Infant and young child feeding (IYCF) practices during the first two years of life are important for the growth and development of a child. According to the United Nations Children’s Fund (UNICEF) (2019), adopting optimal feeding practices is fundamental to a child’s survival, growth and development, but too few children have this benefit. Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Ideally, infants should be breastfed within one hour of birth, breastfed exclusively for the first 6 months of life and continue to be breastfed up to 2 years of age and beyond. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.
An infant that is not exclusively breastfed could be at a substantially greater risk of death from diarrhoea or pneumonia than one who is. Moreover, breastfeeding supports infants’ immune systems and may protect them later in life from chronic conditions such as obesity and diabetes. In addition, breastfeeding protects mothers against certain types of cancer and other health conditions. Adequate feeding from 6 months onwards can prevent undernutrition and decrease the risk of infectious diseases, such as diarrhoea and pneumonia. Yet despite all the potential benefits, only about two fifths of infants 0-5 months of age worldwide are exclusively breastfed, and slightly more than two thirds are introduced to solid foods in a timely manner (UNICEF, 2019).
Recommended Infant and Young Child Feeding (IYCF) Practices
According to the World Health Organisation (WHO) (2020), the recommended infant and young child feeding (IYCF) can be broken into two different but interwoven stages which are:
- Exclusive breastfeeding
- Complementary feeding
Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections which is observed not only in developing but also industrialized countries. Early initiation of breastfeeding, within 1 hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all. Breast-milk is also an important source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished (WHO, 2020).
Children and adolescents who were breastfed as babies are less likely to be overweight or obese. Additionally, they perform better on intelligence tests and have higher school attendance. Breastfeeding is associated with higher income in adult life. Improving child development and reducing health costs results in economic gains for individual families as well as at the national level. Longer durations of breastfeeding also contribute to the health and well-being of mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under 6 months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation (WHO, 2020).
Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by breast milk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods. If complementary foods are not introduced around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter. Guiding principles for appropriate complementary feeding according to WHO (2020) are:
- continue frequent, on-demand breastfeeding until 2 years of age or beyond;
- practise responsive feeding (for example, feed infants directly and assist older children. Feed slowly and patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact);
- practise good hygiene and proper food handling;
- start at 6 months with small amounts of food and increase gradually as the child gets older;
- gradually increase food consistency and variety;
- increase the number of times that the child is fed: 2–3 meals per day for infants 6–8 months of age and 3–4 meals per day for infants 9–23 months of age, with 1–2 additional snacks as required;
- use fortified complementary foods or vitamin-mineral supplements as needed; and
- during illness, increase fluid intake including more breastfeeding, and offer soft, favourite foods.
Impact of Mothers’ Level of Knowledge and Attitudes on Infant and Young Child Feeding (IYCF) Practices
Demilew (2017) identified that malnutrition which is a public health concern in might be correlated with inappropriate infant and young child feeding practice. This in turn is affected by Mothers’ knowledge on feeding practice. Knowledge of the mother has significant association with their IYCF practice. Mothers who have insufficient knowledge on IYCF recommendation are more likely to have inappropriate IYCF practice. Inadequate knowledge is often an important determinant of care givers feeding practice than availability of food. It is also important to note that several factors affect mothers’ knowledge on IYCF practices. These factors include working status of the mother, family size, educational and marital status of the mother, age and sex of the child (Central Statistical Agency [Ethiopia] (2012). Mothers who have sufficient knowledge on IYCF recommendation were more likely to have better feeding practice than mothers who have insufficient knowledge (Meenakshi, Marriyah & Deeksha, 2015)
Early initiation of breastfeeding plays a crucial role for a significant reduction of neonatal and infant mortality. Besides, it has benefit to the health of the mother as early suckling stimulates the release of prolactin, which helps in the production of milk, and oxytocin, which is responsible for the ejection of milk and stimulates the contraction of the uterus after childbirth. Moreover, initiation of breast feeds within 1 hour of birth is the key for successful breast feeding. Mothers’ knowledge on initiation of breast feeding is an important determinant factor for their practice (Edmond, 2006).
