Breastfeeding and related feeding practices during the first 6 months of life in seven countries across Asia and Africa: a cross-sectional survey

Despite investments in breastfeeding, and evidence illustrating that breastfeeding has short- and long-term health and economic benefits, countries are far off from global breastfeeding targets. To inform a breastfeeding counselling and support intervention within a randomized community-based trial titled Breastfeeding Counselling and Management of Growth Faltering in Infants Aged under Six Months (BRANCH in seven low-middle income countries: Bangladesh, India, Pakistan, Ethiopia, Nigeria, Tanzania, and Uganda we conducted a cross-sectional home-based infant feeding survey in each country (September-December 2023). We enrolled 4,308 infants aged 0-6 months. Among 1378 infants aged 60 days or younger, almost all (97.3%, 95% CI 96.3-98.1%) received mothers own milk; however, early breastfeeding initiation within the first hour of birth (EIBF) occurred  in only half (50.8%, 95% CI 48.1-53.6%), with marked regional differences – two-thirds in Africa (66.5% (95% CI 62.9-69.9%) versus one-third in Asia (31.8% (95% CI 28.1-35.7%). EBF prevalence was only 52.9% (95% CI 51.4-54.4%) and 40.2% (95% CI 38.7-41.7%), by 24 hour and 7-days recall, respectively. The foods and fluids that interrupted EBF varied by country. Since birth almost one-quarter of infants (23.9%, 95% CI 22.7-25.2%) had ever received formula milk, with higher use in Asia (31.6%, 95% CI 29.5-33.8%) than Africa (18.4%, 16.9-20.0. Most formula use started within the first month of life (65.0%), predominantly due to perceived insufficient breast milk (64.7%) and advice from healthcare providers (52.0%). Strikingly, only 46.9% of mothers using formula milk prepared it correctly, with substantial variation across sites (8.3% in Bangladesh versus 77.0% in Ethiopia). There is a critical need for context-specific breastfeeding counselling and support strategies for early and exclusive breastfeeding. These should build mothers’ and families’ confidence, strengthen breastfeeding support within the heath system and curb unnecessary formula milk marketing that exploits the fears, and concerns of parents and families.