ethnic groups in Afghanistan are less likely to exclusively breastfeed, whereas some lowcaste groups in India are more likely to do so (Benedict et al. 2018a), suggesting that sociocultural practices may influence exclusive breastfeeding. In India, girls are less likely to be exclusively breastfed than boys (Benedict et al. 2018a).

# _Continued breastfeeding_

Continued breastfeeding from six months to two years and beyond is an important source of key nutrients for healthy growth (Victora et al. 2016) and is particularly important in settings where households have inadequate access to nutritious complementary food. Of all regions, South Asia has the highest rate of continued breastfeeding, at two years, but it has seen little progress between 2000 (68 percent) and 2016 (71 percent) (UNICEF 2016; UNICEF 2018a). Rates are lowest for Pakistan (56 percent) and Afghanistan (59 percent), and highest for Nepal (89 percent) and Sri Lanka (87 percent).

Comparing the continued breastfeeding rates at one year and two years of age indicates a large decline in continued breastfeeding (exceeding 15 percentage points) in Afghanistan, Bhutan, and Pakistan during the second year of life (figures 1c and 1d). A shorter duration of breastfeeding has previously been observed among girls in India (Jayachandran and Kuziemko 2011); however, it is encouraging that 2015–16 statistics from India do not show a significant difference between girls and boys in continued breastfeeding at two years (Benedict et al. 2018a). Continued breastfeeding at two years of age is more likely among women with low body mass index in India, and among less-wealthy households in both India and Pakistan (Benedict et al. 2018a). Children whose mothers have low decision-making autonomy are less likely to be breastfed at two years in both Nepal and Pakistan (Benedict et al. 2018a), in contrast to findings from a multi-country study showing an association between higher autonomy and shorter duration of breastfeeding (Smith et al. 2003).

# _Timing, frequency, diversity, and adequacy of complementary foods_

The timing of an infant’s first food is critical to his or her growth and development (PAHO/WHO 2001). Introducing food too early increases the likelihood of infection and a premature end to breastfeeding, while doing so too late makes undernutrition more likely. Fewer South Asian infants are waiting too long for their first food today than they were 15 years ago: the percentage of infants aged 6–8 months who are fed complementary foods increased from 37 percent in 2000 to 52 percent in 2016 (UNICEF 2018a), but the rate remains lower than those for all other regions with comparable data (UNICEF 2016). Four countries in the region (Bhutan, Maldives, Nepal, and Sri Lanka) have rates exceeding 80 percent (figure 2a). But several countries pull the regional rate down, including Afghanistan (56 percent), Bangladesh (65 percent), India (43 percent), and Pakistan (55 percent).

Children aged 6–23 months need frequent meals because their gastric capacity is small and their nutrient needs are greater than at any other time in life. Yet fewer than one-half of these children in South Asia (44 percent) are fed enough times per day to meet the recommended minimum level (UNICEF 2018a). The minimum meal frequency rate in South Asia is similar to that in Sub-Saharan Africa (45–47 percent) (UNICEF 2016), where the stunting rate is also high. The minimum meal frequency rate is particularly low in India, at 36 percent (figure 2b).

Complementary foods should come from different food groups to help ensure that children receive all the nutrients they need for healthy growth and development. In all South Asian 4