FROM THE FIRST HOUR OF LIFEMaking the case for improved infant and young child feeding everywhere

Key Findings2016

Indicators

RecommendedPractices

Age in months

Early initiation of breastfeeding*

Exclusivebreastfeeding*

Introduction of solid, semi-solid or soft foods*

Continued breastfeeding at 1 year*

Continued breastfeeding at 2 years*

Minimum diet diversity**

Minimum meal frequency**

20-23 months12-15 months6-23 months6-23 months6-23 months6-8 months0-5 months<1 hour

Start breastfeeding within one hour of birth

Breastfeed exclusively for the first 6 months of life

Provide nutritionally adequate, age appropriate and safely prepared complementary foods starting at 6 months; and continue breastfeeding until age 2 or longer.

Pe

rce

nta

ge

0 5 6 23 24+

23

{

{Per cent of children: put to the breast within one hour of birth, exclusively breastfed (0-5 months); introduced to 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), 2015*.

0

20

40

60

80

100

45 43

6452

29

16

74

46

Minimum acceptable diet**

THE IMPORTANCE OF INFANT AND YOUNG CHILD NUTRITION

If the world was issued a scorecard for the way its infants and young children were fed it would receive a failing grade

What, when and how children are fed, particularly in the first two years of life, is critical to health, development and survival. Across the world families invest time, money, and care towards feeding their children, but despite their best efforts, they face immense challenges.

The importance of breastfeedingBreastmilk is more than just food – it is also a potent medicine that is tailored to the needs of each child.1

Exclusive breastfeeding, feeding infants nothing but breastmilk for the first six months of life, is the safest and healthiest option for children everywhere and has great potential to save lives. In low- and middle-income countries, infants who received foods and liquids in addition to breastmilk

before 6 months were up to 2.8 times more likely to die than their exclusively breastfed peers; the risk of dying was 14-fold higher among those not breastfed at all.2 In rich and poor countries alike, long periods of breastfeeding are associated with higher intelligence scores, and there is evidence that this translates into improved academic performance and long-term earnings.

There is growing evidence that breastfeeding may also reduce the incidence of overweight, obesity and chronic diseases later in life.1 Low rates of breastfeeding are responsible for losses of more than $230 billion annually in high-income countries, and $70 billion annually in low- and middle-income countries.3

UNICEF’s global report, From the First Hour of Life: Making the case for improved infant and young child feeding everywhere provides information on how infants and young children are being fed and how these feeding practices match up to the recommended guidelines on infant and young child feeding. This report tells a story about how children are being fed, what obstacles stand in their way, and where and how we can urgently do better. Read the full report at: < uni.cf/iycfreport2016>

The importance of appropriate complementary feedingStarting at 6 months of age, children’s nutrient needs are greater than what breastmilk alone can provide. Feeding children solid, semi-solid or soft foods from 6 months of age is key to prevent deficiencies that could result in undernutrition.4 Diets that meet at least minimum frequency and diversity standards are essential to preventing micronutrient deficiencies, stunting and wasting.

If appropriate complementary feeding practices were scaled-up to nearly universal levels, approximately 100,000 deaths in children under five could be averted each year.5

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.

Gov

ernm

ent

Community

Health system

Workplace

Family and Early Childhood Development

Gov

ernm

ent

Social protection

Family and Early Childhood Development

Community

Private sector

Water, sanitation and hygiene

Education

Agriculture

Health sector

POLICY

WOMEN AND FAMILIES CANNOT DO IT ALONE

Breastfeeding is not a one-woman job

– it requires government leadership and support from families, communities, workplaces and the health system to really make it work.

The first two years of life are a critical opportunity to enhance a child’s future – but a heavy burden to place on the shoulders of mothers and families alone. Good nutrition in the earliest years is a collective responsibility. Government leadership and contributions from key sectors – including health, agriculture, water and sanitation, social protection and education – as well as the private sector, workplaces and families and communities, are needed to support mothers and families to provide their children with the nutrition they need.

Children’s diets are a shared responsibility – no single household can do it alone.

