countries except Maldives, the rates of minimum dietary diversity are much lower than those for minimum meal frequency, indicating that diversity is a greater problem than frequency. Only one in five South Asian children (21 percent) is fed at least four food groups (UNICEF 2018a), which is similar to the rate in Sub-Saharan Africa (19–21 percent) (UNICEF 2016). In four South Asian countries (Afghanistan, Bhutan, India, and Pakistan), fewer that one in four children is fed a minimally diverse diet, while just two countries (Maldives and Sri Lanka) have minimum dietary diversity rates exceeding 70 percent (figure 2c).

Animal source foods are particularly effective at providing essential micronutrients and highquality protein needed for optimal growth, development, and immune function in early life (PAHO/WHO 2003; WHO and UNICEF 2003). A strong association is found between the consumption of animal source foods and child growth in South Asia (Heady et al. 2017). However, the consumption of animal source foods is very low in the region: only one in two infants aged 6–11 months and two in three children aged 12–23 months receive animalsource foods (UNICEF 2016).

Most South Asian children are not fed both frequent and diverse meals, leaving them short of nutrients needed to reach their full potential. Only one in eight children (12 percent) has a minimally acceptable diet that has both the minimum dietary diversity and minimum meal frequency (UNICEF 2018a), marginally above the rate for Sub-Saharan Africa (9–10 percent) (UNICEF 2016). Three out of four children in Afghanistan, Bangladesh, Bhutan, India, and Pakistan are not fed a minimally acceptable diet (figure 2d). The minimally acceptable diet rate exceeds 50 percent in Maldives and Sri Lanka, indicating that countries in South Asia can be much better performers on complementary feeding.

Across South Asia, complementary feeding rates are least favorable among the youngest children. Alarmingly, fewer than one in five children aged 6–11 months has minimally diverse diets in Afghanistan, Bhutan, Bangladesh, India, and Pakistan. One in three infants aged 6–11 months receives only one or no food groups (UNICEF 2016). In general, complementary feeding rates are similar for boys and girls except that boys are more likely to benefit from the timely introduction of complementary foods than girls in both Bangladesh (68 percent versus 61 percent) and Pakistan (71 percent versus 62 percent). An even greater difference in rates existed between boys and girls in Nepal in 2014 (83 percent versus 65 percent), which has been attributed to mothers’ belief that their breastmilk supply is insufficient for boys (Miller 1997); however, this gender gap has since narrowed (86 percent versus 83 percent in 2016).

Low maternal education, younger mothers, and firstborn children are associated with lower rates of complementary feeding practices in South Asia, and may reflect caregivers’ lack of knowledge and experience in feeding (Na et al. 2017a; Na et al. 2017b; Na et al. 2018a; Na et al. 2018b). In Bangladesh, dietary diversity in children is associated with dietary diversity among mothers, suggesting that diverse diets should be promoted for both mother and child (Nguyen et al. 2013). In Nepal, the Dalit and minority ethnic and religious castes have lower rates of complementary feeding practices, which could indicate sociocultural barriers to optimal feeding (Na et al. 2017a). Children who are perceived to be small at birth are less likely to be fed diverse foods in Nepal and Pakistan, possibly due to sociocultural beliefs that a smaller and weaker child is unable to digest some types of foods (Na et al. 2017a; Na et al. 2017b). The number of antenatal care visits and local availability of primary health services are important determinants of dietary diversity and adequate diets in Afghanistan, Nepal, and 5