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Background Previous analyses of trends in feeding indicators of children younger than 2 years have been limited to low-income and middle-income countries. We aimed to assess time trends in the consumption of different types of milk (breastmilk, formula, and animal milk) by children younger than 2 years from 2000 to 2019 at a global level.Methods In this time-series analysis, we combined cross-sectional data from 487 nationally representative surveys from low-income and middle-income countries and information from high-income countries to estimate seven infant and young child feeding indicators in up to 113 countries. Multilevel linear models were used in pooled analyses to estimate annual changes in feeding practices from 2000 to 2019 for country income groups and world regions. Findings For the absolute average annual changes, we found significant gains in any breastfeeding at age 6 months in high-income countries (1•29 percentage points [PPs] per year [95% CI 1•12 to 1•45]; p<0•0001) and at age 1 year in high-income countries (1•14 PPs per year [0•99 to 1•28]; p<0•0001) and upper-middle-income countries (0•53 PPs per year [0•23 to 0•82]; p<0•0001). We also found a small reduction in low-income countries for any breastfeeding at age 6 months (-0•07 PPs per year [-0•11 to -0•03]; p<0•0001) and age 1 year (-0•13 PPs per year [-0•18 to -0•09]; p<0•0001). Data on exclusive breastfeeding and consumption of formula and animal milk were only available for low-income and middle-income countries, where exclusive breastfeeding in the first 6 months of life increased by 0•70 PPs per year (0•51-0•88; p<0•0001) to reach 48•6% (41•9-55•2) in 2019. Exclusive breastfeeding increased in all world regions except for the Middle East and north Africa. Formula consumption in the first 6 months of life increased in upper-middle-income countries and in east Asia and the Pacific, Latin America and the Caribbean, the Middle East and north Africa, and eastern Europe and central Asia, whereas the rates remained below 8% in sub-Saharan Africa and south Asia. Animal milk consumption by children younger than 6 months decreased significantly (-0•41 PPs per year [-0•51 to -0•31]; p<0•0001) in low-income and middle-income countries.Interpretation We found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries. To achieve the global target of 70% exclusive breastfeeding by 2030, however, rates of improvement will need to be accelerated.Funding Bill & Melinda Gates Foundation, through WHO.

SummaryBackgroundLatin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions.MethodsWe analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression.FindingsEthnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries.InterpretationThe lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.FundingThe Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.

Background Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course. Objectives The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6–23 mo in 80 low- and middle-income countries. Methods We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6–23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams. Results Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels &gt;50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls. Conclusions Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.

Background In low- and middle-income countries (LMICs), low levels of formal maternal educational are positively associated with breastfeeding whereas the reverse is true among women with higher levels of formal education. As such, breastfeeding has helped to reduce health equity gaps between rich and poor children. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades. Methods We used 319 nationally representative surveys from 81 countries. We used WHO definitions for breastfeeding indicators and categorized maternal education into three categories: none, primary, and secondary or higher. We grouped countries according to the World Bank income groups and UNICEF regions classifications. The trend analyses were performed through multilevel linear regression to obtain average absolute annual changes in percentage points. Results Significant increases in prevalence were observed for early initiation and exclusive breastfeeding across all education categories, but more prominently in women with no formal education for early breastfeeding and in higher level educated women for exclusive breastfeeding. Small decreases in prevalence were seen mostly for women with no formal education for continued breastfeeding at 1 and 2 years. Among formula indicators, only formula consumption between 6 and 23 months decreased significantly over the period for women with primary education. Analysis by world regions demonstrated that gains in early and exclusive breastfeeding were almost universally distributed among education categories, except in the Middle East and North Africa where they decreased throughout education categories. Continued breastfeeding at 1 and 2 years increased in South Asia, Latin America and the Caribbean, and Eastern Europe and Central Asia for primary or higher education categories. Declines occurred for the group of no formal education in South Asia and nearly all education categories in the Middle East and North Africa with a decline steeper for continued breastfeeding at 2 years. With a few exceptions, the use of formula is higher among children of women at the highest education level in all regions. Conclusions Over the course of our study, women with no formal education have worsening breastfeeding indicators compared to women with primary and secondary or higher education.