All sectors of society need to contribute to guarantee that nutritious food for children is available, affordable, safe and provided with care.

1. Victora, C.G., et al., Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016. 387(10017): p. 475-90. 2. Sankar, M.J., et al., Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr, 2015. 104(467): p. 3-13. 3. Rollins, B., Hajeebhoy, Horton, Lutter, Martines, Piwoz, Richter, Victora; Lancet Breastfeeding Series Group., Why invest, and what it will take to improve breastfeeding practices?

The Lancet, 2016. 387(10017): p. 491-504. 4. WHO Programme of Nutrition., Complementary feeding of young children in developing countries: a review of current scientific knowledge. 1998, Geneva: World Health Organization. 228 p. 5. Bhutta, Z.A., et al., Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet, 2013. 382(9890): p. 452-77.

Unskilled birth attendant (e.g., traditional birth attendant) or others (e.g., relatives)

Skilled birth attendant (e.g., doctor, nurse, midwife)

* South Asia excluding India, East Asia and the Pacific excluding China, Latin America and the Caribbean excluding Brazil, CEE/CIS excluding Russian Federation Per cent of newborns put to the breast within one hour of birth by type of birth delivery attendant,

by region, 2015

Oth

er**

*

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*

insu

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ent

bir

ths

No

dat

a

No

dat

a

0

10

20

30

40

50

60

70

80

90

100

Marginally higher rates with skilled attendants

Marginally higher rates with unskilled/other

Rates about the same/no comparison available

57

40 39

58

51 49

63

47

34

4548 47

65

Per

cen

tag

e

FOCUS ON BREASTFEEDING

Key Findings• Globally, less than half of all newborns are put to the breast within an hour of birth.

• While there is enormous potential for skilled birth attendants to better support women in initiating breastfeeding immediately after birth – this is not happening everywhere. In the Middle East and North Africa, for example, fewer newborns delivered with the assistance of a skilled attendant were put to the breast within an hour of birth than newborns delivered by unskilled attendants.

• While the case of exclusive breastfeeding is sound and compelling, less than half of children under 6 months of age receive nothing but breastmilk for the first 6 months of life. Progress on exclusive breastfeeding is also slow – with only South Asia making notable strides the past 15 years.

• The International Code of Marketing of Breastmilk Substitutes is crucial to protect and promote breastfeeding by prohibiting the promotion of breastmilk substitutes such as infant formula. However, the strength and comprehensiveness of these measures vary widely across countries. More than half of countries in Latin American and the Caribbean, East Asia and the Pacific and CEE/CIS have only minimal or no legislation in place.

• Globally, continued breastfeeding rates drop between children’s ages of 12 and 23 months – from 74 per cent to 46 per cent.

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources.Note: Analysis is based on a subset of 66 countries with recent (2010-2014) disaggregated data for early initiation rates by type of delivery provider covering 46 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, East Asia and the Pacific does not include China, Latin America and the Caribbean does not include Brazil and CEE/CIS does not include Russian Federation. **Early initiation rates were not included for the birth attendant category of “Unskilled or other” for CEECIS because an insignificant proportion of births were delivered by these attendants in the majority of countries studied in this region and therefore did not allow for reliable early initiation estimates to be generated for this disaggregation. ***Other refers to mainly high-income countries not included within UNICEF programme regions.

Children should be put to the breast immediately after birth, be breastfed exclusively for the first 6 months of life and continue to be breastfed after solid foods are introduced from 6 months to 2 years and beyond.

While there is enormous potential for skilled birth attendants to better support women in initiating breastfeeding immediately after birth – this is not happening everywhere.

Only 45 per cent of newborns were put to the breast within the first hour of life.

= 10 million newborns

newborns had to wait too longto be put to the breast.

Of the 140 million live births in 2015, Globally, only

1 in every 6 children is receiving a minimum acceptable diet.

The minimum acceptable diet refers to meeting both the minimum meal frequency and minimum diet diversity.