Exclusive breast feeding for the first 6 months of life has a significant effect in the reduction of morbidity and mortality as well as to ensure overall development. Despite the well-recognized importance, exclusive breastfeeding practice is not widespread in the developing countries. Continuation of breast feeding up to the age of 2 years or beyond is important as it provides useful amounts of energy, good quality protein and other nutrients essential for brain development. However, in a study carried out in Ethiopia, only 20.4% of mothers knew that breast feeding is to be continued for 2 years or beyond. In Ethiopia, 10% of infants under-6 months are given complementary foods in addition to breast milk and 49% of children age 6–8 months consume solid, semi-solid, or soft foods. Among breastfed children age 6–23 months, only 4% receive foods from at least four foods groups (the minimum acceptable diet), while 48% are fed the minimum number of times or more. This low level of knowledge might be due to low attention of participants during nutrition education, often diversity and frequency of complementary food is discussed near the end of education section (Demilew, 2017).
Educational status of the mother had statistically significant association with mothers’ knowledge on IYCF practice. Mothers who attained beyond primary education were 2.5 times more likely to have sufficient knowledge than mothers who attained lower than secondary education. This might be due to the fact that literate mothers understand nutrition information given by the health and nutrition programs (Illyasu, Kabir, Abubakar & Galadanci, 2005).
In a study by Central Statistical Agency [Ethiopia] (2014), women who come to the health institution to get immunization service, to attained antenatal and postnatal care is counseled on maternal and child nutrition. In addition to this, in each health facility, theoretical and practical education on IYCF practice is given one times per month during “mothers’ day”. In this “mothers’ day” complementary feeding preparation is demonstrated by health professionals. Moreover, education on IYCF practice is given in the health post to the women who come to get immunization service, to attained antenatal and postnatal care by health extension workers (HEWs). Furthermore, HEWs give nutrition education to all pregnant and lactating women at their home. All these have direct contribution on maternal knowledge.
Measures to Promote Adequate Infant and Young Child Feeding (IYCF) Practices
Federal Ministry of Health (2010) highlighted the following measures to promote adequate infant and young child feeding (IYCF) practices:
- Legal, gender and cultural considerations
- Advocacy and social mobilisation
- Communication for Behaviour and Social Change (CBSC)
- Capacity building and development
- Counselling and Support services
- Monitoring and Evaluation
Legal, Gender and Cultural Considerations
Legal, gender and cultural considerations should be addressed by reviewing, harmonising, enacting and enforcing national laws and adapting international conventions and recommendations that would enhance gender equality and equity, child’s rights and the situation of women and children, particularly with respect to infant and young child feeding. These shall be achieved by:
- Enforcing NAFDAC Marketing of Infant and Young Child Nutrition (Regulation, Sales,etc Regulation 2005) This is to ensure that the procurement and distribution of breast milk substitutes and other designated products strictly adhere to international and national standards.
- Integrating Public Service Regulation, Labour Acts, Child’s Rights Acts and other existing policies, maternity entitlement National Policy on Infant and Young Child Feeding in Nigeria as defined in ILO Convention 183 and Recommendation 2000, (No191) into existing legislation, to enhance optimal infant and young child feeding.
- Ensuring that National Development Policies, Plans, Programmes and Strategies such as Vision 2020, Health Sector Reform Plan, National Poverty Eradication Programme (NAPEP) and National Economic Empowerment and Development Strategies (NEEDS) give prominence to infant and young child feeding.
- Guidelines shall be reviewed and developed for relevant ministries, healthcare providers, NGOs and other stakeholders assisting communities for effective coordination of efforts in the areas of infant and young child feeding.
- This Policy shall be reviewed periodically to address emerging issues on infant and young child feeding.
