Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Abstract

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

1. Introduction

Appropriate infant and young child feeding (IYCF, comprising of breastfeeding and complementary feeding) play important roles in optimal child growth and development. This is because appropriate breastfeeding is associated with a lower prevalence of childhood diarrhea [1,2], upper respiratory tract infection and obesity, and maternal diseases like diabetes mellitus [3]. Additionally, appropriate complementary feeding is associated with a reduced risk of undernutrition (i.e., underweight, stunting, and/or wasting) [4,5,6]. Despite the benefits of appropriate IYCF, many low- and middle-income countries (LMICs) still report higher prevalence of inappropriate IYCF [1,7,8,9,10,11,12]. In India, inappropriate IYCF practices have contributed to childhood malnutrition contributing to about 68% of the under five deaths and 83% of the neonatal deaths [13]. Inappropriate IYCF was the underlying source for an estimated 0.9 million under-five deaths in 2016 [2]. Inappropriate IYCF are feeding behaviors that do not meet the recommendations of the World Health Organization/United Nations Children’s Fund (WHO/UNICEF) indicators for assessing IYCF practices [14]. Core WHO/UNICEF recommendations include the initiation of breastfeeding for newborns within the first hour of birth, followed by exclusive breastfeeding (EBF) for the first six months of birth, and continued breastfeeding for up to two years and more, with nutritionally-balanced and safe complementary foods introduced to the infant when the child is six months old [14].

To improve global infant and young child feeding, the WHO recently endorsed a set of Global Nutrition Targets (WHO GNT, including Goals 1, 5, and 6). These goals aim to reduce the number of stunted children by 40%, increase the global EBF rate to at least 50%, and reduce and maintain childhood wasting to less than 5% by the year 2025, respectively [15]. However, there are varied reports on how many countries in LMICs are on track to meet the WHO GNT. For example, a recent study showed that only three African countries would meet the GNT for EBF [16].

In India, a recent study showed that the prevalence of EBF was 55% at the national level [17], higher than the WHO GNT for EBF. While this is commendable, improving EBF prevalence and other breastfeeding practices is also essential to further reduce the burden of diarrhea-related morbidity [2] and stunting in India [4]. Notably, recent research indicates that the prevalence of inappropriate complementary feeding is high in India [18]. The prevalence of introduction of solid, semi-solid, or soft foods (complementary foods) among infants aged 6–8 months was 42.7% nationally [19], while that of minimum dietary diversity was 22% at national level [19]. Prevalence of minimum meal frequency nationally was 35.9% [19] and minimum acceptable diet was 9.6% [19]. Inappropriate complementary feeding practices are a significant contributor to the burden of childhood underweight, stunting, and wasting in India [4,20,21].

Understanding what factors act as enablers and barriers to the broader IYCF practices across regional areas and at the national level in India is essential to improving childhood nutritional status in the country. In 2017, a systematic review conducted for India showed that complementary feeding behaviors were largely influenced by cultural practices, limited knowledge of appropriate complementary feeding practices, and low parental education [20]. While useful for informing policy interventions in India, the study has several limitations. Firstly, the study did not incorporate or assess what can influence other important IYCF behaviors (e.g., early initiation of breastfeeding (EIBF) or EBF). Secondly, the study did not capture recent studies that used recent nationally representative data in India. Hence, there is need for a comprehensive systematic review to incorporate newer IYCF indicators based on the newer health data to better guide the policymakers and public health researchers towards improving children’s health and their nutrition requirements. The availability of recent health data reflects current socioeconomic and health status of the community and suggests the need for up-to-date evidence on what can influence IYCF behaviors in the household and community. Finally, a lack of assessment of important IYCF behaviors using new data may be limited in informing multi-faceted approaches required to improve the nutritional needs of Indian children.

Accordingly, this review aims to systematically examine published studies and report on enablers and barriers to appropriate IYCF practices in India. The evidence will help government and non-government policy decision-makers to prioritize and implement targeted interventions that aim to improve the nutritional status of Indian children.

