# **Introduction**

While child undernutrition has multiple causes, inadequate dietary intake by children is among the most immediate (UNICEF 2013). The survival, growth, and development of children are sensitive to what and how they are fed from birth to two years (UNICEF 2016). Global evidence suggests that breastfeeding protects against childhood infections and saves infant lives, improves cognitive function, and reduces the likelihood of overweight and diabetes in later life (Victora et al. 2016). Appropriate complementary foods and feeding promote child survival and protect against stunting, micronutrient deficiency, overweight, and obesity (Bhutta et al. 2013; Begin and Aguayo 2017; Michaelsen et al. 2017).

In terms of evidence from South Asia, poor infant and young child feeding (IYCF) practices underlie the high rate (prevalence) of undernutrition (Aguayo and Menon 2016). Children are more likely to be wasted if they are not breastfed immediately after birth, if they are fed prelacteal foods in the first few days of life, and if they are not exclusively breastfed (Harding et al. 2018). Stunting is more common among infants aged 6–8 months who are not fed any complementary foods, and among children aged 6–23 months whose complementary foods do not comprise enough food groups (Kim et al. 2017). In addition, low meal frequency is associated with a higher likelihood of severe wasting (Kim et al. 2017).

This study argues that the issue of suboptimal feeding of children under two years needs greater attention in South Asia, and considers options for increasing the rates of recommended feeding practices. Specifically, the study examines the current levels, recent trends, and determinants of the rates of recommended feeding practices in South Asia, based on published statistics and a review of the empirical literature. The study also reviews the literature that examines actions by governments, the private sector, communities, and households that promote or undermine recommended feeding practices in the region.

Published statistics on the rates for recommended feeding practices are obtained from statistical reports for the latest rounds of relevant national household sample surveys, such as Demographic and Health Surveys. Except Maldives, all countries in the region have statistics on recommended feeding practices from surveys administered in the last five years. The reviewed literature includes articles identified using a search of PubMed, as well as reports, briefs, and other literature sourced from organizational websites and experts.

# **State of child feeding**

The Global Strategy for Infant and Young Child Feeding (WHO and UNICEF 2003) and guiding principles on complementary feeding (PAHO/WHO 2003; WHO 2005) recommend that breastfeeding be initiated within the first hour of birth (known as “early initiation of breastfeeding”), that breastmilk be fed exclusively to an infant for the first six months of life (“exclusive breastfeeding”), and that breastfeeding be continued until the child’s second birthday or beyond (“continued breastfeeding”). The guidelines also recommend that complementary foods be introduced at six months of age (“timely introduction of complementary foods”), that they be fed frequently according to the child’s age (meeting “minimum meal frequency”), and that they include a sufficient number of diverse food groups (meeting “minimum dietary diversity”).

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