From The First Hour Key Findings2016 For Web PDF

FROM THE FIRST
HOUR OF LIFE
Making the case for improved infant and
young child feeding everywhere
Key Findings
2016
THE IMPORTANCE OF INFANT AND YOUNG CHILD NUTRITION
UNICEF’s global report, From the First Hour of Life: Making the case for improved infant and young child feeding
everywhere provides information on how infants and young children are being fed and how these feeding practices
match up to the recommended guidelines on infant and young child feeding. This report tells a story about how
children are being fed, what obstacles stand in their way, and where and how we can urgently do better. Read the full
report at: <uni.cf/iycfreport2016>
What, when and how children are fed, before 6 months were up to 2.8 times more The importance of appropriate
particularly in the first two years of life, is likely to die than their exclusively breastfed complementary feeding
critical to health, development and survival. peers; the risk of dying was 14-fold higher Starting at 6 months of age, children’s
Across the world families invest time, among those not breastfed at all.2 In rich nutrient needs are greater than what
money, and care towards feeding their and poor countries alike, long periods of breastmilk alone can provide. Feeding
children, but despite their best efforts, they breastfeeding are associated with higher children solid, semi-solid or soft
face immense challenges. intelligence scores, and there is evidence foods from 6 months of age is key to
that this translates into improved academic prevent deficiencies that could result in
The importance of breastfeeding
performance and long-term earnings. undernutrition.4 Diets that meet at least
Breastmilk is more than just food – it is also
minimum frequency and diversity standards
a potent medicine that is tailored to the There is growing evidence that breastfeeding
are essential to preventing micronutrient
needs of each child.1 may also reduce the incidence of
deficiencies, stunting and wasting.
overweight, obesity and chronic diseases
Exclusive breastfeeding, feeding infants
later in life.1 Low rates of breastfeeding are If appropriate complementary feeding
nothing but breastmilk for the first six
responsible for losses of more than $230 practices were scaled-up to nearly universal
months of life, is the safest and healthiest
billion annually in high-income countries, levels, approximately 100,000 deaths
option for children everywhere and has great
and $70 billion annually in low- and middle- in children under five could be averted
potential to save lives. In low- and middle-
income countries.3 each year.5
income countries, infants who received
foods and liquids in addition to breastmilk
If the world was issued a scorecard for the way its infants and young children
were fed it would receive a failing grade
Age in months 0 5 6
+ 23 24
Recommended
Practices { Start
breastfeeding
within one hour
Breastfeed
exclusively for
the first 6 months
Provide nutritionally adequate, age appropriate and safely prepared complementary
foods starting at 6 months; and continue breastfeeding until age 2 or longer.
of birth of life
100
80
Percentage
60
74
64
40 52
45 43 46
20
29
16 23
0
{
Early initiation Exclusive Introduction of Minimum Minimum Minimum Continued Continued
Indicators of breastfeeding* breastfeeding* solid, semi-solid meal diet acceptable breastfeeding breastfeeding
<1 hour 0-5 months or soft foods* frequency* diversity* diet* at 1 year* at 2 years*
6-8 months 6-23 months 6-23 months 6-23 months 12-15 months 20-23 months
Per cent of children: put to the breast within one hour of birth, exclusively breastfed (0-5 months); introduced to solid, semi-solid or
soft foods (6-8 months), with a minimum meal frequency, minimum diet diversity and minimum acceptable diet (6-23 months) and
continued breastfeeding at 1 year (12-15 months) and 2 years (20-23 months), 2015.
Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. *See full report at <uni.cf/iycfreport2016> for notes on the data.
WOMEN AND FAMILIES CANNOT DO IT ALONE
The first two years of life are a critical opportunity to enhance a child’s future – but a heavy burden to place on
the shoulders of mothers and families alone. Good nutrition in the earliest years is a collective responsibility.
Government leadership and contributions from key sectors – including health, agriculture, water and sanitation,
social protection and education – as well as the private sector, workplaces and families and communities, are needed
to support mothers and families to provide their children with the nutrition they need.
t
m
en
Health system
Breastfeeding is not a
rn
one-woman job
ve
Go
– it requires government
Family and
Early Childhood
Development
leadership and support