2. Methods

2.1. Information Sources and Search Strategy

The review was conducted using the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines provided in Supplementary Table S1 [21]. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), and the registration number is CRD42020170021. A list of relevant MeSH words and sub-headings of keywords was generated and used to comprehensively search peer-reviewed articles from six computerized bibliographic databases: Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE. The search covered research conducted in India and published between 1 January 2008, to 30 April 2020. The year 2008 was used as a baseline in this review to capture the period when the new IYCF indicators (breastfeeding and complementary feeding indicators) were introduced by the WHO [5].

The articles retrieved from each database were imported into an EndNote X8 (Clarivate Analytics, USA). We searched the bibliographical references of all retrieved articles that met the inclusion criteria, in addition to citation tracking using Google Scholar for additional relevant publications that might have been missed. The following combination of keywords was used in the search:(Child* or Preschool* or Pediatric* or Infant* or Bab* or Newborn* or Neonate*)AND(Feed* or Breastfeed* or Complementary Feed* or Food*)AND(Factor* or Determinant* or Correlate* or Cause* or Influence* or Enabler* or Barrier* or Promoter*)AND(India)

2.2. Eligibility Criteria

Studies were included in the review if they meet the following criteria: (i) focused on children under two years of age, (ii) were conducted in India, (iii) analyzed factors associated with IYCF indicators (EIBF; EBF; continued breastfeeding at one year; introduction of solid, semi-solid, or soft foods; minimum dietary diversity (MDD); minimum meal frequency (MMF); minimum acceptable diet (MAD); continued breastfeeding at two years; predominant breastfeeding; and bottle feeding), (iv) were published between 1993 and 2020, (v) were observational studies (qualitative studies, case studies, books, policy briefs, or theses were excluded), (vi) were published in a peer-reviewed journal (non-peer-reviewed research, review, or commentaries were excluded), and (vii) were written in English. Eight WHO/UNICEF IYCF indicators were selected for this review based on the available published literature at the regional and national level of India [18,22,23,24,25]. These indicators were defined using the WHO/UNICEF definitions for assessing IYCF practices [5]:EIBF was defined as the proportion of children born in the last 24 months who were put to the breast within one hour of birth.EBF was defined as the proportion of infants 0–5 months of age who receive breast milk as the only source of nourishment but are allowed oral rehydration solution, drops or syrups of vitamins, and medicines.Continued breastfeeding at one year was defined as the proportion of children 12–15 months of age who are fed breast milk.Introduction of solid, semi-solid, or soft foods was defined as the proportion of infants 6–8 months of age who receive solid, semi-solid, or soft foods.MDD was defined as the proportion of children 6–23 months of age who receive foods from four or more food groups. The seven foods groups used for this indicator are: grains, roots and tubers, legumes and nuts, dairy products (milk, yogurt, cheese), flesh foods (meat, fish, poultry, and liver/organ meats), eggs, vitamin-A rich fruits and vegetables, as well as other fruits and vegetables.MMF was defined as the proportion of breastfed and non-breastfed children 6–23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more (Minimum is defined as: two times for breastfed infants 6–8 months, three times for breastfed children 9–23 months, and four times for non-breastfed children 6–23 months).MAD was defined as the proportion of children 6–23 months of age who receive a minimum acceptable diet (apart from breast milk).Continued breastfeeding at two years was defined as the proportion of children 20–23 months of age who are fed breast milk.Predominant breastfeeding was defined as the proportion of infants 0–5 months of age who receive breast milk as the main source of nourishment but are allowed water, water-based drinks, fruit juice, oral rehydration solution, drops or syrups of vitamins, and medicines.Bottle feeding was defined as the proportion of children 0–23 months of age who are fed with a bottle during the previous day.

2.3. Data Collection Process and Data Items

All articles identified in the search were exported into EndNote X8 and used for removing duplicates, screening, and selection. A three-step screening process was then employed. In the first screening phase, the first author (MVD) screened all publications by reading the titles. The second screening phase involved reading the abstracts of studies retained from the first screening phase, and eligible articles were retained. In the final screening phase, MVD read the full text of the remaining articles and retained studies that met the inclusion/exclusion criteria. All data extraction and appraisals of retrieved studies were independently reviewed by MVD and BA, and all disagreements between the two reviewers were resolved through discussion and consensus. A third reviewer FAO adjudicated the differences that emerged in the selection of the final studies for inclusion. The summary of the selected studies was recorded, and this included: author, year of publication, number of children/number of mothers, age of children, factors associated with IYCF indicators, and quality assessment score.

