Complementary Feeding is Positively Related with Family Care, Care for Women, and Improved Water and Sanitation among Populations
Authors: Basnet Sulochana , Frongillo Edward A , Kulkarni Shibani , de Castro Filipa 
Published: November 2023

Care is conceptualized by the United Nations Children's Fund (UNICEF) as provision of resources and support to meet requirements of children and mothers. Care behaviors include preparation and storage of food; care for pregnant and lactating women; hygiene and sanitation; and feeding, health‐seeking, and family (i.e., psychosocial and cognitive) care for infants and young children. Despite evidence that these care behaviors are vital for survival, growth, and development of children, no epidemiological studies have been made of the interrelationships among them. This study aimed to examine the interrelationships of care behaviors in low‐and middle‐income populations and in particular to understand whether populations with better feeding behaviors are also better in other care domains.We used data from 47 surveys obtained from 42 countries and five sub‐countries collected during rounds 3 and 4 of UNICEF's Multiple Cluster Indicator Surveys. For each survey, data were collapsed to population level using sampling weights. The surveys contained data on 16 care behaviors. The data were reduced to six domains using confirmatory factor analysis: exclusive and predominant breastfeeding, complementary feeding, family care, vaccination of children, water and sanitation, and care for women. We performed correlational analysis on the resulting factor scores.Across populations, predominant breastfeeding (55.4%) was twice as prevalent as exclusive breastfeeding (25.8%). About half of children had appropriate timing for introduction of complementary foods (53.9%) and minimum meal frequency (46.3%). Prevalence of positive indicators of family care varied from 29.8% (father's involvement in stimulating activities) to 59.7% (adequate availability of play materials). About half (50.9%) and two‐thirds (64.5%) had access to improved drinking water and improved sanitation facility, respectively. The prevalence of indicators of care for women was about three‐fifths.Family care was significantly correlated with each of the other five domains: exclusive and predominant breastfeeding (−0.444), complementary feeding (0.578), vaccination (0.313), water and sanitation (0.568), and care for women (0.768). Whereas exclusive and predominant breastfeeding was negatively correlated with water and sanitation (−0.448) and care for women (−0.341), complementary feeding was positively correlated with these two variables (0.537 and 0.560, respectively). Care for women was significantly correlated with vaccination (0.480) and water and sanitation (0.350).Populations with better family care, water and sanitation, and care for women had better complementary feeding but lower exclusive and predominant breastfeeding. Some possible reasons for greater sub‐optimal breastfeeding among the populations with better care behaviors in other domains are employment of women, promotion of and access to breast‐milk substitutes, wealth, and shifts in social and cultural norms. The positive associations of complementary feeding and other care domains that were observed support current initiatives to encourage integration of these domains in policy and program development.Support or Funding InformationSackler Institute for Nutrition Science at the New York Academy of Sciences