+ 4+

frequency diversity

Oth

er**

No

dat

a

No

dat

a

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

0

10

20

30

40

50

60

70

80

90

100

33

26

Mid

dle

Eas

t an

dN

ort

h A

fric

a

30

Eas

t Asi

a an

dth

e Pa

cifi

c*

30

20

Wes

t an

dC

entr

al A

fric

a

64

47

So

uth

Asi

a

21

CE

E/C

IS*

54

43

Eas

tern

an

dS

ou

ther

n A

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a

3331

Lati

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mer

ica

and

the

Car

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ean

46

36

Wo

rld

*

Per

cen

tag

e

30 30

Around 2015

Around 2000

* East Asia and the Pacific excluding China, CEE/CIS excluding Russian Federation, World excluding China and Russian Federation

No legal measures

Few provisions in law

Many provisions in law

Full provisions in law

no data

Number of countries with full or many provisions in law

Total number of countriesin the region

Other*

13/24

13/33

0/37

12/23

7/21

7/8

10/19

8/29

70/194

Eastern andSouthern Africa

CEE/CIS

West andCentral Africa

Middle East andNorth Africa

South AsiaEast Asia and

the Pacific

World

•

•

••

•

•

•

•

•

•

•

•

Latin America andthe Caribbean

135 countries have some legal measures in line with the Code – yet most of these need to be further strengthened

Status of national measures on the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly resolutions, by country and by region*, 2016

Source: WHO, UNICEF, IBFAN. Marketing of Breast-milk Substitutes: National Implementation of the International Code. Status Report 2016. Geneva: World Health Organization; 2016.( • denotes countries have no dedicated Code legislation, but have Code-related provisions incorporated in other legal measures.). The regional summaries indicate the number of countries with a full provision or many provision law (green circle) out of all countries in the region (blue circle). *Other refers to mainly high income countries not included within UNICEF programme regions (see annex 2). 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. 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 for 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, East Asia and the Pacific does not include China and CEE/CIS does not include Russian Federation. **Other refers to mainly high-income countries not included within UNICEF programme regions.

Global progress on exclusive breastfeeding rates has been slow, but progress is possible – South Asia has made the greatest strides of all regions

FOCUS ON COMPLEMENTARY FEEDING

CE

E/C

IS*

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Wo

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Per cent of children fed solid, semi-solid or soft foods, by age and by region, 2015

0

10

20

30

40

50

60

70

80

90

100

age inmonths

Per

cen

tag

e

91

88

82

47

14

7

18

4

87

81

65

33

13

4

84

76

57

34

13

6

79

70

54

27

5

78

68

49

19

9

5

83

75

58

29

11

5

13

84

76

57

34

13

6

79

70

54

27

51

78

68

49

19

95

83

75

58

29

11

5

Oth

er**

87

80

58

22

51

87

81

65

33

13

4

9093

80

48

18

4

9188

82

47

14

7

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

8-9

4-5

0-1

10-11 6-7

2-3

No

data

More than one-third of infants are receiving their first foods too early, and far too many are receiving their first foods too late

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. Notes: Analysis is based on a subset of 79 countries with data on feeding of solids between 2010-2014 for all age groups, covering 74 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, CEECIS does not include Russian Federation and World does not include China and Russian Federation. ** Other refers to mainly high-income countries not included within UNICEF programme regions.

Key Findings• The late introduction of solid, semi-solid or soft foods poses a threat to growth and

development; this is worrying since about one third of infants 6–8 months old are not yet eating solid foods. Early introduction of solid foods is also of concern, and globally, more than one quarter of infants between 4 and 5 months of age are already consuming solid foods.

• Children need to eat frequently throughout the day to meet their energy needs, but globally half of all children 6-23 months of age are not being fed even the recommended minimum number of meals a day. The regions where stunting rates are highest, namely South Asia and sub-Saharan Africa, have the lowest rates of minimum meal frequency of all.

• Eating a diverse diet helps ensure children consume all of the essential nutrients their growing bodies demand, but less than one third of the world’s infants and young children are receiving a diet with the recommended minimum variety of foods (food from at least four food groups). In South Asia and sub-Saharan Africa, the situation is dire: only one in five children aged 6–23 months is eating a minimally diverse diet.

