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A. INTRODUCTION

Infant and young child feeding (IYCF) practices directly affect the health, development and nutritional status of children less than two years of age and, ultimately, impact child survival. Improving IYCF practices in children 0–23 months of age is therefore critical to improved nutrition, health and development.

WHO guiding principles for complementary feeding of the breastfed child (1) along with guiding principles for feeding non-breastfed children 6–24 months of age (2) provide global guidance on optimal feeding practices for supporting growth, health and behavioural development for infants and young children (IYC) under two years of age. To support programmatic action and to contribute to monitoring progress on IYCF at national and global levels, indicators for assessing infant and young child feeding practices were published in 2008 (3, 4). This guidance document recommended a set of eight core and seven optional indicators. These indicators have served as the standard for data collection and reporting on IYCF practices throughout the world.

In 2017 and 2018, WHO and UNICEF convened two inter-agency technical consultations to discuss revisions of the IYCF indicators. A broad group of experts working on IYCF programmes and measurement, including those involved in the development of the earlier IYCF indicator documents, examined potential modifications, deletions, replacements and new indicators (lists of participants are included in Annex 1 and Annex 2). The consultations covered issues relating to dietary diversity, food groups, additional breastfeeding indicators and indicators of unhealthy food and beverage consumption. A key conclusion of these technical consultations was that assessment ought to include selected unhealthy eating practices.

A summary of the revised set of IYCF indicators is presented in Table 1. Unlike in 2008, no distinction is made between core and optional indicators in this set of recommendations. It is important to assess data using the full set of indicators for any given population and to report all findings. Table 2 summarizes key changes between the 2008 and 2021 recommended indicators.

This document describes the currently recommended set of indicators for IYCF. The purposes of the indicators include:

• assessment: to make national and subnational comparisons and describe trends over time;

• targeting: to identify populations at risk, target interventions and make policy decisions about resource allocation;

• monitoring and evaluation: to monitor progress in achieving goals and evaluate the impact of interventions.

The recommended indicators are population-level indicators which have mainly been designed for data collection in large-scale surveys or by national programmes, although smaller local and regional programmes may also be able to make use of them. They should not be applied for screening or assessment of individuals. Furthermore, they are not intended to meet all needs in programme monitoring and evaluation. Programmes and projects should supplement them with more specific indicators that reflect their own interventions, messages and behaviour-change objectives.

To support programme assessment, planning and monitoring, national-level reporting on estimates for IYCF indicators should take place approximately every three to five years. Every effort should be made to coordinate with those implementing other surveys in any given country in order to avoid duplication of efforts.

Where sample sizes are adequate, it is recommended that indicators be further disaggregated into smaller age groups since feeding practices may change dramatically as children grow up. For example, it may be useful to present data on exclusive breastfeeding for infants aged 0–1 month, 2–3 months and 4–5 months. For continued breastfeeding, the indicator should be presented separately for children aged 12–15 months, 16–19 months and 20–23 months. For all the complementary feeding indicators, it may be useful to present separately for children aged 6–11 months, 12–17 months and 18–23 months. Additional disaggregation may be beneficial if surveys collect information on supplementary background characteristics such as income quartiles or quintiles, maternal education, etc. However, as a general rule, estimates should not be presented if less than 25 children (unweighted) are included in the denominator.

In addition to indicators, which are calculated as individual percentages, this document also recommends the use of area graphs to illustrate how IYCF practices progress as children grow older. These graphs are useful in understanding patterns of exclusive breastfeeding at different age groups across the 0–5 month window, and provide insight into the types of beverages (and in some cases solid foods) being consumed in addition to breastmilk at each age.

SCOPE OF DOCUMENT

In Part 1 of this document, we provide an overview of the 17 IYCF indicators (Table 1) followed by a rationale and definition for each indicator, including the infant feeding area graphs. This is followed by a section summarizing the key changes between the 2008 and 2021 recommended indicators (Table 2).

Part 2 of this document provides information and tools for measuring the IYCF indicators and constructing the area graphs, including sections on:

A. Overview of methods
B. Example questionnaires
C. Instructions for calculating indicators and area graph values
D. Recommendations for adapting the questionnaire to survey context
E. Selecting and training interviewers

Several other topics are covered in the technical annexes.

AUDIENCE

This document’s target audience is technical staff involved in surveys for collecting IYCF data, and is especially intended for:

• survey managers;

• technical assistance providers for surveys;

• national survey organizations (reporting to government on sustainable development goals and World Health Assembly nutrition targets, and implementers of surveys that include IYCF practices);

• international and national organizations with an interest in IYCF practices;

• researchers; and

• public health nutritionists.