Proportion of infants 0-5 months of age who are fed exclusively with breast milk
The percent of infants ages 0 to 5 months who received only breast milk during the previous day, with no other solids or liquids, including water (UNICEF/WHO, 2009). Exclusively fed infants are allowed to have drops of vitamins/minerals/medicines. The time frame 0-5 months includes from birth through the end of the infant’s fifth month of life. This indicator includes breastfeeding by a wet nurse and feeding expressed breast milk. An alternative definition includes only infants who are fed exclusively at the mother’s breast, which captures more of the maternal and infant bonding and biological aspect of exclusive breastfeeding on the mother. This indicator is calculated as: (Number of infants 0 to 5 months exclusively breastfed / Total number of infants 0 to 5 months) x 100 For more detail on this and related indicators, see: WHO NLIS (2010); UNICEF/WHO (2009); UNICEF et al. (2007); WHO (1991).
A 24-hour recall of food consumption of infants less than six months of age. WHO’s Indicators for Assessing Breast-feeding Practices (1991), the Demographic Health Survey (DHS) and UNICEF Multiple Indicator Cluster Surveys (MICS) all calculate the exclusive breastfeeding rate (EBR) using the prompted 24-hour recall method. Evaluators can obtain the best estimates of exclusive breastfeeding from current status data in cross-section surveys. The primary advantage of this approach is that it reduces subject recall error. Evaluators should interpret the measure as the percent of infants who are currently being exclusively breastfed, rather than the percent exclusively breastfed since birth. The indicator can be further disaggregated into 0-1 months; 2-3 months; 4-5 months; and 0-3 months (UNICEF et al., 2007). Where the data are available, this indicator also can be disaggregated by the mother’s age, parity, education, income quintiles, and urban/rural residences.
Population-based surveys employing representative samples (e.g., DHS, MICS); The DHS country reports and Nutrition Reports both present the EBR incrementally for infants 0-5 months of age. The MICS and WHO Nutrition Landscape Information System (NLIS) databases report EBR for 0-<4 and 0-<6 months. Program records of EBR can be used to track trends but not impact.
This indicator estimates the level of exclusive breastfeeding of infants through the end of their fifth month and can be used to examine current EBR and trends over time. Indicators of current breastfeeding practices are sensitive to changes resulting from program activities. Human breast milk alone is the ideal food for infants in the first six months of life. Even in hot, dry climates, breast milk contains sufficient water for an infant’s needs. Additional water or sugary drinks are unnecessary to quench the infant’s thirst, and they can also be harmful. If the infant is also given water, or drinks made with water, then the risk of diarrhea and other illnesses increases. The WHO/UNICEF Baby Friendly Hospital Initiative has laid out the linkages for how breastfeeding and complementary feeding contribute to achieving each of the eight of the Millennium Development Goals (WHO/UNICEF, 2009).
Using a 24-hour recall period to measure current status may slightly overestimate the proportion of exclusively breast-fed infants since birth because some infants who are given other liquids irregularly may not have received them in the 24 hours before the survey. Retrospective data, such as, information collected on past breastfeeding practices at 12 or 24 months postpartum are subject to recall bias and not recommended for estimating the EBR during the first six months.
breastfeeding (BF), family planning, newborn (NB)
The rate of exclusive breastfeeding, if disaggregated by sex, can be an indication of whether gender bias exists in the country. In the south Gujarat region of India, Chudasama et al. (2009) found no gender bias in initiating breastfeeding, while Malhotra et al. (2008) report that termination of breastfeeding of female children is significantly earlier than of male children in urban India. Sen (2001) reported gender differences in the duration of breastfeeding by women in rural India. Breastfeeding of daughters was discontinued in the first six months more often than of sons. Sen identifies early discontinuation of exclusive breastfeeding as one of several factors ultimately contributing to a lower female/male sex ratio in India as compared to countries where son preference is not evident for (Sen, 2001).
Chudasama, R.K., Patel, P.C., Kavishwar, A.B., 2009, “Breastfeeding initiation practice and factors affecting breastfeeding in South Gujarat region of India,” The Internet Journal of Family Practice™ ISSN: 1528-8358.
Malhotra, R., Noheria, A., Amir, O., Ackerson, L.K., and Subramanian, S.V., 2008, “Determinants of termination of breastfeeding within the first 2 years of life in India: evidence from the National Family Health Survey-2,” Maternal Child Nutr, 4(3): 181-103.
Sen, A., 2001, “Many Faces of Gender Inequality,” Frontline 18, 22. UNICEF, UC Davis, USAID, IFPRI, WHO, 2007, Indicators for assessing infant and young child feeding practices, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf
UNICEF and WHO, 2009, Tracking Progress on Child and Maternal Nutrition. http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
WHO, 2010, Integrated WHO Nutrition Global Database: Nutrition Landscape Information System (NLIS), Geneva: WHO. http://apps.who.int/nutrition/landscape/search.aspx?dm=51&countries=&year=all&ses=all
WHO/UNICEF, 2009, Baby-Friendly Hospital Initiative: Revised, updated and expanded for integrated care, Geneva: WHO. http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/
WHO, 1991, Indicators for Assessing Breast-feeding Practices, Geneva: WHO. http://www.who.int/child_adolescent_health/documents/cdd_ser_91_14/en/index.html