Scaling‐up interventions to improve infant and young child feeding in India: What will it take?

Abstract

We assessed India's readiness to deliver infant and young child feeding (IYCF) interventions by examining elements related to policy, implementation, financing, and evidence. We based our analysis on review of (a) nutrition policy guidance and program platforms, (b) published literature on interventions to improve IYCF in India, and (c) IYCF program models implemented between 2007 and 2012. We find that Indian policies are well aligned with global technical guidance on counselling interventions. However, guidelines for complementary food supplements (CFS) need to be reexamined. Two national programs with the operational infrastructure to deliver IYCF interventions offer great potential for scale, but more operational guidance, capacity, and monitoring are needed to actively support delivery of IYCF counselling at scale by available frontline workers. Many IYCF implementation efforts to date have experimented with approaches to improve breastfeeding and initiation of complementary feeding but not with improving diet diversity or the quality of food supplements. Financing is currently inadequate to deliver CFS at scale, and governance issues affect the quality and reach of CFS. Available evidence from Indian studies supports the use of counselling strategies to improve breastfeeding practices and initiation of complementary feeding, but limited evidence exists on improving full spectrum of IYCF practices and the impact and operational aspects of CFS in India. We conclude that India is well positioned to support the full spectrum of IYCF using existing policies and delivery platforms, but capacity, financing, and evidence gaps on critical areas of programming can limit impact at scale.

Progress and inequalities in infant and young child feeding practices in India between 2006 and 2016

“…Although programme and policy strategies in India are well aligned with global guidance on IYCF and provide a vision for intervention scale‐up (Avula, Oddo, Kadiyala, & Menon, ), progress in improving IYCF practices has been mixed, and several practices remain suboptimal. Prior research using the 2005–2006 NFHS documented poor IYCF practices in India and strong associations between most IYCF practices and SES status and maternal education (Patel et al, ).…”

“…The ICDS and health platforms in India, both of which have high coverage in many states, could also play a much stronger role in supporting complementary feeding behaviours by strengthening the behaviour change communication and community mobilization components of the programme. The evidence on the impact of strategies deployed within or alongside the ICDS to address IYCF behaviours is limited FIGURE 3 Inequality trends in infant and young child feeding practices between 2006 and 2016, by socio-economic status quintile and rural/urban residence (Avula et al, 2017), but ample evidence now exists of group-based and individual counselling strategies in India that have been successful at improving complementary feeding practices (Nair et al, 2017;Vazir et al, 2013). Adapting these for scale-up through the ICDS platform, or in collaboration with the ICDS, could help close the gaps in IYCF knowledge and practices.…”

It takes a village: An empirical analysis of how husbands, mothers‐in‐law, health workers, and mothers influence breastfeeding practices in Uttar Pradesh, India

“…In Uttar Pradesh, breastfeeding rates are much lower compared with the national average with EIBF at only 7% in National Family Health Survey (NFHS)‐3 (2005–2006; IIPS, ) and increasing to 25% in NFHS 4 (2015–2016); however, in this period, EBF rates decreased from 51% to 42%, slipping below global targets (IIPS, ). To address these challenges, India has developed comprehensive infant and young child feeding programmes and policies that are well aligned with global guidance (Avula, Oddo, Kadiyala, & Menon, ; Bhutta et al, ; India‐MoHFW, ; MoWCD, ; Vir et al, ). More recently, India's new nutrition strategy and programme efforts (Ministry of Women and Child Development, ; National Institution for Transforming India Aayog, ) place interventions to address infant and young child feeding at the heart of efforts to improve nutrition.…”

“…In Uttar Pradesh, breastfeeding rates are much lower compared with the national average with EIBF at only 7% in National Family Health Survey (NFHS)-3 IIPS, 2017b) and increasing to 25% in NFHS 4 (201525% in NFHS 4 ( -2016; however, in this period, EBF rates decreased from 51% to 42%, slipping below global targets (IIPS, 2017b). To address these challenges, India has developed comprehensive infant and young child feeding programmes and policies that are well aligned with global guidance (Avula, Oddo, Kadiyala, & Menon, 2017;Bhutta et al, 2013;India-MoHFW, 2013;MoWCD, 2013;Vir et al, 2014).…”

Feeding of Infants and Young Children in South Asia

“…Across South Asia, complementary feeding receives much less attention than breastfeeding in health interventions. For example, fewer than one-half of infant and young child feeding programs in India promote age-appropriate quantity and diversity of complementary feeding (Avula et al 2017). Only four countries in the region (Afghanistan, Bhutan, Nepal, and Pakistan) have a national behavior change communication strategy that includes complementary feeding (table 2).…”