Abstract

Limited evidence exists on socio‐economic status (SES) inequalities in infant and young child feeding (IYCF) in India. We examine trends and changes in inequalities for IYCF practices over 2006–2016 and identify factors that may explain differences in IYCF across SES groups. We use data from the 2015–2016 and 2005–2006 National Family Health Surveys (n = 112,133 children < 24 months). We constructed SES quintiles (Q) and assessed inequalities using concentration and slope indices. We applied path analyses to examine the relationship between SES inequalities, intermediate determinants, and IYCF. Breastfeeding improved significantly over 2006–2016: from 23% to 42% for early initiation of breastfeeding (EIBF) and 46% to 55% for exclusive breastfeeding (EBF). Minimum dietary diversity (MDD) improved modestly (15% to 21%), but adequate diet did not change (~9%). Large SES gaps (Q5–Q1) were found for EIBF (8–17%) and EBF (−15% to −10%) in 2006; these gaps closed in 2016. The most inequitable practices in 2006 were MDD and iron‐rich foods (Q5 ~ 2–4 times higher than Q1); these gaps narrowed in 2016, but levels are low across SES groups. Factors along the path from SES inequalities to IYCF practices included health and nutrition services, information access, maternal education, number of children < 5 years, and urban/rural residence. The improvements in breastfeeding and narrowing of equity gaps in IYCF practices in India are significant achievements. However, ensuring the health and well‐being of India's large birth cohort will require more efforts to further improve breastfeeding, and concerted actions to address all aspects of complementary feeding across SES quintiles.

Highlights

  • Appropriate nutrition during early life, including adequate infant and young child feeding (IYCF) practices, is essential for optimal growth and development

  • A more in‐depth assessment of inequalities in IYCF practices, considering intersectionality (López & Gadsden, 2016) between wealth and residence, is essential for strategic investment, and targeting and planning of interventions to close the equity gap. We address this knowledge gap by focusing on three objectives: (a) examine trends in IYCF practices between 2006 and 2016, (b) assess the changes in absolute and relative socio‐ economic inequalities in IYCF practices in both rural and urban areas, and (c) identify factors associated with socio‐economic inequalities that explain differences in IYCF practices

  • The equity gaps in complementary feeding practices narrowed, complementary feeding shows slow progress and poor practices across all segments of society. These results call for special efforts to further improve breastfeeding, and concerted actions to address all aspects of complementary feeding across socio‐economic status (SES) quintiles

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Summary

| INTRODUCTION

Appropriate nutrition during early life, including adequate infant and young child feeding (IYCF) practices, is essential for optimal growth and development. In addition to socio‐economic factors, geographic inequalities such as state‐ specific or urban and rural residence disparities influence nutrition outcomes and their determinants, including access to health services and preventive and curative interventions. Evidence from 36 developing countries, including India, showed that complementary feeding practices are generally better in urban areas compared with rural areas, breastfeeding (BF) practices are consistently worse (Smith, Ruel, & Ndiaye, 2005). These studies examined inequalities for urban/rural and wealth quintile separately and focused on relative ratios, rather than more robust measures that take into account the cumulative population wealth distribution.

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