Abstract
BackgroundIn low- and middle-income countries (LMICs), low levels of formal maternal educational are positively associated with breastfeeding whereas the reverse is true among women with higher levels of formal education. As such, breastfeeding has helped to reduce health equity gaps between rich and poor children. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades.MethodsWe used 319 nationally representative surveys from 81 countries. We used WHO definitions for breastfeeding indicators and categorized maternal education into three categories: none, primary, and secondary or higher. We grouped countries according to the World Bank income groups and UNICEF regions classifications. The trend analyses were performed through multilevel linear regression to obtain average absolute annual changes in percentage points.ResultsSignificant increases in prevalence were observed for early initiation and exclusive breastfeeding across all education categories, but more prominently in women with no formal education for early breastfeeding and in higher level educated women for exclusive breastfeeding. Small decreases in prevalence were seen mostly for women with no formal education for continued breastfeeding at 1 and 2 years. Among formula indicators, only formula consumption between 6 and 23 months decreased significantly over the period for women with primary education. Analysis by world regions demonstrated that gains in early and exclusive breastfeeding were almost universally distributed among education categories, except in the Middle East and North Africa where they decreased throughout education categories. Continued breastfeeding at 1 and 2 years increased in South Asia, Latin America and the Caribbean, and Eastern Europe and Central Asia for primary or higher education categories. Declines occurred for the group of no formal education in South Asia and nearly all education categories in the Middle East and North Africa with a decline steeper for continued breastfeeding at 2 years. With a few exceptions, the use of formula is higher among children of women at the highest education level in all regions.ConclusionsOver the course of our study, women with no formal education have worsening breastfeeding indicators compared to women with primary and secondary or higher education.
Highlights
To achieve optimal growth, development, and health the World Health Organization (WHO) recommends infants and young children are exclusively breastfed for the first 6 months of life, and thereafter receive nutritionally adequate and safe complementary foods, while breastfeeding continues for up to 2 years of age or beyond [1]
This article is a part of the Interventions and policy approaches to promote equity in breastfeeding collection, guest-edited by Rafael Pérez-Escamilla, PhD and Mireya Vilar-Compte, PhD
Breastfeeding is a positive health behavior that is more prevalent among women with low levels of formal education compared to women with high levels of formal education in low- and middle-income countries (LMICs)
Summary
Development, and health the World Health Organization (WHO) recommends infants and young children are exclusively breastfed for the first 6 months of life, and thereafter receive nutritionally adequate and safe complementary foods, while breastfeeding continues for up to 2 years of age or beyond [1]. Substantial improvements in levels of formal education among girls and young women in low- and middle-income countries (LMICs) has occurred. In these countries, low levels of formal education are positively associated with breastfeeding practices whereas the reverse is true among women with higher levels of formal education [5]. WHO considers ensuring equitable access to breast milk for all infants is a key component of essential newborn care [7] This is further reflected in the ‘nutrition equity’ theme of the 2020 Global Nutrition Report, which calls on governments, donors, civil society groups and others to develop equity-sensitive nutrition policies, programming actions and data systems in support of the Sustainable Development Goals [8]. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades
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