from families, communities,
workplaces and the health
system to really make it
Workplace
work.
Community
t
Children’s diets are a shared en
m
rn
responsibility – no single Health sector

ve
Go
Family and
household can do it alone. Early Childhood
Development
Social protection
All sectors of society need to POLICY
contribute to guarantee that

nutritious food for children is
Community
Agriculture
available, affordable, safe and

provided with care.
Private sector
Education
Water, sanitation
and hygiene
1. Victora, C.G., et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016. 387(10017): p. 475-90.
2. Sankar, M.J., et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr, 2015. 104(467): p. 3-13.
3. Rollins, N., et. al. Lancet Breastfeeding Series Group., Why invest, and what it will take to improve breastfeeding practices? The Lancet, 2016. 387(10017): p. 491-504.
4. WHO Programme of Nutrition. Complementary feeding of young children in developing countries: a review of current scientific knowledge. 1998, Geneva: World Health Organization.
5. Bhutta, Z.A., et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet, 2013. 382(9890): p. 452-77.
FOCUS ON BREASTFEEDING
Children should be put to the breast immediately after birth, be breastfed exclusively for the first 6 months of life
and continue to be breastfed after solid foods are introduced from 6 months to 2 years and beyond.
Key Findings
Of the 140 million live births in 2015,
• Globally, less than half of all newborns are put to the breast within an hour of birth.
• While there is enormous potential for skilled birth attendants to better support
women in initiating breastfeeding immediately after birth – this is not happening
everywhere. In the Middle East and North Africa, for example, fewer newborns
delivered with the assistance of a skilled attendant were put to the breast within an newborns had to wait too long
hour of birth than newborns delivered by unskilled attendants. to be put to the breast.
• While the case of exclusive breastfeeding is sound and compelling, less than half
of children under 6 months of age receive nothing but breastmilk for the first 6
months of life. Progress on exclusive breastfeeding is also slow – with only South
Asia making notable strides the past 15 years.
• The International Code of Marketing of Breastmilk Substitutes is crucial to protect
and promote breastfeeding by prohibiting the promotion of breastmilk substitutes
such as infant formula. However, the strength and comprehensiveness of these
measures vary widely across countries. More than half of countries in Latin
Only 45 per cent of newborns were put to the
American and the Caribbean, East Asia and the Pacific and CEE/CIS have only breast within the first hour of life.
minimal or no legislation in place.
= 10 million newborns
• Globally, continued breastfeeding rates drop between children’s ages of 12 and 23
months – from 74 per cent to 46 per cent.
While there is enormous potential for skilled birth attendants to better support women
in initiating breastfeeding immediately after birth – this is not happening everywhere.
100
Latin America and
Middle East and
Southern Africa
the Caribbean*
90
Central Africa
East Asia and

North Africa
South Asia*
Eastern and
the Pacific*
West and
CEE/CIS*
80
Other*
70
65
60 63
Percentage
57 58
50
51
48 49
47 47
45
40
40 39
30 34
Skilled birth attendant (e.g.,
doctor, nurse, midwife)
insufficient births
20
Unskilled birth attendant

10
No data
No data
(e.g., traditional birth

attendant) or others (e.g.,
0 relatives)
Marginally higher rates Marginally higher rates Rates about the same/no comparison available
with skilled attendants with unskilled/other
Per cent of newborns put to the breast within one hour of birth by type of birth delivery attendant, by region, 2015
Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. * See full report at <uni.cf/iycfreport2016> for notes on the data.
Global progress on exclusive breastfeeding rates has been slow, but
progress is possible – South Asia has made the greatest strides of
all regions
100
Latin America and

