Background Early introduction of liquid/solid food before 6 months of age is one of the major barriers to exclusive breastfeeding. Our objective was to analyze the evolution of infant feeding practices for infants under 6 months of age in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010. Method Cross-sectional time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six Latin America and Caribbean countries: Bolivia (1994 to 2008), Colombia (1995 to 2010), Dominican Republic (1996 to 2013), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2018). Pooled sample comprised of 22,545 infants under the age of 6 months. Surveys were grouped in three decades: 1990s for surveys from 1990 to 1999, 2000s for surveys from 2000 to 2009, and 2010s for surveys from 2010 to 2017. Exclusive breastfeeding (EBF), predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, infant formula, semi-solid/solid) were analyzed. Prevalence of breastfeeding and food indicators were calculated in pooled sample, according to the infant monthly age groups, decade of survey and residence area(rural/urban). Results Between 1990s and 2010s, there was an increase in the exclusive breastfeeding prevalence (1990s = 38.1%, 2010s = 46.6%) and a reduction in the PBF prevalence (1990s = 51.7%, 2010 s = 43.1%). There was a decrease in the liquids (1990s = 40.7%, 2010s = 15.8%) and milk prevalence (1990s = 20.4%, 2010s = 8.3%) and an increase in water (1990s = 32.3%, 2010s = 37.6%), and infant formula (1990s = 16.6%, 2010s = 25.5%) prevalence. All breastfeeding indicators, except exclusive breastfeeding, progressively increased according to the monthly age group in three decades, and EBF prevalence sharply decreased from 2 to 3 months of age in all decades. Exclusive breastfeeding prevalence was higher in rural area in the three decades (1990s rural = 43.8%, 1990s urban = 32.4%, 2010s rural = 51.1%, 2010s urban = 42.4%) and infant formula prevalence was higher in urban area (1990s rural = 8.6%, 1990s urban = 24.6%, 2010s rural = 15.9%, 2010s urban = 34.1%). Conclusions In the last three decades, in all age groups, there was an increase in exclusive breastfeeding prevalence, as well as a significant reduction in liquids and milk. In the rural area, EBF prevalence remains higher than in urban. Increased water and infant formula feeding are the main barriers to achieving the Global Nutrition Target 2025 for exclusive breastfeeding.

Background: The World Health Organization set a global nutrition target to increase the rate of exclusive breastfeeding (EBF) among infants younger than 6 months to at least 50% by the year 2025. Yet, the early introduction of solid food (before 6 months of age) occurs in approximately one in three infants, making it a major barrier to EBF. The aim of this study was to analyze the evolution of the early introduction of foods offered to infant under the age of six months in Latin American and Caribbean countries in the last three decades (1990, 2000,2010).Method: This is a time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six countries in Latin America and the Caribbean: Bolivia (1994 to 2008); Colombia (1995 to 2010), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2012) and the Dominican Republic (1996 to 2013). The total sample consisted of 20,633 infants under the age of six months. Surveys were grouped in three decades as following: 1990s for surveys from 1990 to 1999; 2000s for surveys from 2000 to 2009; and 2010s for surveys from 2010 to 2017. EBF, predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, formula and semi-solid/solid) were analyzed. Mean prevalence rates of breastfeeding and food indicators were calculated for all countries, according to monthly age groups and decade of survey.Results: Between 1990s and 2010s, there was an increase in the mean prevalence of EBF (38.6% and 46.2%, respectively) and a reduction in the mean prevalence of PBF (50.8% and 43.0%, respectively). There was a reduction in the means of liquids (1990s=40.4%,2010s=15.9%) and milk (1990s=20.3%,2010s=8.4%) and an increase in water (1990s=31.7%,2010s=37.5%), and formula (1990s=16.4%, 2010s=25.8%).Conclusions: In the last three decades, n all age groups, there was an increase in the prevalence of EBF, as well as a significant reduction in fluids and milk. The increased supply of water and infant formula are the main barriers to achieving the Global Nutrition Target 2025 for EBF.

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