Good infant and young child feeding practices for children under 2 years of age are critical for their health and development. These practices include breastfeeding exclusively up until 6 months of age and complementary feeding (the use of solid or semi-solid food in addition to breast milk) between the ages of 6 and 23 months. Accordingly, to achieve its goal to reduce chronic malnutrition by 20 percent over 5 years, the 2014–2025 USAID Multi-Sectoral Nutrition Strategy supports optimal breastfeeding and appropriate complementary feeding and tracking change over time in populations served by development nutrition programs.
FANTA contributed to the ability to measure such change by helping to develop indicators to measure complementary feeding practices and working with academic and international organizations to coauthor a tool, Indicators for Assessing Infant and Young Child Feeding (IYCF) Practices (published by the World Health Organization), which provides guidance to programs on how to collect and use the indicators.
“For the first time it struck home that complementary feeding was the most neglected and biggest problem of all infant and young child feeding, not just exclusive breastfeeding.”
The purpose of simple, yet valid and reliable population-level indicators is to: (1) make national and subnational comparisons and describe trends over time; (2) identify populations at risk, target interventions, and make policy decisions about resource allocation; and (3) monitor progress in achieving goals and to evaluate the impact of interventions. The process used to develop and validate the indicators involved analysis of datasets, field-testing of selected indicators, and technical meetings and workshops to promote dialogue and to reach consensus on the best indicators. FANTA specifically worked with various organizations to initiate research to validate indicators for feeding frequency and nutrient density of complementary foods and to foster international consensus on better indicators for complementary feeding practices.
This work resulted in three new indicators to measure complementary feeding practices: minimum meal frequency, minimum dietary diversity, and minimum adequate diet. These three indicators were then included in the tool, Indicators for Assessing IYCF Practices. The indicators make it possible to reliably measure progress and make improvements in infant and young child feeding.
Indicators and Definitions
FANTA assisted in developing the following indicators for complementary feeding, which would be collected through a household survey.
Minimum dietary diversity: Proportion of children 6–23 months of age who receive food from four or more of seven food groups (grains, roots, and tubers; legumes and nuts; dairy products; meat, fish, and poultry; eggs; vitamin-A rich fruits and vegetables; and other fruits and vegetables).
Minimum meal frequency: Proportion of breastfed and non-breastfed children 6–23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) a minimum number of times or more (two times for breastfed infants 6–8 months, three times for breastfed children 9–23 months, and four times for non-breastfed children 6–23 months).
Minimum acceptable diet: Proportion of children 6–23 months of age who receive a minimum acceptable diet (apart from breast milk). The indicator is a composite of minimum dietary diversity and minimum meal frequency.
Stakeholders that FANTA reached out to on use of the indicators reported that the availability of the indicators contributed to improved identification of poor complementary feeding practices among the beneficiaries they served. One stakeholder reflected that the indicators broadened the programmatic and policy focus on exclusive breastfeeding and introduction of complementary foods to also give emphasis to the adequacy of complementary feeding: “For the first time it struck home that complementary feeding was the most neglected and biggest problem of all infant and young child feeding, not just exclusive breastfeeding.” At the programmatic level, the indicators have enabled the identification of gaps in feeding practices and helped to tailor interventions to address those gaps. At the policy level, the availability of standardized data from the indicators enabled stakeholders to compare results across programs and countries, which helped them make strategic decisions on what interventions and areas programs needed to focus on.
In addition to its usefulness for the collection of complementary feeding indicators, the IYCF tool helps users understand the elements of proper nutrition, and provides a solid basis for the training of enumerators, technical staff, and collaborating organizations on the collection and use of the indicators. The publication has been embraced by the international community as a standard tool to measure IYCF practices.