Advocacy and Social Mobilisation
Advocacy and social mobilisation should be strengthened to address the mandate of relevant ministries, NGOs, community-based organisations, political and traditional leadership groups, media organisations, educational institutions, and the relevant private sectors on infant and young child feeding and related issues These shall be achieved by:
- Harmonisation of Messages to Eliminate Conflicts
- Creating awareness about optimal infant and young child feeding at all levels.
- Developing a National Social Marketing Strategy to advocate from the highest policy level to the lowest community level, to address different issues of care in infant and young child feeding for the general public, as well as children in special situations. 21 National Policy on Infant and Young Child Feeding in Nigeria
- Utilising notable events such as World Breastfeeding Week, Maternal Newborn and Child Health Week, Safe Motherhood Day, Day of the African Child and Micronutrient Day to promote optimal infant and young child feeding in various states, local governments and communities.
- Encouraging communities’ involvement (particularly male groups) in infant and young child feeding activities and nutrition of the family in general.
- Actively involving the media in all advocacy and social mobilisation for all the issues elaborated in this Policy.
Communication for Behaviour and Social Change (CBSC)
Communication for Behaviour and Social Change Communication packages should be developed, disseminated and reviewed to deliver appropriate, technically correct and up-to-date information on optimal infant and young child feeding. This can be achieved by:
- Assessment of information needs of different target populations shall be carried out.
- Behaviour and Social Change Communication materials (including guidelines) shall be developed, disseminated, reviewed, and adapted for different target groups of the general public.
- All working documents including guidelines on infant and young child feeding shall be reviewed, developed and regularly updated as appropriate.
Capacity Building and Development
Capacity Building and Development should be encouraged to enhance effectiveness and efficacy at the National, State, Local Government Area and community levels for implementation of this Policy. In pursuance of this:
- Training for pre-service, in-service and informal sector should be promoted for all healthcare providers in private and public institutions as well as community-based organizations.
- Communities should be enlightened to access the skill acquisition initiatives, micro-credit facilities and other poverty alleviation programmes for optimal infant and young child feeding.
- Infant and young child feeding and nutrition issues should be promoted as an examinable subject in the pre-service curricula of all health workers and related professions, to provide consistent, up-to-date information and practical skills.
- The Nutrition Division of the Federal Ministry of Health (FMOH) should collaborate with institutions of learning to assess training needs, develop curricula, resource texts, teaching modules, guidelines, information packs and other materials for use in preservice and informal trainings, as well as in advocacy work, for this Policy.
- A plan of action for continuous in-service training should be developed to update different cadres of health care providers on infant and young child feeding.
- All health facilities providing maternity services should teach and practice the “Ten Steps to Successful Breastfeeding” as set out in the WHO/UNICEF Joint Statement on Breastfeeding and Maternity Services.
- Trainer competency criteria for various levels of training should be established to maintain training standards.
- A mechanism should be designed to include concerns of children from special situations and emergencies into relevant existing programmes, including programmes for humanitarian assistance and emergency preparedness.
- Informal training should be promoted to contribute to capacity building of the general public for effective participation in the implementation of this Policy.
- Prospective partners and networks should be identified, including the media, community and religious leaders to incorporate infant and young child feeding issues in their mandates.
Counselling and Support Services
These services should be regarded as essential services to ensure sustainability of implementation of this Policy at all levels. To this effect;
- Nutrition counselling should be institutionalised in all areas concerned with infant and young child feeding.
- Health workers should provide mothers, fathers and other caregivers with objective, consistent and adequate information about appropriate infant and young child feeding practices free from commercial influence.
- Health workers should provide skilled support to mothers in the initiation and sustenance of appropriate infant and young child feeding practices.
- Community and facility-based support groups should be strengthened where in existence and established where necessary.
- Mothers should be provided with infant and young child feeding counselling services and referred to other support services for follow-up and care where necessary.
