The report should serve as a wake-up call for healthcare professionals, policymakers, and society at large to reevaluate assumptions about infant feeding practices
Nepal Demographic and Health Survey (NDHS) 2022 challenges the conventional wisdom surrounding infant and young child feeding practices in Nepal. The first two years of a child's life are a critical period for promoting proper growth and development through optimal feeding practices. Evidence suggests that if universal coverage of optimal breastfeeding is achieved, it could prevent around 13 per cent of deaths in children under the age of 5 worldwide. Additionally, promoting appropriate complementary feeding practices could lead to an additional 6 per cent reduction in under-five mortality.
The government has been implementing the Integrated Infant and Young Child Feeding (IYCF) programme in all 77 districts.
IYCF recommended practices include initiating breastfeeding within the first hour after birth, exclusively breastfeeding for the first two days, exclusively breastfeeding for the first six months, continuing breastfeeding for at least two years, and introducing safe and appropriate complementary foods at six months of age.
The Sustainable Development Goal has set the target of achieving 90 per cent exclusive breastfeeding.
Likewise, it has targeted to have 80 per cent children fed according to recommended IYCF practices, reduce anemia among children under five to less than 15 per cent, and reduce overweight and obesity among children below five years to less than 1 percent.
The recently published sixth NDHS 2022 has revealed an unexpected trend among selective indicators of infant and young child feeding practices in Nepal.
According to this report, among families in the lowest wealth category, approximately two-thirds (62%) of children are breastfed within one hour of birth, and around fourfifths (82%) are exclusively breastfed for the first two days. Conversely, among families in the highest wealth category, only around two-fifths (41%) of children are breastfed within one hour of birth, and a similar proportion (40%) are exclusively breastfed for the first two days.
There is a noticeable difference in early initiation of breastfeeding and exclusive breastfeeding for the first two days based on mothers' education levels.
Children born to mothers with no education have higher rates of breastfeeding initiation and exclusive breastfeeding compared to those born to mothers with higher levels of education.
Among children born to mothers with no education, around three-fifths (61%) were breastfed within one hour of birth, and a little over half (58%) were exclusively breastfed for the first two days. In contrast, among children born to mothers with more than a secondary education, the figures were lower, with around one-third (36%) being breastfed within one hour of birth, and around one-third (32%) being exclusively breastfed for the first two days.
The percentage of children aged 0-5 months who are exclusively breastfed is significantly higher in the lowest wealth quintile, with two-thirds (64%) of children being exclusively breastfed. In contrast, only around one-third (44%) of children in the highest wealth quintile receive exclusive breastfeeding during this age range. Children of mothers with a secondary education are thrice as likely to receive mixed milk feeding (28%) compared to children whose mothers have no education (9%).As mother's education level increases, the proportion of children who are bottle-fed is four times higher.
Having a higher socioeconomic position is usually associated with better living and working conditions, access to nutritious food, healthier behaviours, and improved psychological well-being. Additionally, higher socioeconomic status has a positive impact on reducing health inequalities and promoting fairness in health outcomes.
However, according to NDHS 2022, children with lower socioeconomic status have better infant and young child feeding practices in Nepal.
In Sudurpashchim Province, almost double the percentage of children (69%) are breastfed within one hour of birth compared to Bagmati Province (43%). Similarly, the rate of exclusive breastfeeding for the first two days after birth is nearly double in Sudurpashchim Province (82%) compared to Bagmati Province (48%). In terms of location, two-thirds (63%) of children in rural areas are breastfed within one hour of birth, while slightly over half (51%) of children in urban areas receive the same.
The provincial and rural-urban differences in indicators further reinforce the inverse socioeconomic relationship with health behaviours concerning infant and young child feeding practices.
Traditionally, high socioeconomic status has been associated with better access to resources, including healthcare, education, and nutrition and vice versa.
However, the study's findings, based on a comprehensive survey conducted across various socioeconomic backgrounds, have turned this notion on its head.
One factor that could contribute to this paradox is the influence of cultural and societal norms. In some low socioeconomic communities, breastfeeding and proper infant feeding practices may be deeply ingrained cultural practices.
In contrast, the high socioeconomic group might be more susceptible to societal pressures, such as the promotion of convenience-oriented and commercialised feeding methods.
The report should serve as a wake-up call for healthcare professionals, policymakers, and society at large to reevaluate assumptions about infant and young child feeding practices. Efforts should be made to bridge the knowledge and practice gap across socioeconomic lines and ensure that all families, regardless of their socioeconomic status, have access to accurate and up-to-date information on optimal feeding practices.
By promoting a more refined understanding of infant and young child nutrition, we can work towards creating an environment for child development.
A version of this article appears in the print on July 10, 2023, of The Himalayan Times.