Abstract
SummaryBackgroundPrevious analyses of trends in feeding indicators of children younger than 2 years have been limited to low-income and middle-income countries. We aimed to assess time trends in the consumption of different types of milk (breastmilk, formula, and animal milk) by children younger than 2 years from 2000 to 2019 at a global level.MethodsIn this time-series analysis, we combined cross-sectional data from 487 nationally representative surveys from low-income and middle-income countries and information from high-income countries to estimate seven infant and young child feeding indicators in up to 113 countries. Multilevel linear models were used in pooled analyses to estimate annual changes in feeding practices from 2000 to 2019 for country income groups and world regions.FindingsFor the absolute average annual changes, we found significant gains in any breastfeeding at age 6 months in high-income countries (1·29 percentage points [PPs] per year [95% CI 1·12 to 1·45]; p<0·0001) and at age 1 year in high-income countries (1·14 PPs per year [0·99 to 1·28]; p<0·0001) and upper-middle-income countries (0·53 PPs per year [0·23 to 0·82]; p<0·0001). We also found a small reduction in low-income countries for any breastfeeding at age 6 months (−0·07 PPs per year [–0·11 to −0·03]; p<0·0001) and age 1 year (−0·13 PPs per year [–0·18 to −0·09]; p<0·0001). Data on exclusive breastfeeding and consumption of formula and animal milk were only available for low-income and middle-income countries, where exclusive breastfeeding in the first 6 months of life increased by 0·70 PPs per year (0·51–0·88; p<0·0001) to reach 48·6% (41·9–55·2) in 2019. Exclusive breastfeeding increased in all world regions except for the Middle East and north Africa. Formula consumption in the first 6 months of life increased in upper-middle-income countries and in east Asia and the Pacific, Latin America and the Caribbean, the Middle East and north Africa, and eastern Europe and central Asia, whereas the rates remained below 8% in sub-Saharan Africa and south Asia. Animal milk consumption by children younger than 6 months decreased significantly (−0·41 PPs per year [–0·51 to −0·31]; p<0·0001) in low-income and middle-income countries.InterpretationWe found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries. To achieve the global target of 70% exclusive breastfeeding by 2030, however, rates of improvement will need to be accelerated.FundingBill & Melinda Gates Foundation, through WHO.
Highlights
WHO recognises that breastfeeding is essential for achieving optimal child growth, development, and health
Interpretation We found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries
No multi-country studies are available on the consumption of non-human milk other than formula in children younger than 2 years. Aiming to address these gaps, we examined time trends and worldwide patterns in the consumption of different types of milk by children aged under 2 years, in 113 countries from 2000 to 2019
Summary
WHO recognises that breastfeeding is essential for achieving optimal child growth, development, and health. The organisation recommends that children initiate breastfeeding within the first hour of life, breastfeed exclusively for the first 6 months, and thereafter receive adequate and safe complementary foods while breast feeding continues up to age 2 years or beyond.[1,2] For children, breastfeeding protects against infections and malocclusion; is associated with increases in intelligence quotient points in childhood, adolescence, and adulthood; and is likely to reduce the risk of overweight and diabetes.[3] Women who breastfeed their children have a reduced risk of ovarian and breast cancer, and breastfeeding promotes spacing out births.[3] some parents are unwilling or unable to breastfeed their children, breastfeeding is regarded as an essential component of optimal nurturing care for child health and development globally.[3,4] Suboptimal breastfeeding is estimated to cause almost 600 000 annual child deaths from pneumonia and diarrhoea alone and the death of nearly 100 000 women from breast and ovarian cancer and type 2 diabetes.[5]
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