2.4. Quality Assessment

The quality assessment of the review was based on the assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) for quality assessment of Observational Cohort and Cross-Sectional Studies and Controlled Intervention Studies [26]. The checklist consists of 14 items that evaluate the external validity (based on potential selection bias) and internal validity (based on potential measurement biases and confounding) of observational studies. After the initial assessment of all reviewed studies, the items were further collapsed into eight quality-appraisal criteria: sample size, sampling methodology, responses rate, outcome measures, statistical analyses, study limitation, ethical consideration, and control for confounding. Scores assigned to each reviewed study range from zero to 14 points (zero if none of the criteria were met and 14 points if all criteria were met). The sum of points awarded represented the overall quality of the study. Studies were rated as good (≥11), medium (6–10), and poor (≤5). A low-quality rating implies a high risk of bias in the study and vice versa. Research has indicated that the NIH checklist is a comprehensive tool for assessing the risk of bias in observational and experimental studies [27,28,29].

3. Results

A total of 6968 articles were retrieved from the six databases. A manual search of the bibliographic references of the retained articles identified 10 additional articles. After the removal of duplicates, 4537 articles were retained. The screening of the titles in the first screening phase resulted in the exclusion of 4323 articles. Further screening of the resulting 214 abstracts led to the exclusion of another 134 articles. In the final screening phase, the full texts of the remaining 80 articles were reviewed, and a further 39 articles were excluded. After the entire screening, 41 articles met the inclusion criteria and were thereby retained, as shown in Figure 1.

3.1. Characteristics of the Study

Table A1 and Table A2 demonstrates the summary of the studies included in this review. Of the studies conducted, nine studies were conducted at the national level, and 32 studies were conducted at the regional level. Sample sizes ranged from 77 mothers/children to 94,401 mothers/children. The criteria used to evaluate the quality of the included studies demonstrated that all the 41 studies were of medium quality. The details of the specific scores are provided in Supplementary Table S2. The extensive details of the studies have been provided in Supplementary Tables S3–S12. During the search, three randomized control trials (RCTs) were found. However, the RCTs were not included in the review, as their sampling procedures, study design, methodology, implementation, and the quality assessment criteria were different from observational studies.

3.2. Evidence from the Reviewed Studies

As shown in Table A1 and Table A2, the most consistent factors associated with the IYCF indicators included (i) socioeconomic factors such as family characteristics such as marital status, socioeconomic status/standard of living, family type/size and access to media sources like newspapers, radio, and television; (ii) child characteristics such as sex, birth status (pre-term, term, post-term), perceived size of the baby at birth, preceding birth interval, and birth order of the child; (iii) maternal characteristics such as maternal age, maternal age at marriage, education/literacy level, employment status, power over earnings, power over household purchases, type of caste or tribe, and religion and parity; (iv) community-level characteristics such as place of residence (urban or rural); and (v) health service factors such as breastfeeding counselling, registration for antenatal care (ANC), number of ANC visits, place of birthing, type of birthing assistance, and mode of birthing.

3.2.1. Factors Associated with EIBF

The review showed that higher socioeconomic status [28,29], higher maternal education [28,30,31,32,33,34,35,36], maternal employment [24], access to media sources [24], term/post-term birth [32,33,34] [34,36,37], and maternal age (≥20 years) [32,36] were associated with EIBF. Similarly, a receipt of breastfeeding counselling [32,34,37], frequent ANC visits [31] (≥3 [36], ≥4 [30], ≥7 [23,24]), health facility birthing [30,35,37,38], births assisted by health professionals [28], and vaginal birthing [30,32,33,34,38] were associated with EIBF. However, rural/urban residence [35] and caesarean birthing [30] were associated with delayed initiation of breastfeeding.

