Breastfeeding Practices and Dietary Diversity among Infants and Young Children in Rural and Urban-Slum Populations in India: An Observational Study


  • Urmila Deshmukh BioTRaK Research Foundation, Jatharpeth Road, Akola, Maharashtra, 444005
  • Tinku Thomas Department of Biostatistics, St. John’s Medical College, Bangalore, Karnataka 560034, India
  • Sumathi Swaminathan Division of Nutrition. St John’s Research Institute, Bangalore, Karnataka 560034, India
  • Anura Kurpad Department of Physiology and Nutrition, St. John’s Medical College, Bangalore, Karnataka 560034, India



Breastfeeding, complementary feeding, India, IYCF practices, predictors.


Background: Nutritional exposures and growth in early life are linked to immediate and also to long term health outcomes.

Objective: To assess infant and young child feeding (IYCF) practices using WHO-UNICEF defined indicators in rural and urban-slum populations in India.

Methods: A community-based, cross-sectional study was conducted in mothers and infants up to age 24 months. Data on socio-demographics, birth history, feeding practices (WHO-UNICEF IYCF indicators), maternal weight, height, and infant's weight, length, mid-arm, and head circumferences were collected.

Results: Five hundred and two (252 rural and 250 urban-slum) mother-infant dyads were studied. Proportions of IYCF indicators in rural and urban-slum infants were: Early initiation of breastfeeding 71 and 64%; Exclusive breastfeeding under six months, 59 and 25%; Minimum acceptable diet 11 and 27% respectively. Consumption of animal-source food (other than dairy products) and vitamin-A rich fruits and vegetables was below 15%. Cesarean section [aOR, 95% CI: 2.94 (1.53, 5.65)], hospitalization of newborn [aOR, 95% CI: 6.21 (2.95, 13.16)], pre-lacteal feeding [aOR, 95% CI: 3.38 (1.77, 6.45)], needing help in breastfeeding [aOR, 95% CI: 2.15 (1.04, 4.17)], and male gender [aOR, 95% CI: 2.13 (1.15, 4.25); p<0.05 for all] were associated with delayed initiation of breastfeeding, whereas lower monthly household income [aOR, 95% CI: 2.62 (1.10, 6.25)], and younger age [aOR, 95% CI: 1.24 (1.11, 1.38); p<0.05 for both] were associated with poor dietary diversity.

Conclusions: Education of optimum IYCF practices, targeting early initiation of breastfeeding, increasing meal frequency and intake of vitamin-A rich and animal-source foods need urgent attention.


Richter LM, Daelmans B, Lombardi J, Heymann J, Boo FL, Behrman JR, et al. Paper 3 Working Group and the Lancet Early Childhood Development Series Steering Committee. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet 2017; 389: 103-118.

For every child, a fair chance. UNICEF Report; 2015. ISBN: 978-92-806-4817-1 [cited 14th August 2018]: Available from: air_chance.pdf

Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 2010; 125: e473-80.

WHO, IFPRI, UC Davis, FANTA, USAID, UNICEF, Indicators for assessing infant and young child feeding practices: Part 1 - Definitions, Geneva, World Health Organization, 2008 [cited 14 August 2018]: 43895/1/9789241596664_eng.pdf

WHO, IFPRI, UC Davis, FANTA, USAID, UNICEF, Indicators for assessing infant and young child feeding practices: Part 2 - Measurement, Geneva, World Health Organization, 2010 [cited 14 August 2018]: 10665/44368/1/9789241599757_eng.pdf

Patel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ. Determinants of inappropriate complementary feeding practices in young children in India: secondary analysis of National Family Health Survey 2005–2006. Matern Child Nutr 2012; 8(Suppl 1): 28-44.

International Institute for Population Sciences. National Family Health Survey (NFHS-4), 2015-16, India Fact Sheet [cited 14 August 2018]: India.pdf

Menon P, Bamezai A, Subandoro A, Ayoya MA, Aguayo V. Age-appropriate infant and young child feeding practices are associated with child nutrition in India: insights from nationally representative data. Matern Child Nutr 2015; 11: 73-87.

Aguayo VM, Nair R, Badgaiyan N, Krishna V. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra's comprehensive nutrition survey. Matern Child Nutr 2016; 12(Suppl 1): 121-40.

Arora NK, Mohapatra A, Gopalan HS, Wazny K, Thavaraj V, Rasaily R, et al. Setting research priorities for maternal, newborn, child health and nutrition in India by engaging experts from 256 indigenous institutions contributing over 4000 research ideas: a CHNRI exercise by ICMR and INCLEN. J Glob Health 2017; 7: 011003.

Samuel TM, Thomas T, Bhat S, Kurpad AV. Are infants born in baby-friendly hospitals being exclusively breastfed until 6 months of age? Eur J Clin Nutr 2012; 66: 459-65.

IIPS and Macro International. 2008. National Family Health Survey (NFHS-3), India, 2005–06: Maharashtra. International Institute for Population Sciences and Macro International, Mumbai.

WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76-85.

Bentley A, Das S, Alcock G, Shah More N, Pantvaidya S, Osrin D. Malnutrition and infant and young child feeding in informal settlements in Mumbai, India: findings from a census. Food Sci Nutr 2015; 3: 257-71.

Chandhiok N, Singh KhJ, Sahu D, Singh L, Pandey A. Changes in exclusive breastfeeding practices and its determinants in India, 1992-2006: analysis of national survey data. Int Breastfeed J 2015; 10: 34.

Patel A, Bucher S, Pusdekar Y, Esamai F, Krebs NF, Goudar SS, et al. Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study. Reprod Health 2015; 12(Suppl 2): S10.

Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM. Neovita Study Group. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS One 2017; 12: e0180722.

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475-90.

Lim GH, Toh JY, Aris IM, Chia AR, Han WM, Saw SM, Godfrey KM, Gluckman PD, Chong YS, Yap F, Lee YS, Kramer MS, Chong MF. Dietary Pattern Trajectories from 6 to 12 Months of Age in a Multi-Ethnic Asian Cohort. Nutrients 2016; 8(6): pii: E365.

Senarath U, Dibley MJ. Complementary feeding practices in South Asia: analyses of recent national survey data by the South Asia Infant Feeding Research Network. Matern Child Nutr 2012; 8(Suppl 1): 5-10.

Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Open 2015; 5: e005180.

Pappachan B, Choonara I. Inequalities in child health in India. BMJ Paediatrics Open 2017; 1: e000054.

Kuriyan R, Kurpad AV. Complementary feeding patterns in India. Nutr Metab Cardiovasc Dis 2012; 22: 799-805.






General Articles