This Policy recognises the importance of research in the overall attainment of its goal and objectives on a sustainable basis, and will therefore support various aspects of research on infant and young child feeding. To achieve this:
- Research on the implementation of the Code of Marketing of Breastmilk Substitutes should be supported.
- Epidemiological, clinical and operational research on infant and young child feeding should be carried out and used for policy review.
- Research into infant and young child feeding trends should be carried out for policy review to comply with global and national goals.
- Other research that will have impact on infant and young child feeding should be supported and carried out.
Monitoring and Evaluation
Monitoring and evaluation of the implementation of this Policy should be carried out at various levels as appropriate. The following key activities and tasks should be carried out for a successful programme implementation:
- Monitoring and evaluation of the implementation of this Policy should be the responsibility of the Ministry of Health.
- All designated baby friendly facilities should be periodically monitored and re-assessed to ensure compliance with the “Ten Steps to Successful Breastfeeding”
- Growth and development of infants and young children should be monitored as a routine nutrition exercise with particular attention to at-risk infants and young children especially low birth weight, sick infants and those born to HIV positive mothers.
- The Ministry of Health should regularly monitor infants and young child feeding practices to evaluate the impact of interventions.
- Application of the Policy on maternity entitlements should be regularly monitored.
Supervision should be a continuous process designed to ensure that programme operations at all levels, are proceeding according to plan. Supervision is also necessary in order to assess the quality and effectiveness of services being provided. To achieve this:
- An integrated supervisory system should be established within the Nutrition Division of the Federal Ministry of Health which should be responsible for supervision of all infant and young child feeding activities.
- Supervisory schedules and checklists for infant and young child feeding activities should be developed for all tiers of service.
- Supportive supervision should be carried out at facility and community levels.
- A mechanism should be established to provide regular feedback at all levels.
Coordination of the implementation of this Policy should be streamlined and enhanced to ensure effective involvement of all key stakeholders, make maximum use of resources, provide guidance and set standards of achievements. To achieve this:
- At the National level, Nutrition Division of the Federal Ministry of Health should coordinate all infant and young child feeding activities.
- At the State level, the State Committees on Food and Nutrition should coordinate the implementation of this Policy.
- At the Local Government level, the coordination of the implementation of this Policy should rest on the Local Government Committee on Food and Nutrition. The composition and roles of these Food and Nutrition committees should be as spelt out in the National Policy on Food and Nutrition.
Central Statistical Agency [Ethiopia] (2014). Ethiopia mini demographic and health survey 2014. Addis Ababa
Central Statistical Agency [Ethiopia] (2012), ICF International. Ethiopia demographic and health survey 2011. Addis Ababa and Calverton: Central Statistical Agency and ICF International.
Demilew Y. M. (2017). Factors associated with mothers’ knowledge on infant and young child feeding recommendation in slum areas of Bahir Dar City, Ethiopia: cross sectional study. BMC research notes, 10(1), 191. https://doi.org/10.1186/s13104-017-2510-3
Edmond, K. (2006). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 117(3):e380–e386. doi: 10.1542/peds.2005-1496.
Federal Ministry of Health (2010). National Policy on Infant and Young Child Feeding in Nigeria. Abuja: Federal Ministry Of Health, Department of Family Health
Illyasu, Z., Kabir, M., Abubakar, I. & Galadanci, N. (2005). Current knowledge and practice of exclusive breastfeeding among mothers in Gwale LGA of Kano State. Niger Med Prac. 48(2):50–55.
Meenakshi, G., Marriyah, H. & Deeksha, K. (2015). Infant and young child feeding (IYCF) practices in Udupi district, Karnataka. J Nut Res. 3(1):38–44.
United Nations Children’s Fund (UNICEF) (2019). Infant and young child feeding. Retrieved from https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ on 28th April, 2021.
World Health Organisation (WHO)(2020). Infant and young child feeding. Retrieved from https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding on 28th April, 2021.