• Alarmingly, only 1 out of every 6 children age 6-23 months is receiving a minimum acceptable diet, which refers to meeting both the minimum number of meals and minimum diet diversity.

Starting at 6 months, children need to be fed with nutritionally adequate, age appropriate and safely prepared solid foods in addition to breastmilk.

Only 45 per cent of newborns were put to the breast within the first hour of life.

= 10 million newborns

newborns had to wait too longto be put to the breast.

Of the 140 million live births in 2015, Globally, only

1 in every 6 children is receiving a minimum acceptable diet.

The minimum acceptable diet refers to meeting both the minimum meal frequency and minimum diet diversity.

+ 4+

frequency diversity

FOCUS ON COMPLEMENTARY FEEDING

Less than a third of children 6-23 months of age receive a minimum diet diversity, and rates are lowest among infants 6-11 months old

Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources, 2010-2016. Note: 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. 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. Note: Analysis is based on a subset of 53 countries with available data on the consumption of the 7 food groups by age group, covering 55 per cent of the global population. While other graphs in this report present population weighted averages, unweighted means are presented for this graph due to low population coverage for three regions. As such these figures should be interpreted as illustrative values rather than representing these regions or the world as a whole. The number of countries included in the analysis for each region is presented in brackets beside the region name. *Other refers to mainly high-income countries not included within UNICEF programme regions.

Per cent of children 6-23 months of age with minimum meal frequency, 2015

Half of all children are not receiving a minimum meal frequency

Per cent (unweighted) of children 6-23 months of age in each food group category, by age and by region, 2015

0

10

20

30

40

50

60

70

80

90

100

Oth

er*

Eas

tern

an

dS

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ther

n A

fric

a(n

=13)

Wes

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a(n

=18)

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dle

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=4)

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=4)

Wo

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(n=5

3)

No

dat

a

Per

cen

tag

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CE

E/C

IS(n

=5)

7 food groups

6 food groups

5 food groups

4 food groups

3 food groups

2 food groups

1 food groups

0 food groups

Eas

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=4)

Lati

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)

18-2312-176-11 18-2312-176-11 18-2312-176-11 18-2312-176-11 18-2312-176-11 18-2312-176-11 18-2312-176-1118-2312-176-11 18-2312-176-11

Types of food groups

age inmonths

<20%

20-39%

40-59%

60-79%

≥80

no data

%

52

78%

Eastern andSouthern Africa

West andCentral Africa

Middle East andNorth Africa

South Asia

East Asia andthe Pacific*

Latin America andthe Caribbean

World

%

© United Nations Children’s Fund (UNICEF) data@unicef.org | www.unicef.org

Improved infant and young child nutrition is fundamental to guaranteeing children a brighter and more equitable future. We all have a responsibility to make it happen.

Let’s start now.

For the full report please visit: http://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

THE WAY FORWARD

What do we need to do better to support breastfeeding?• Fully implement the International Code of Marketing of

Breastmilk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.

• Enact family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.

• Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.

• Improve access to skilled lactation counselling as part of comprehensive breastfeeding policies and programmes in health facilities.

• Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.

• Create monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets.

What do we need to do better to support complementary feeding?• Enact legislation and adopt policies in line with the Guidance

on Ending the Inappropriate Promotion of Foods for Infants and Young Children to prohibit the inappropriate promotion of all commercially produced food or beverage products marketed as suitable for children up to 3 years of age.

• Select and combine multiple strategies and interventions that are evidence-based and informed by adequate situation analyses.

• Create a healthy and nurturing feeding environments within households and communities. Early childhood development interventions that stimulate and encourage responsive feeding should be integral to child nutrition programmes.

• Coordinate actions among key government sectors, including health, agriculture, water and sanitation, social protection and education.

• Harness the potential of the private sector to create food solutions and hold them accountable for complying with food production, labelling and marketing regulations.

• Create monitoring systems to track progress effectively. Governments need to ensure that credible and comprehensive data on infant and young child feeding, aligned with the standard global indicators.

To truly change this story, we need greater recognition that good nutrition in the earliest days of life matters deeply; this should translate to greater investment for infant and young child nutrition.