3.3 Conceptualizing Infant Feeding Behaviours
The full impact of optimal breastfeeding and complementary feeding, as measured by population level reductions in mortality and morbidity and improved health and development, will never be realized unless women and caregivers adopt recommended behaviours. Recommended behaviours change as an infant and young child grows.12 WHO defines optimal behaviours as exclusive breastfeeding for four to six months, breastfeeding with complementary feeding starring at about six months of age, and continued breastfeeding in the second year of life and beyond.26 Field studies show that complementary foods introduced between four and six months of age replace nutrients from breastmilk and confer no advantage on growth or development.27, 28 As a result UNICEF and many ministries of health in general recommend exclusive breastfeeding for about six months. Having two sets of recommendations creates confusion, and policy harmonization is urgently needed in this area.
Whether or not optimal behaviours are adopted is a result of the interaction of many factors. The closest determinants relate to a woman’s choice and her ability to act upon this choice. For optimal breastfeeding and complementary behaviours to occur, a woman must both wish to use them and be able to choose them. The two factors are influenced most immediately by the infant feeding information a woman receives as well as the physical and social support provided to her during pregnancy, childbirth, and postpartum. These factors are, in turn, influenced by familial, medical, and cultural attitudes and norms, demographic and economic conditions (including the resources to grow or purchase needed foods and maternal employment), commercial pressures, and national and international policies and norms. Thus, to promote optimal breastfeeding and complementary feeding behaviours, interventions need to be targeted not only to individual women but also to changing the context in which infant and child feeding choices are made.
The determinants of infant feeding behaviours are shown in Figure 3.1. This figure elaborates the interplay between factors that determines the capacity, resources, and care practices for young children.
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