Optimal feeding practices of infants can increase their chances of survival. They play an important role for healthy growth and development, decrease rates of stunting and obesity and stimulate intellectual development (UNICEF, 2019[1]).
Breastfeeding is an unequalled way of providing nutrition for infants. Breast milk gives infants the nutrients they need for healthy development, including the antibodies that help protect them from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of under-five child mortality worldwide. Breastfeeding is also linked with better health outcomes later in life. Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type 2 diabetes (Horta, Victora and WHO, 2013[2]; Horta, Loret de Mola and Victora, 2015[3]; Victora et al., 2016[4]). Breastfeeding among other factors can be associated with higher school attendance and higher income in adult life. More than 800 000 deaths amongst children under five could be saved every year globally if all children 0‑23 months were optimally breastfed. Breastfeeding also benefits mothers through assisting in fertility control, reducing the risk of breast and ovarian cancer later in life and lowering rates of obesity (UNICEF, 2019[1])
The WHO Baby-Friendly Hospital Initiative outlines detailed recommendations on protecting, promoting, and supporting breastfeeding in facilities providing maternal and newborn services (WHO, 2017[5]). WHO and UNICEF recommend early initiation of breastfeeding within 1 hour of birth, exclusive breastfeeding for the first 6 months of life, and introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.
Globally rates of exclusive breastfeeding in the first six months of life have increased by 10 percentage points over the past decade and are at 48% for 2023, close to the World Health Assembly target of 50% by 2025 (WHO/UNICEF, 2023[6]). In the Asia-Pacific region, Sri Lanka, the Solomon Islands, DPRK, India, Papua New Guinea, Mongolia, Nepal, Bangladesh, Myanmar, Indonesia and Cambodia have already achieved this target). The proportion of infants exclusively breastfed for the first six months of life in lower-middle- and low-income Asia-Pacific countries was 1.5 times the proportion reported in upper-middle-income countries. Policies and regulations on marketing of breast-milk substitutes and workplace support to breastfeeding as well as breastfeeding counselling in health facilities and societal beliefs favouring mixed feeding contribute to variations in exclusive breastfeeding rates across countries (Local Burden of Disease Exclusive Breastfeeding Collaborators, 2021[7]).
However, several Asia-Pacific countries and territories are lagging as less than 40% infants was exclusively breastfed in China and Thailand). Key factors contributing to inadequate breastfeeding rates include unsupportive hospital and healthcare practices and policies; lack of adequate skilled support for breastfeeding, specifically in health facilities and the community; aggressive marketing of breast milk substitutes and inadequate maternity and paternity leave legislation and unsupportive workplace policies (UNICEF, 2019[1]). Several countries and territories which increased exclusive breastfeeding practice have implemented these policies. In 2012, Viet Nam’s National Assembly amended its Labour Code to extend paid maternity leave from four to six months. It decided that public funds would be allocated to cover the cost to reduce the possibility that women would face discrimination in recruitment because of the longer paid leave period. Viet Nam’s exclusive breastfeeding rates increased from 24% in 2014 to 45% in 2020 (WHO/UNICEF, 2023[6]). In Pakistan, Infant and Young Child Feeding (IYCF) counselling services rebounded, following significant disruptions in 2020 due to the COVID‑19 pandemic. In 2021, 7.8 million mothers and caregivers received IYCF counselling through health facilities and in communities – a more than five‑fold increase from 1.4 million in 2020. More than 10 700 healthcare providers built their capacity to provide IYCF counselling via the UNICEF comprehensive training package. Community-led peer support groups were established as well. Pakistan has seen an increase in exclusive breastfeeding rates from 38% in 2013 to 48% in 2018 (WHO/UNICEF, 2023[6]). However it remains difficult to achieve sustained improvements in exclusive breastfeeding practice even if countries see improvement – therefore sustained and broad-based support is essential.
After the first six months of life, an infant needs additional nutritionally adequate and safe complementary foods, while continuing breastfeeding. Appropriate complementary foods were introduced to around half of the children between 6‑8 months in India, whereas complementary foods were introduced to more than nine out of ten infants in Fiji and Sri Lanka (Figure 4.5).
In Cambodia, Mongolia, Lao PDR, Nepal, Philippines, India, Bangladesh and Indonesia, the rate of exclusive breastfeeding was relatively higher amongst women living in households in the poorest income quintile as compared to women living in the richest households (Figure 4.6). Across countries and territories in Asia-Pacific, a higher level of education was not always associated with a higher rate of exclusive breastfeeding. While in Myanmar, Papua New Guinea Bangladesh and Mongolia women with the highest education level were much more likely to follow exclusive breastfeeding recommendations than those with the lowest education, the opposite trend was observed in countries and territories such Cambodia and Viet Nam. In Thailand, women living in rural areas are almost 2 times more likely to breastfeed as compared to women living in urban areas.
Considering persisting high levels of childhood malnutrition (see indicator “Child malnutrition and overweight” in Chapter 4), infant feeding practices must be further improved (UNICEF, 2019[1]).
