New and Updated Indicators for Assessing Infant and Young Child Feeding

The World Health Organization (WHO) and partners have released new and updated indicators for assessing infant and young child feeding practices for use in population-based surveys. The indicators reflect current recommendations for appropriate infant and young child feeding and provide important new information on feeding practices in children 6 to 23 months of age. Simple, valid, and reliable indicators are crucial for tracking progress and guiding investment to improve nutrition and health during the first 2 years of life. In 1991, WHO issued indicators for assessing breastfeeding practices that have since been used widely and have contributed to directing program efforts in many countries 1. However, a set of indicators that could be used in population-based surveys to assess complementary feeding practices was not available. This limited the understanding of the magnitude and distribution of inadequate feeding practices and hampered progress in the development of effective program responses. Recognizing this gap, WHO, together with partners from the International Food Policy Research Institute, the Food and Nutrition Technical Assistance Project/ Academy of Educational Development, Macro International, the University of California at Davis, the United States Agency for International Development, and UNICEF jointly undertook the effort to develop new and updated indicators to assess infant and young child feeding practices. The work was guided by updated recommendations for the duration of exclusive breastfeeding 2, 3, the Guiding Principles for Complementary Feeding of the Breastfed Child 4, the Guiding Principles for Feeding Non-Breastfed Children 5, and a conceptual framework for identifying potential indicators of complementary feeding 6. An extensive analysis of infant and young child dietary intake data from 10 sites was performed to assess relationships between dietary diversity and mean micronutrient density adequacy and between feeding frequency and energy intake 7, 8. The results of this 5-year effort have been recently published 9. Eight core and seven additional indicators now cover optimal breastfeeding practices and food-related aspects of appropriate feeding practices in children 6 to 23 months of age. New indicators include measures of dietary diversity, feeding frequency, and the consumption of iron-rich or iron-fortified foods. Most indicators can be derived from questions already used in widely implemented surveys, such as Demographic and Health Surveys and UNICEF Multiple Indicator Cluster Surveys. An operational guide to facilitate standardized measurement is under development. The indicators and indicator definitions are summarized in the Annex.