Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
Alive & Thrive, FHI 360, Washington, DC, USA.
Matern Child Nutr. 2018 Nov;14 Suppl 4(Suppl 4):e12663. doi: 10.1111/mcn.12663.
Limited evidence exists on socio-economic status (SES) inequalities in infant and young child feeding (IYCF) in India. We examine trends and changes in inequalities for IYCF practices over 2006-2016 and identify factors that may explain differences in IYCF across SES groups. We use data from the 2015-2016 and 2005-2006 National Family Health Surveys (n = 112,133 children < 24 months). We constructed SES quintiles (Q) and assessed inequalities using concentration and slope indices. We applied path analyses to examine the relationship between SES inequalities, intermediate determinants, and IYCF. Breastfeeding improved significantly over 2006-2016: from 23% to 42% for early initiation of breastfeeding (EIBF) and 46% to 55% for exclusive breastfeeding (EBF). Minimum dietary diversity (MDD) improved modestly (15% to 21%), but adequate diet did not change (~9%). Large SES gaps (Q5-Q1) were found for EIBF (8-17%) and EBF (-15% to -10%) in 2006; these gaps closed in 2016. The most inequitable practices in 2006 were MDD and iron-rich foods (Q5 ~ 2-4 times higher than Q1); these gaps narrowed in 2016, but levels are low across SES groups. Factors along the path from SES inequalities to IYCF practices included health and nutrition services, information access, maternal education, number of children < 5 years, and urban/rural residence. The improvements in breastfeeding and narrowing of equity gaps in IYCF practices in India are significant achievements. However, ensuring the health and well-being of India's large birth cohort will require more efforts to further improve breastfeeding, and concerted actions to address all aspects of complementary feeding across SES quintiles.
关于印度婴幼儿喂养（IYCF）方面社会经济地位（SES）不平等问题的证据有限。我们研究了 2006 年至 2016 年期间 IYCF 实践中不平等现象的趋势和变化，并确定了可能解释 SES 群体之间 IYCF 差异的因素。我们使用了 2015-2016 年和 2005-2006 年全国家庭健康调查（n=112133 名<24 个月的儿童）的数据。我们构建了 SES 五分位数（Q），并使用集中和斜率指数评估了不平等现象。我们应用路径分析来研究 SES 不平等、中间决定因素与 IYCF 之间的关系。2006 年至 2016 年期间，母乳喂养得到了显著改善：EIBF 从 23%提高到 42%，EBF 从 46%提高到 55%。MDD 略有改善（15%至 21%），但适当饮食没有改变（~9%）。2006 年，EIBF（8-17%）和 EBF（-15%至-10%）之间存在较大的 SES 差距（Q5-Q1）；这些差距在 2016 年缩小了。2006 年最不平等的做法是 MDD 和富含铁的食物（Q5 比 Q1 高 2-4 倍）；这些差距在 2016 年缩小了，但 SES 群体的水平仍然较低。SES 不平等到 IYCF 实践的路径上的因素包括卫生和营养服务、信息获取、母亲教育、5 岁以下儿童数量以及城乡居住。印度母乳喂养的改善和 IYCF 实践中公平差距的缩小是显著的成就。然而，要确保印度庞大出生队列的健康和福祉，需要进一步努力，进一步提高母乳喂养率，并采取协调行动，解决 SES 五分位数中所有方面的补充喂养问题。
