2nd World Breastfeeding Conference
Johannesburg, South Africa – 11-14 December 2016
Promotion of Complementary Feeding
for Optimal Growth and Development
By France Bégin, Ph.D.
Stunting prevalence, 2015
Percentage of stunted children under 5, by country, 2015
One out of every three infants is waiting too long
for his or her first solid, semi-solid or soft foods
Per cent of infants 6-8 months of age fed solid, semi-solid or soft foods, 2015
Source: UNICEF global databases, 2016
Per cent of children fed solid, semi-solid or soft foods, by age and by region, 2015
Source: UNICEF global databases, 2016
World
Other**
South Asia
Middle East and
North Africa
West and
Central Africa
CEE/CIS*
Eastern and
Southern Africa
Latin America and
the Caribbean
East Asia and
the Pacific*
More than one-third of infants are receiving their
first foods too early
Globally, even in the richest households, far too
few receive a minimum meal frequency
Latin America and the
Caribbean (n=10)
CEE/CIS
(n=11)
East Asia and the Pacific
(n=6)
South Asia
(n=5)
Middle East and North
Africa (n=8)
Eastern and Southern
Africa (n=14)
West and Central Africa
(n=22)
World
(n=76)
Percentage
●poorest ●richest
Per cent (unweighted) of children aged 6-23 months with
minimum meal frequency, by wealth quintile and region, 2015
Source: UNICEF global databases, 2016
Only one in four children is eating food from the
minimum number of food groups
Per cent of children 6-23 months of age with the minimum diet diversity, 2015
Source: UNICEF global databases, 2016
The gap between the richest and poorest children
for diet diversity is stark
East Asia and the Pacific
(n=5)
CEE/CIS
(n=5)
Latin America and the Caribbean
(n=4)
Middle East and North Africa
(n=5)
Eastern and Southern Africa
(n=12)
South Asia
(n=5)
West and Central Africa
(n=22)
●poorest ●richest
World (n=76)
Percentage
Per cent (unweighted) of children aged 6-23 months with
minimum diet diversity, by wealth quintile and region, 2015
Source: UNICEF global databases, 2016
World
(n=53)
Other*
West and
Central Africa
(n=18)
South Asia
(n=4)
Eastern and
Southern Africa
(n=13)
Middle East (and
North Africa n=4)
East Asia and
the Pacific (n=4)
CEE/CIS (n=5)
Latin America
and the
Caribbean (n=5)
Children 6–11 months of age have the least
diverse diet
Food groups
7 food groups
6 food groups
5 food groups
4 food groups
3 food groups
2 food groups
1 food groups
0 food groups
Per cent (unweighted) of children 6-23 months of age in each food group category, by age and by region, 2015
Source: UNICEF global databases, 2016
World*
Other***
Middle East
and North
Africa
West and
Central Africa
Eastern and
Southern
Africa
South Asia
East Asia and
the Pacific*
CEE/CIS***
Latin America
and the
Caribbean*
Globally, the vast majority of children are eating only
one type of animal source food – or none at all
Number of types of animal
source foods consumed****
types of animal source foods
types of animal source foods
types of animal source foods
types of animal source foods
Per cent of children 6-23 months of age in each animal source food group category, by age and by region, 2015
Source: UNICEF global databases, 2016
Consumption of type of animal source food varies
by age
Source: UNICEF global databases, 2016
Results of multivariate analysis: number of animal source
food groups and stunting
***
***
1 types of animal source food
**
2 types of animal source food
(vs. reference of 3 types)
1.0
*p<0.05; ** p<0.01, ***p<0.001
Controlled for 12 other factors related to stunting
Odds ratio
Only one in every six children is getting a diet that has both
the minimum diversity and minimum frequency
Per cent of children 6-23 months of age with a minimum acceptable diet, 2015
Source: UNICEF global databases, 2016
Continued breastfeeding is integral part of
complementary feeding
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.
We know
what works…
Optimize utilization of local foods and improve
feeding practices
Community IYCF counselling package now used
in 66 countries
Community IYCF Counselling Package:
more than just training community health workers
• Strategic collaboration between UNICEF HQ, Nutrition Policy and
Practice (NPP), Center for Human Services, University Research
Co (URC/CHS)
• First version 2010, updated in 2012
• Contents of package:
– Planning Guide; Adaptation Guide; Facilitator Guide;
Participant Materials, training “handouts”; IYCF Counselling
Cards (28); Key Messages Booklet; Take-home Brochures (3);
Supportive Supervision/Mentoring, monitoring, mentoring
guide (since 2013)
• Focus on skills building
• Training: participatory adult learning techniques for people of low
literacy
Assessing the package in Nigeria
Aminci Support Group
members contribute
money to a common
pool of funds that can
be used to increase the
diversity of foods eaten
by their families
Communication for behavior and social change
Example from Alive & Thrive projects
Interpersonal communication and mass
communication had a combined and mutually
reinforcing impact
Using multiple delivery channels
SCALE
Half million contacts in a typical month,
phase 1 Bangladesh (BRAC)
Monthly average March-May, 2012
21
Results – Alive & Thrive project
Feeding with love and care
“Feed your child with love, patience and humor”
Peru
Increase availability of quality local foods
Agriculture
diversification +
nutrition education
Increase affordability and access to quality foods
• Income-generating
activities
• Vouchers/coupons,
cash transfers and other
social safety nets
• Fortified complementary
foods or home
fortification, when
needed
Promote adequate complementary feeding
during illnesses
Children given less or denied liquids and foods in
diarrhea
100
Feeding practices of sick children during diarrhea (INDIA)
90
0- 5 months
80
6-11 months
11 - 23 months
70
Percentage (%)
60
50
40
30
20
10
0
More liquids Same amt of
liquids
LIQUIDS
Less Liquid
Stopped
More Foods Same amt of
food
Less food
FOOD
Stopped
Never gave
food
NFHS survey data
2006
Summary of Literature Review on IYCF during
and after common illnesses (1990-2014)
• Diarrhea and pneumonia are leading
infectious causes of childhood
morbidity and mortality
• Most information is limited and
restricted only to diarrhea.
Information on IYCF after illnesses
is non-existent.
• IYCF behaviors and practices during
illness are sub-optimal
• Health professionals give little or
no advice to mothers/caregivers
Global meeting
recommendations
G
Global meeting Recommendations
1.
2.
3.
4.
5.
6.
7.
Communicate clearly that adequate complementary
contribute to short and long term outcomes
There Is no single strategy that can work universally or in
isolation – programs need to combine 2 or more strategies
Implementation of strategies and approaches need to be
evidence-based
Multiple sectors relevant to food systems are needed
Evidence-based behaviour change communication is an
essential component
Monitoring and evaluation tools and processes must be
aligned with programme design, information needs and the
time and resources available
Advocacy needs to address significant resources required
The Way Forward for 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 environment within
households and communities. Early childhood development
interventions that stimulate and encourage responsive feeding
should be integral to child nutrition programmes.
The Way Forward for Complementary Feeding
• 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.
Look out for the First Foods (MCN Journal)
coming out soon!
Thank you!