3.2.2. Factors Associated with EBF Less than Six Months of Age

In the review, we found that middle or higher socioeconomic status [25,39,40,41], nuclear family [42,43,44], small family size [42,45], male children [17,46], female children [47], preterm birth [43], smaller babies at birth [44], lower birth order [30], maternal age [23,48] (20–25 years [37,39]), higher maternal education [42,46,49,50,51,52,53], maternal unemployment [38,45], and multiparity [39] were associated with EBF. Similarly, low socioeconomic status [38], low maternal education [38,43], employed mothers [44], and primiparity [51] and breastfeeding counselling [49,54,55] were also associated with EBF. Additionally, some studies found that young maternal age (15–24 years [53], <20 years [44]), low socioeconomic status [53], and urban residence [44] were associated with low EBF. In contrast, breastfeeding counselling [54,56,57], registration for ANC [39,41], number of ANC visits (≥3 [27,48,51], ≥4 [51], ≥7 [48]), hospital birthing [30,41], access to the type of birthing assistance, and vaginal birthing [26,33,44] were associated with EBF.

In contrast, factors such as high socioeconomic status [44], male children [46], early marriage of parents [46], young maternal age (≤20 years) [50], low maternal education [25,46], primiparity [50], employed mothers [44,46], less frequent ANC visits (≤4) [46], caesarean birthing [46], delayed initiation of breastfeeding [46], a lack of knowledge about EBF [46], and poor maternal counselling regarding EBF [46] were barriers to EBF. Additionally, higher socioeconomic status [17,26,58], nuclear family [59], higher birth order [17], female children [17], larger baby size at birth [17], higher maternal education [17,25,52,58,60], consecutive birthing (≤24 months) [50], rural residence [17,44], health facility birthing [24], and birthing in summer [59] were negatively associated with EBF whereas one study Mahmood et al. [56] found no association between maternal factors and EBF.

3.2.3. Factors Associated with Continued Breastfeeding at One Year (12–15 Months)

Only one study by Kumar et al. [40] considered continued breastfeeding at one year, and the study showed that maternal age (21–30 years) and joint family were associated with continued breastfeeding at one year.

3.2.4. Factors Associated with the Introduction of Solid, Semi-Solid, or Soft Foods, 6–8 Months

In the reviewed studies, we found that middle or high socioeconomic status [18,57,58,61], access to media [24,61], male children [30], high birth order [18,58], high maternal education [30,31,37,57,58], high parity [57], urban residence [18], frequent ANC visits [37,60] (≥4 [18], ≥6 [61], >7 [24]), health professional advice [60], hospital birthing [57,58], and vaginal birthing [57] were associated with introduction of solid, semi-solid, or soft foods.

3.2.5. Factors Associated with MDD, 6–23 Months

The review demonstrated that MDD was associated with higher socioeconomic status [18,22], media exposure [60], higher maternal education [18], woman’s autonomy over power of earnings [18], higher birth order [18,22], urban residence [22], and frequent ANC visits (≥4) [18]. Low socioeconomic status [61], low maternal education [61], lower media exposure [61], and fewer ANC visits (<6 to none) [61] were associated with inadequate MDD.

3.2.6. Factors Associated with MMF, 6–23 Months

The review showed that MMF was associated with higher socioeconomic status [18], media exposure [60], male gender [22], higher birth order (≥2) [18], higher maternal education [18,22], woman’s autonomy over finances [18], urban residence [22], health professional-assisted births [18], and frequent ANC visits (≥4) [18]. Low socioeconomic status [61], less exposure to media [61], low maternal education [61], less power over household decision making [61], and less frequent ANC visits (<6 to none) [61] were associated with inadequate MMF.

3.2.7. Factors Associated with MAD, 6–23 Months

The reviewed studies demonstrated that MAD was associated with richer households [18,22], male children [22], higher birth order [18,22], older maternal age (≥25 years) [18], urban residence [22], health facility birthing [18,58], and ANC visits (≥4) [18]. Lower socioeconomic status [61], low maternal education [61], less exposure to media [61], less power over household decision making [61], and less frequent ANC visits (<6 to none) [61] were associated with inadequate MAD.

3.2.8. Factors Associated with Continued Breastfeeding at Two Years (20–23 Months)

In the reviewed studies, we found that high socioeconomic status [62], high maternal education [63], private hospital birthing [62], and increasing urbanicity [63] were associated with breastfeeding discontinuation before 24 months. Male children [62,64], higher birth order (≥2) [62], rural women [62,64], younger mothers (≤20 years) [64], and increasing maternal age at childbirth [62] were associated with continued breastfeeding at two years. Additionally, frequent ANC visits [62] and birthing assistance by a friend [64] were associated with continued breastfeeding at two years.

