of time period under examination. Higher education level was found to have more uptake of diversified diet compared to those who had received low or no education at all, though the 10-year trend was found to be on the rise irrespective of the education status of the mothers. Based on the socio-economic status, the rise in the trend across all the household quintiles was observed to be rising, though this change was almost negligible. 

Indicator 7: Minimal Meal Frequency (MMF)

The MMF was found to be more for girls (39.5%) compared to boys (38%) at the end of the survey period. Overall, it showed a rising trend. The trend of MMF was observed to be rising for all age-groups except for the 6–11-month age group where the trend was declining as well as the prevalence of MMF was also the lowest (27%). As the age increased, the minimum meal frequency also increased. A substantial increase in trend was seen across the urban location, mothers with secondary or higher education, and among the households with the highest wealth quintiles. 

Indicator 8: Minimum Acceptable Diet (MAD) 

The MAD decreased across genders, all age groups and any type of location from 2015 to 2017. The prevalence of minimum acceptable diet was higher in those with higher education level (10.8%) and highest household wealth index (11.4%).

The decadal prevalence of early initiation of breastfeeding was more in the rural areas than in the urban areas. More educated women had a greater prevalence of early initiation of breastfeeding [3]. The early introduction of solid foods is a common practice in many cultures. Some mothers believe that it can reduce sleep interruptions by increasing the time between overnight feeds, and can increase the baby’s growth rate, the latter being viewed as beneficial in some cultures [4]. However, the early introduction of solid foods may also increase infant morbidity and mortality, though it is difficult to separate this effect from the decrease in breastfeeding and the dysbiosis of the microbiome [5]. In many countries foods and water supplies are likely to be contaminated with bacteria, resulting in gastrointestinal infection [6]. Introduction of complementary food, minimum dietary diversity, minimum meal frequency and minimum acceptable diet was more in the educated, and affluent families living in the urban areas. One possible explanation could be that urban people have more purchasing power than rural families, and with the increase in income, children’s diets become more diversified.

India is in the path to meet the targets for maternal, infant and young child nutrition (MIYCN). No instrumental progress has been made towards reduction of anaemia among women of reproductive age group, with 53.0% of women aged 15 to 49 years now affected. Meanwhile, there is dearth of data to assess the improvement that India has made towards achieving the low-birth-weight target, nor there is sufficiently available prevalence data [7]. India is 'on course' for the exclusive breastfeeding target, with 58.0% of infants aged 0 to 5 months exclusively breastfed. Similarly, India is on the right track to meet the target for stunting, but 34.7% of children under 5 years of age are still affected, which is higher than the average for the Asia region (21.8%). India has not made much progress towards achieving the target for wasting, with 17.3% of children under 5 years of age affected, which is higher than the average for the Asia region (8.9%). The prevalence of overweight children under 5 years of age is 1.6% and India is 'on course' to prevent the figure from increasing.

India has shown limited progress towards achieving the diet-related non-communicable disease (NCD) targets. The country has shown no progress towards achieving the target for obesity, with an estimated 6.2% of adult (aged 18 years and over) women and 3.5% of adult men living with obesity. India's obesity prevalence is lower than the regional average of 10.3% for women and 7.5% for men. At the same time, diabetes is estimated to affect 9.0% of adult women and 10.2% of adult men.

Effective interventions to promote optimum breastfeeding and complementary feeding practices, including counseling, food supplementation and food based comprehensive approaches, micronutrient interventions and general supportive strategies, are being established. However, for best outcomes at a national level, such interventions need to be supported by appropriate policies and guidelines. Key areas where policy can enhance IYCF interventions are through support to women at home and in the work place, consistent messages regarding IYCF, training of health care workers to deliver IYCF interventions, and ensuring that policies for promotion, protection and support for IYCF practices are consistently supported in implementation level documents. Findings of the present study impart several suggestions such as a strong focus on young children, intensive training to mothers on optimal feeding practices, and considering the divisional, regional (rural/urban), birth order, and parental education variability in complementary feeding practices while designing and implementing feeding programs and policies There is a need to focus on younger children, particularly when complementary feeding is initiated, and greater attention is required when designing feeding programs and policies.

1. Global Nutrition Report. “Nutrition profiles: Southern Asia, India.” Global Nutrition Report, https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/india. Accessed 24 Apr. 2022.

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3. Chandhiok, N., et al. “Changes in Exclusive Breastfeeding Practices and Its Determinants in India, 1992–2006: Analysis of National Survey Data.” International Breastfeeding Journal, vol. 10, 2015, p. 34. International Breastfeeding Journal, vol. 10, 2015, pp. 34.

4. Inoue, M. and C. W. Binns. “Introducing Solid Foods to Infants in the Asia Pacific Region.” Nutrients, vol. 6, 2014, pp. 276–288.

5. Yu, C., C. W. Binns, and A. H. Lee. “The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China.” Nutrients, vol. 11, no. 4, 2019, p. 760.

6. Islam, M.A., et al. “Microbiological quality of complementary foods and its association with diarrhoeal morbidity and nutritional status of Bangladeshi children.” European Journal of Clinical Nutrition, vol. 66, 2012, pp. 1242–1246.

7. Sapra, D. et al. “Infant and young child feeding practices amongst children referred to the paediatric outpatient department.” Medical Journal Armed Forces India, vol. 71, 2015, pp. 359–362.