Consumption of breast milk, formula and other non-human milk by children aged under 2 years: analysis of eighty-six low- and middle-income countries

Abstract

Objective: To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC).

Design: We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities.

Setting: Nationally representative surveys from 2010 onwards from eighty-six LMIC.

Participants: 394 977 children aged under 2 years.

Results: Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding.

Conclusions: Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.

Keywords: Breast milk substitutes; Breast-feeding; Developing countries; Economic status; Infant formula; Nutrition surveys; Socio-economic factors.

Fig. 1

Trajectories of the frequency of consumption of different types of milk by children’s age. Shaded lines represent 95 % CI. , Any breast-feeding; , formula consumption; , other milk consumption

Fig. 2

Trajectories of the frequency of consumption of different types of milk by children’s age, by poorest and wealthiest quintiles. Shaded lines represent 95 % CI. , Any breast-feeding – Poorest; , any breast-feeding – Richest; , formula consumption – Poorest; , formula consumption – Richest; , other milk consumption – Poorest; , other milk consumption − Richest

Fig. 3

Relationship between feeding practices of children and absolute income (2011 international dollars, purchasing power parity). Each dot represents a wealth quintile in each survey (430 dots). World Bank income group: , low-income; , lower middle income; , upper middle income

Fig. 4

Top and bottom countries in relation to the feeding practices and absolute income (2011 international dollars, purchasing power parity) and relative wealth (represented as shaded dots in the background). Each dot represents a wealth quintile in each survey (430 dots). Wealth quintiles: , Poorest; , second; , third; , fourth; , wealthiest