3.2.9. Factors Associated with Predominant Breastfeeding Less than Six Months of Age

Srivastava et al. [25] demonstrated that factors associated with predominant breastfeeding included lower socioeconomic status, lower maternal and paternal education, fewer ANC visits (<3), and fewer TT vaccinations.

3.2.10. Factors Associated with Bottle Feeding, 0–23 Months

Patel et al. [24] found that the factors associated with bottle feeding included birthing assisted by non-health professionals, smaller birth size, higher socioeconomic status, higher media exposure, maternal employment, higher maternal education, and urban residence.

4. Discussion

The review showed that the most common factors associated with appropriate IYCF indicators were middle/higher socioeconomic status, frequent exposure to media, child gender (male), and higher birth order (≥2). Other common factors included maternal age, higher maternal education, employment status (housewife and employed), multiparity and a higher number of ANC visits (≥3), health facility birthing, and vaginal birthing.

The association between higher socioeconomic status and IYCF practices reported in this review is consistent with studies conducted in Bangladesh [65,66] and Pakistan [67,68]. Higher socioeconomic status and better media exposure [69] may translate into better awareness about appropriate IYCF practices, which may in turn influence a mother’s decision to improve child-related health outcomes, including nutrition [70]. Our review also showed that male children and those with higher birth order (≥2) were more likely to be appropriately fed. Similarly, a study from Bangladesh [71] has found significant association between birth order and IYCF practices, while studies from Pakistan [72,73,74] and Nepal [75] have reported that higher birth order was associated with inappropriate IYCF practices, whereas a study from Sri Lanka [76] has found no significant association between birth order and IYCF practices. Higher birth order may reflect a more experienced mother in relation to appropriate infant feeding, as the mother may be more aware of what type of food to give to the child at every stage of growth and development [77]. In India, evidence suggests that there is an increasing desire for male children, and this male preference may have an impact on child health and development [78]. It is uncertain to what extent this cultural practice may be affecting infant and young child nutrition in the population, and future research may consider the impact of male preference on infant and young child nutrition in the country.

Previous studies from Pakistan, Bangladesh, and Nepal have reported that maternal characteristics such as higher maternal age (≥25 years) [67], higher maternal education [67,79], employment status [80,81,82], parity (≥2), and maternal autonomy in finance [83] were associated with appropriate IYCF practices. Similarly, our review showed that maternal characteristics (maternal age, maternal education, employment status, parity, and maternal autonomy) were associated with appropriate IYCF indicators. Globally, women empowerment indicators have been shown as a major determining factor for optimal child growth and development [80,81,84,85]. Higher maternal education increases women’s opportunities for employment, household earnings, and autonomy; empowers the woman to make informed child health-related decisions such as the uptake of appropriate IYCF information; and improves the woman’s attitude towards seeking appropriate child health support for appropriate IYCF [82]. While some studies have shown that women in employment have advantages of improving earnings/confidence and subsequent health-related decisions for IYCF [67,86,87,88], other studies have indicated that “stay-at-home” mothers (housewives) also have advantages for appropriate IYCF [89,90]. Being a housewife allows the mother to have enough time and support for careful consideration of appropriate IYCF practices, and the mother is not distracted by external work activities compared to the mother in employment [89,90].

Globally, numerous studies from LMICs have shown that health service factors (including breastfeeding counselling in health facilities, ANC visits, and health facility birthing and normal vaginal births) are strongly associated with appropriate IYCF [91,92,93,94]. Consistent with past studies, the review showed that health service factors were associated with appropriate IYCF in India. Empirical evidence suggests that increased access to health services for women can improve many maternal and child health domains. These areas include access to relevant information and support for behavior change for both mother and child; better opportunities for making informed decisions about preventive maternal and child health measures; and possibly providing an entry point for better household decision-making process about child health [95].

