Nutrition

Improving breastfeeding, complementary foods and feeding practices

What and how we feed babies is critically important

Infants and young children need the right foods at the right time to grow and develop to their full potential. The most critical time for good nutrition is in the brief 1,000 day period from the start of a woman’s pregnancy until a child’s second birthday.

Breastmilk is a crucial food for children’s health and development during this critical window. It provides all of the vitamins, minerals, enzymes and antibodies that children need to grow and thrive in the first 6 months of life, and continues to be a pivotal part of their diet up to the age of 2 or beyond.

Breastmilk is safe: it is always the right temperature, requires no preparation, and is available even in environments with poor sanitation and unsafe drinking water. In this way, breastfeeding guarantees babies access to a reliable, sufficient quantity of affordable, nutritious food. Breastfeeding also supports healthy brain development, higher educational achievement, and lowers the risk of obesity and other chronic diseases.

Breastfeeding is a miracle investment. It is a universally available, low-tech, high impact, cost-effective solution for saving babies’ lives – but globally, it hasn’t received the attention it should. UNICEF is working to change this.

Breastfeeding is the closest thing the world has to a magic bullet for child survival. In developing countries, optimal breastfeeding – starting within one hour of birth, exclusive breastfeeding (no additional foods or liquids, including water) for the first 6 months of life, and continued breastfeeding until age 2 or longer – has the potential to prevent more than 800,000 deaths in children under age 5 and 20,000 deaths in women every year.^[1] Exclusively breastfed children are less susceptible to diarrhoea and pneumonia and are 14 times more likely to survive than non-breastfed children.^[2]

Mothers also benefit from breastfeeding: it helps prevent post-partum hemorrhage, reduce the risk of breast and ovarian cancers, and allows women to better space their pregnancies.

As infants grow, their nutrient needs grow with then. 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. The foods consumed between 6 months and 2 years of life are called complementary foods because they ideally complement an already breastmilk-based diet, and the 18-month period between 6 months and age 2 is referred to as the complementary feeding period.

During the complementary feeding period, it is recommended that children eat a frequent and diverse diet of nutrient-rich and hygienically prepared complementary foods in addition to breastmilk.  Evidence has shown that a diet comprising at least four food groups a day is associated with improved growth in young children.^[3] Introducing children to healthy and diverse foods at an early age also helps to establish taste preferences and good eating habits later in life.

The role of the caregiver during feeding is as important as the food itself: caregivers need to interact and engage with the child, respond to his or her hunger signals, and encourage him or her to eat.

What are the challenges?

Globally, breastfeeding and complementary feeding practices are poor. Only 43 per cent of the world’s infants under 6 months of age are exclusively breastfed and the vast majority of young children are not fed a diverse diet during the complementary feeding period.

One of the biggest challenges is a lack of awareness on the part of national governments. This has, in turn, meant limited prioritization and financial investment for things like protective legislation, training of health workers, and counselling programmes to improve breastfeeding and complementary feeding practices.

Any mother will tell you that breastfeeding itself can be challenging: skilled support is crucial. However, many countries have a shortage of health workers trained to counsel and support mothers with both breastfeeding and complementary feeding. This needs to change.

Strong national policies and legislation – reflecting the International Code of Marketing of Breastmilk Substitutes – are needed to combat the aggressive and often unethical marketing tactics of formula producing companies that undermine breastfeeding norms and practices.

Governments also need to better support working mothers to breastfeed. Adopting supportive national policies and legislation – such as paid maternity leave, breastfeeding breaks, and designated breastfeeding spaces – will help guarantee that breastfeeding and working are not mutually exclusive.

The lack of access to affordable, nutrient-rich foods is an ongoing problem for many families around the world. Too often, solid and soft foods are introduced too soon or too late, the frequency and amount of food offered is less than required for normal child growth, or the consistency or nutrient density of the food may be inappropriate for the child's needs.

Inadequate food and hygiene practices are related to a number of factors: lack of education of caregivers, beliefs and cultural taboos, the workload of the caregiver, poor access to resources, poverty, and food insecurity. The marketing of unhealthy food and drinks to children is also a barrier to good nutrition.

Feeding babies becomes even more challenging during emergencies. Caregivers often struggle to find safe spaces to feed their children, and emergency-related food shortages hit vulnerable populations the hardest. The uncontrolled and untargeted distribution of breastmilk substitutes during emergencies also undermines breastfeeding.

How is UNICEF responding?

Global Breastfeeding Advocacy Initiative – UNICEF and WHO are leading a global partnership to galvanize political commitment and investments to increase breastfeeding rates. Rapid progress is possible: some countries have already made dramatic gains in improving breastfeeding.

Protective policies and legislation – UNICEF advocates for national laws to protect breastfeeding and stop infant formula companies from using unethical marketing practices. UNICEF supports countries to enforce and monitor these policies.  In addition UNICEF supports the recent WHA resolution and guidance to end the inappropriate promotion of food for infant and young children.

UNICEF also works with governments to develop and enforce policies that provide time, space, and support for women to breastfeed. This includes maternity leave legislation to allow women more time with their babies before returning to work, supportive work-family policies, and policies to allow time and designated spaces for breastfeeding or expressing milk in the workplace.

Programme guidance – UNICEF provides global guidance on appropriate care and feeding practices. Some of these include UNICEF’s Programming Guide for infant and young child feeding, and most recently, guidance on infant and young child feeding in the context of Ebola.

Training and capacity strengthening – UNICEF and WHO have developed an integrated course on infant and young child feeding, including supportive supervision to build the capacity of health workers to better counsel and support mothers. UNICEF provides an online training course, in partnership with Cornell University on supporting infant and young child feeding programmes in developing countries. 

Baby-friendly hospital initiative – This initiative, led by UNICEF and WHO, helps mothers initiate breastfeeding after birth, which in turn supports its continuation after the mother returns home. A maternity facility can be designated 'baby-friendly' when it does not accept free or low-cost breastmilk substitutes and has implemented 10 specific steps to support successful breastfeeding.

Community-based approaches – UNICEF works with communities to establish counselling opportunities for mothers to adopt appropriate feeding practices. UNICEF has produced a community-based infant and young child feeding counselling package to train community workers. Counselling is tailored to the contexts in which families live, providing concrete actions to change behaviors, improve feeding practices, and strengthen support networks. It is particularly important in places where the health system is weak.

Improving access to nutritionally adequate complementary foods – UNICEF provides caregiver nutrition education to improve complementary feeding. In settings plagued by food insecurity, UNICEF promotes the use of fortified foods and micronutrient powders to improve the nutrient quality of complementary foods.

Support in emergencies – UNICEF is on the front lines in humanitarian situations, providing counselling, working to establish safe spaces for infant feeding, and monitoring the distribution of unsolicited donations of breastmilk substitutes.

Support on the feeding of HIV-exposed infants – UNICEF assists governments in HIV-affected countries to develop national strategies and policies on HIV and Infant Feeding based on the latest guidance and to build the capacities of health workers to support HIV-infected mothers to breastfeed safely.

 

 

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^[1] Victora CG, Bahl R, Barros AJD, et al, for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong eff ect. Lancet 2016; 387: 475–90.

^[2] Black, R. et al., ‘Maternal and child undernutrition and overweight in low-Income and middle-income countries’, The Lancet, vol.382, no. 9890, 3 August 2013, pp.427-451.

^[3] Onyango, A.W., et al., Complementary feeding and attained linear growth among 6-23-month-old children. Public Health Nutr, 2014. 17(9): p. 1975-83.