Middle East and
Southern Africa
the Caribbean
90
Central Africa
East Asia and
North Africa
Eastern and
South Asia
the Pacific*
West and
CEE/CIS*
80
World*
Other*
70
60 64
Percentage
50 54
47 46
40 43
36
30 33 33
31 30 30 30 30
26
20
20 21
Around 2000
No data
No data
10
0 Around 2015
Trends in per cent of infants aged 0-5 months exclusively breastfed, by region, around 2000 and around 2015
135 countries
have some legal • 70/194
measures in •
•
7/21 World
•
line with the •
• CEE/CIS
0/37
Code – yet most Other*
•
of these need ••
to be further No legal measures 7/8

8/29
East Asia and

strengthened Few provisions in law •
10/19 South Asia the Pacific
Middle East and
Many provisions in law 13/24 North Africa •
West and
Full provisions in law Central Africa
•
no data
13/33
Total number of countries Latin America and 12/23

in the region
the Caribbean Eastern and
Number of countries with full
or many provisions in law Southern Africa
Status of national measures on the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World
Health Assembly resolutions, by country and by region*, 2016
Source: WHO, UNICEF, IBFAN. Marketing of Breast-milk Substitutes: National Implementation of the International Code. Status Report 2016. Geneva: World Health Organization; 2016.
( • denotes countries have no dedicated Code legislation, but have Code-related provisions incorporated in other legal measures.). See full report at <uni.cf/iycfreport2016> for notes on
the data.
FOCUS ON COMPLEMENTARY FEEDING
Starting at 6 months, children need to be fed with nutritionally adequate,
age appropriate and safely prepared
Of thesolid foods in
140 million addition
live to 2015,
births in breastmilk. Globally, only
Key Findings
• The late introduction of solid, semi-solid or soft foods poses a threat to growth and
1 in every 6
development; this is worrying since about one third of infants 6–8 months old are not children is receiving
newborns
of solidhad toiswait too long and globally,
yet eating solid foods. Early introduction
4 and
foods
to be put to the breast.
more than one quarter of infants between 5 months
also of
of age
concern,
are already consuming a minimum
solid foods.
acceptable diet.
• Children need to eat frequently throughout the day to meet their energy needs, but
globally half of all children 6-23 months of age are not being fed even the recommended
minimum number of meals a day. The regions where stunting rates are highest, namely
South Asia and sub-Saharan Africa, have the lowest rates of minimum meal frequency
of all.
• Eating a diverse diet helps ensure children consume all of the essential nutrients their
growing bodies demand, but lessOnly than45one
perthird of newborns
cent of the world’s infants
were put toand
the young + 4+
children are receiving a diet with the recommended minimum variety
breast within the first hour of life. of foods (food
from at least four food groups). In South Asia and sub-Saharan Africa, the situation is frequency diversity
= 10 million newborns
dire: only one in five children aged 6–23 months is eating a minimally diverse diet.
The minimum acceptable diet refers to
• Alarmingly, only 1 out of every 6 children age 6-23 months is receiving a minimum meeting both the minimum meal frequency
acceptable diet, which refers to meeting both the minimum number of meals and and minimum diet diversity.
minimum diet diversity.
More than one-third of infants are receiving their first foods too early, and far
too many are receiving their first foods too late
Latin America and
Middle East and

Southern Africa
the Caribbean*
Central Africa
East Asia and
North Africa
Eastern and
the Pacific*
South Asia
West and
CEE/CIS*
Other*
World
100
93
91 90
90 88 91
87 87
88
82 87 84 83
80 81 80 84
80 82
81 79 78
83
76 79
78 75
76
75
70 70
70 68
65 68
65
60 58 58
57
Percentage
58
57 54
54
50 48 49
47 49
47
40
33 34
34
30 33
29
27 29
27
22
20 18 19
19
No data
14 18
13 13 13
14 11
10 13 13
9
7 6
11
7 4 4 5 5 5
9
5
6
4 4 1 1 5 5 5
0
age in
10-11
10-11
10-11
10-11
10-11
10-11
10-11
10-11
10-11
0-1
0-1
0-1
0-1
0-1
0-1
0-1
0-1
0-1
6-7
6-7
6-7
6-7
6-7
6-7
6-7
6-7
6-7
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
2-3
4-5
8-9
8-9
8-9
8-9
8-9
8-9
8-9
8-9
8-9
months
Per cent of children fed solid, semi-solid or soft foods, by age and by region, 2015
52%
World
Half of all
children are
not receiving a 78%
minimum meal Latin America and
the Caribbean
frequency <20% East Asia and
the Pacific*
20-39% South Asia
Middle East and
40-59%
West and North Africa %
60-79% Central Africa
≥80
no data Eastern and