4.1. Policy Implications of the Study Findings

In India, information relating to IYCF policy initiation and implementation has been extensively documented in previously published studies [2,4,17,18,35]. Briefly, we highlight various national policies and programs that are being implemented in India to improve child nutrition. These policies are in support of the major IYCF programs introduced nationally to support the Integrated Child Development Scheme (ICDS) [96]. Efforts have been made to improve the coordination between the national and state level ICDS implementation through recommendations in the Twelfth five-year plans (2012–2017), such as organization “Village Health and Nutrition Days” to promote the uptake of appropriate IYCF practices [97]. However, the strategic decision to restructure the focus of ICDS to children under three years of age to target the increased uptake of key IYCF indicators to guide policies and laws still requires revisions to document any major impact on the nutritional status of children. Additional policies to support ICDS have been implemented, which include the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) [98], Pradhan Mantri Matru Vandana Yojana (PMMVY) [99], LaQshya programme [100], HealthPhone [101], cash transfer schemes such as Janani Suraksha Yojna (JSY) [102], and recent amendments to the Maternity Benefit Act, 1961 (now known as the Maternity Benefit Amendment Act, 2017) [103]. The impacts of these initiatives across regional and national India are yet to be publicly documented, as current estimates of IYCF showed that these indicators are below expected levels in many regional areas [17,18]. Similarly, employed mothers still face significant resistance around workplace breastfeeding [104]. Streamlining India’s IYCF policies and programs may likely have maximal impacts due to the positive impacts of policy-driven and targeted approaches for IYCF interventions employed in other contexts. For example, Sri Lanka now has a strong focus on policy directives on mass communication for maternal education and special consideration for working mothers around IYCF. This initiative has been shown to significantly increase the uptake of IYCF practices across all levels of the population [105].

Moreover, the improvement of breastfeeding and complementary feeding participation of Indian women would also require an increase in female education as articulated in the Sustainable Development Goals [106] as well as the pragmatic implementation of the World Breastfeeding Trends Initiative (WBTi) recommendations [107]. One of the recommendations includes the establishment of standard BFHI centers for promoting, protecting, and supporting breastfeeding. While the Government of India has established programs, including Mother’s Absolute Affection (MAA) [108] and the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan [109] to promote, protect, and support breastfeeding, intensifying efforts to improve the uptake of these programs is still needed [108].

Worldwide, husband/partner and family (e.g., grandmother) support for breastfeeding is essential for appropriate IYCF practices in the household [110]. With the appropriate knowledge, these key family members provide an emotional, psychological, and physical support system for new mothers [111]. A recent systematic review indicated that appropriate partner breastfeeding support (in terms of verbal encouragement to new mothers from their partners, assistance in preventing and managing breastfeeding difficulties, and/or assistance with household/child care duties) influenced new mothers’ decision to initiate, continue, or cease breastfeeding in the early postnatal period [112]. The important role of grandmothers in influencing maternal IYCF decisions has also been documented in Malawi [113], Nigeria [114], and internationally [115]. In India, the new Home-Based Care for Young Child initiative introduced in 2018 aims to strengthen the nutritional levels of children through structured home visit counselling of the caregivers and mothers [116]. This initiative is focused on a community-based approach with family units as the center of care to improve the IYCF uptake of children. However, these policy interventions that seek to improve IYCF practices in India should also consider maximizing the aspects of a family support system to improve the IYCF uptake.

4.2. Strengths and Limitations

This systematic review is a comprehensive search of existing literature on the association between socioeconomic, demographic, and health service factors and IYCF practices in India to inform targeted policy interventions. The strengths of our systematic review lie in the exhaustive search through extensive databases utilizing broad search strings and having two independent reviewers undertake the study selection, reanalyzing the studies to be included in the review based on the inclusion and exclusion criteria through discussion and consensus, as well as quality assessment. However, the study has limitations. First, the review was limited to quantitative studies with the exclusion of qualitative studies to appropriately answer the research question. The inclusion of the qualitative studies would allow for triangulation of results and provide alternative explanations for the findings [117]. Future studies should be conducted to highlight the in-depth reasons for the varied patterns of IYCF feeding practices in India. Second, the exclusion of studies not written in English and those published in multiple centers across different countries (including India) would have limited our evidence, as those excluded studies may have had additional information. Third, there may have been a publication bias, given that grey literature was excluded. Fourth, most of the included studies were cross-sectional studies, and recall bias is potentially inherent in the findings due to the nature of the data collection. Finally, the evidence from this study may be limited, given the study design. Future experimental studies that investigate the association between the socioeconomic, demographic, and health service factors and IYCF practices in India may be needed.

