# **Monitoring, research, and evaluation**

National data on breastfeeding and complementary feeding are needed to help governments assess progress in improving feeding practices. All South Asian countries except Maldives have recent data on feeding practices and should continue to collect data about every three to five years.

Only three countries (Afghanistan, Bangladesh, and Pakistan) have health systems that routinely monitor the number of caregivers who receive information and counseling on breastfeeding and complementary feeding. The data gap in other countries makes it challenging for administrators to hold themselves and others to account for delivering these services and ensuring that children in greatest need are reached. Data on the quality of services are also lacking. All countries in the region should examine how to integrate indicators on the coverage of counseling services into health information systems, and ensure that the quality of services is monitored as part of supervision.

Evidence is lacking on the impact of large-scale programs to improve complementary feeding in South Asia (Bhutta et al. 2013; Aguayo 2017), particularly programs employing a mix of sectors, strategies, and interventions to address both demand- and supply-side barriers. One exception is the Alive & Thrive project in Bangladesh, which had the explicit aim of learning how to strengthen delivery systems to programmatically achieve behavior change at scale (Piwoz et al. 2013).

Well-designed operational research is needed to understand the program-impact pathways to success–or failure–in improving feeding practices (Frongillo 2017). Evidence is also needed on how to effectively engage the private sector in improving complementary feeding (van Liere et al. 2017).

Notable evidence gaps exist on what works, and through what pathways, to improve breastfeeding practices for certain countries (Afghanistan, Nepal, and Pakistan), on continued breastfeeding, and on policies and workplace interventions for working mothers (Benedict et al. 2018b). Addressing these gaps will provide additional evidence on how to protect, promote, and support recommended breastfeeding practices in South Asia.

# **Conclusion**

The poor quality of young children’s diets in South Asia is holding back efforts to improve the growth, development, and well-being of children. While relatively good progress has been made in improving rates of early and exclusive breastfeeding in all countries except Afghanistan and Pakistan, continued breastfeeding rates have only marginally increased, while dietary diversity and other aspects of complementary feeding require improvement. Children most at risk include those who are born small, with younger mothers, in poorer households, and in communities with lower access to, or uptake of, health services.

Countries in the region have implemented a range of approaches aimed at improving breastfeeding and complementary feeding practices. These include policies and legal measures to protect feeding practices, education and counseling to influence behaviors, and agriculture and social protection interventions to improve access to nutritious and affordable food. However, these efforts have been unevenly applied across the region, and have often 15