Southern Africa
Per cent of children 6-23 months of age with minimum meal frequency, 2015
Source: UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources, 2010-2016. *See full report at <uni.cf/iycfreport2016> for notes on the data.
Less than a third of children 6-23 months of age receive a minimum diet
diversity, and rates are lowest among infants 6-11 months old
Latin America and
Middle East and
Southern Africa
the Caribbean
Central Africa
East Asia and
North Africa
Eastern and
South Asia
the Pacific
West and
CEE/CIS
Other*
(n=53)
(n=13)
(n=18)
World
(n=5)
(n=4)
(n=5)
(n=4)
(n=4)
Types of food groups

100
90
80
70
7 food groups
60
6 food groups
Percentage
50
5 food groups
40
4 food groups
30 3 food groups
20 2 food groups
No data
10 1 food groups
0 food groups
0
age in 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23 6-11 12-17 18-23
months
Per cent (unweighted) of children 6-23 months of age in each food group category, by age and by region, 2015
THE WAY FORWARD
What do we need to do better to support What do we need to do better to support
breastfeeding? complementary feeding?
• Fully implement the International Code of Marketing of • Enact legislation and adopt policies in line with the Guidance
Breastmilk Substitutes and relevant World Health Assembly on Ending the Inappropriate Promotion of Foods for Infants
resolutions through strong legal measures that are enforced and Young Children to prohibit the inappropriate promotion of all
and independently monitored by organizations free from commercially produced food or beverage products marketed as
conflicts of interest. suitable for children up to 3 years of age.
• Enact family leave and workplace breastfeeding policies, • Select and combine multiple strategies and interventions that
building on the International Labour Organization’s maternity are evidence-based and informed by adequate situation analyses.
protection guidelines as a minimum requirement, including • Create a healthy and nurturing feeding environment within
provisions for the informal sector. households and communities. Early childhood development
• Implement the Ten Steps to Successful Breastfeeding in interventions that stimulate and encourage responsive feeding
maternity facilities, including providing breastmilk for sick and should be integral to child nutrition programmes.
vulnerable newborns. • Coordinate actions among key government sectors, including
• Improve access to skilled lactation counselling as part of health, agriculture, water and sanitation, social protection and
comprehensive breastfeeding policies and programmes in education.
health facilities. • Harness the potential of the private sector to create food
• Strengthen links between health facilities and solutions and hold them accountable for complying with food
communities, and encourage community networks that production, labelling and marketing regulations.
protect, promote, and support breastfeeding. • Create monitoring systems to track progress effectively.
• Create monitoring systems that track the progress of Governments need to collect credible and comprehensive data on
policies, programmes, and funding towards achieving both infant and young child feeding, aligned with the standard global
national and global breastfeeding targets. indicators.
To truly change this story, we need greater recognition that good nutrition in the earliest days of life
matters deeply; this should translate to greater investment for infant and young child nutrition.
Improved infant and young child

nutrition is fundamental to
guaranteeing children a brighter and
more equitable future. We all have a
responsibility to make it happen.
Let’s start now.
© United Nations Children’s Fund (UNICEF)

data@unicef.org | www.unicef.org
For the full report please visit:

http://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

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FROM THE FIRST

leadership and support

responsibility – no single Health sector

All sectors of society need to POLICY

contribute to guarantee that

available, affordable, safe and

East Asia and

Unskilled birth attendant

(e.g., traditional birth

Latin America and

to be further No legal measures 7/8

East Asia and

Total number of countries Latin America and 12/23

Middle East and

no data Eastern and

Middle East and

Types of food groups

Improved infant and young child

Let’s start now.

© United Nations Children’s Fund (UNICEF)

For the full report please visit:

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