5. Conclusions

In India, our review has shown that the factors associated with IYCF practices are multi-factorial. There is a need for a multi-sectorial strategy that hinges on both facility- and community-based approaches at the sub-national and national levels to improve IYCF practice in India. These public health measures should not only include IYCF education or counselling sessions for mothers, but should also involve other important hierarchical (socioeconomic, demographic, and health service) factors in the households and community to improve childhood feeding.

Acknowledgements

AcknowledgmentsGloMACH Members are Kingsley E. Agho, Felix A. Ogbo, Thierno M. O. Diallo, Osita K. Ezeh, Osuagwu L. Uchechukwu, Pramesh R. Ghimire, Blessing J. Akombi, Pascal Ogeleka, Tanvir Abir, Abukari I. Issaka, Kedir Yimam Ahmed, Rose Victor, Deborah Charwe, Abdon Gregory Rwabilimbo, Daarwin Subramanee, Mehak Mehak, Nilu Nagdev, and Mansi V. Dhami.

Competing interests

Conflicts of InterestThe authors declare that they have no conflict of interest.

References

1. Ogbo F.A., Page A., Idoko J., Claudio F., Agho K.E.. Diarrhoea and suboptimal feeding practices in Nigeria: Evidence from the national household surveys. Paediatr. Perinat. Epidemiol.. 2016 doi:10.1111/ppe.12293 PubMed
2. Dhami M.V., Ogbo F.A., Diallo T.M., Agho K.E.. Regional Analysis of Associations between Infant and Young Child Feeding Practices and Diarrhoea in Indian Children. Int. J. Environ. Res. Public Health. 2020 doi:10.3390/ijerph17134740 PubMed
3. Victora C.G., Bahl R., Barros A.J.D., França G.V., Horton S., Krasevec J. et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016 doi:10.1016/S0140-6736(15)01024-7 PubMed
4. Dhami M.V., Ogbo F.A., Osuagwu U.L., Ugboma Z., Agho K.E.. Stunting and severe stunting among infants in India: The role of delayed introduction of complementary foods and community and household factors. Glob. Health Action. 2019 doi:10.1080/16549716.2019.1638020 PubMed
5. Darsene H., Geleto A., Gebeyehu A., Meseret S.. Magnitude and predictors of undernutrition among children aged six to fifty nine months in Ethiopia: A cross sectional study. Arch. Public Health. 2017 doi:10.1186/s13690-017-0198-4 PubMed
6. Rakotomanana H., Hildebrand D., Gates G., Thomas D., Stoecker B.. Complementary Feeding Practices and Child Growth in a Region with a High Burden of Child Undernutrition in Madagascar. Curr. Dev. Nutr.. 2020 doi:10.1093/cdn/nzaa053_096 PubMed
7. Roba K.T., O’Connor T.P., Belachew T., O’Brien N.M.. Variations between post-and pre-harvest seasons in stunting, wasting, and Infant and Young Child Feeding (IYCF) practices among children 6–23 months of age in lowland and midland agro-ecological zones of rural Ethiopia. Pan Afr. Med. J.. 2016 doi:10.11604/pamj.2016.24.163.9387 PubMed
8. Hanley-Cook G., Argaw A., Dahal P., Chitekwe S., Kolsteren P.. Infant and young child feeding practices and child linear growth in Nepal: Regression–decomposition analysis of national survey data, 1996–2016. Matern. Child Nutr.. 2020 doi:10.1111/mcn.12911 PubMed
9. Issaka A.I., Agho K.E., Renzaho A.M.. Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries: A meta-analysis of demographic and health surveys (2010–2015). BMJ Open. 2017 doi:10.1136/bmjopen-2016-014145 PubMed
10. Khamis A., Omar A., Suleiman S., Ali F.. Prevalence of exclusive breastfeeding and its predictors among mothers in Micheweni, Chake-Chake and North ‘A’districts, Zanzibar. Clin. Mother Child Health. 2017 doi:10.4172/2090-7214.1000259
11. Belachew A., Tewabe T., Asmare A., Hirpo D., Zeleke B., Muche D.. Prevalence of exclusive breastfeeding practice and associated factors among mothers having infants less than 6 months old, in Bahir Dar, Northwest, Ethiopia: A community based cross sectional study, 2017. BMC Res. Notes. 2018 doi:10.1186/s13104-018-3877-5 PubMed
12. Khokhar S., Jatoi H., Lassi Z.. Prevalence of timely introduction of complementary feeding and its related factors in children 6-24 months of age in Hyderabad, Pakistan. Nurs. Midwifery Stud.. 2017 doi:10.4103/nms.nms_19_17
13. Kumar P., Singhal N.. Mapping neonatal and under-5 mortality in India. Lancet. 2020 doi:10.1016/S0140-6736(20)31050-3 PubMed
14. Indicators for Assessing Infant and Young Child Feeding Practices—Part 1—Definitions. 2008
15. Global Targets 2025. To Improve Maternal, Infant and Young Child Nutrition. 2014
16. Bhattacharjee N.V., Schaeffer L.E., Marczak L.B., Ross J.M., Swartz S.J., Albright J. et al. Mapping exclusive breastfeeding in Africa between 2000 and 2017. Nat. Med.. 2019 doi:10.1038/s41591-019-0525-0 PubMed
17. Ogbo F.A., Dhami M.V., Awosemo A.O., Olusanya B.O., Olusanya J., Osuagwu U.L. et al. Regional prevalence and determinants of exclusive breastfeeding in India. Int. Breastfeed. J.. 2019 doi:10.1186/s13006-019-0214-0 PubMed
18. Dhami M.V., Ogbo F.A., Osuagwu U.L., Agho K.E.. Prevalence and factors associated with complementary feeding practices among children aged 6-23 months in India: A regional analysis. BMC Public Health. 2019 doi:10.1186/s12889-019-7360-6 PubMed
19. National Family Health Survey (NFHS-4), 2015–2016. 2017
20. Manikam L., Prasad A., Dharmaratnam A., Moen C., Robinson A., Light A. et al. Systematic review of infant and young child complementary feeding practices in South Asian families: The India perspective. Public Health Nutr.. 2018 doi:10.1017/S136898001700297X PubMed
21. Moher D., Shamseer L., Clarke M., Ghersi D., Liberati A., Petticrew M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev.. 2015 doi:10.1186/2046-4053-4-1 PubMed
22. Ahmad I., Khalique N., Khalil S., Urfi Maroof M.. Complementary feeding practices among children aged 6-23 months in Aligarh, Uttar Pradesh. J. Fam. Med. Prim. Care. 2017 doi:10.4103/jfmpc.jfmpc_281_16 PubMed
23. Veeranki S.P., Nishimura H., Krupp K., Gowda S., Arun A., Madhivanan P.. Suboptimal Breastfeeding Practices among Women in Rural and Low-Resource Settings: A Study of Women in Rural Mysore, India. Ann. Glob. Health. 2017 doi:10.1016/j.aogh.2017.10.012 PubMed
24. Patel A., Badhoniya N., Khadse S., Senarath U., Agho K.E., Dibley M.J.. Infant and young child feeding indicators and determinants of poor feeding practices in India: Secondary data analysis of National Family Health Survey 2005–2006. Food Nutr. Bull.. 2010 doi:10.1177/156482651003100221 PubMed
25. Srivastava N.M., Awasthi S.. Breastfeeding practices for newborns among urban poor in Lucknow, northern India: A prospective follow-up study. Clin. Epidemiol. Glob. Health. 2014 doi:10.1016/j.cegh.2013.03.003
26. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies 2020
27. Connolly M.P., Haitsma G., Hernández A.V., Vidal J.E.. Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole. Pathog. Glob. Health. 2017 doi:10.1080/20477724.2017.1377974 PubMed
28. Mangin D., Stephen G., Bismah V., Risdon C.. Making patient values visible in healthcare: A systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity. BMJ Open. 2016 doi:10.1136/bmjopen-2015-010903 PubMed
29. Ward J.L., Harrison K., Viner R.M., Costello A., Heys M.. Adolescent cohorts assessing growth, cardiovascular and cognitive outcomes in low and middle-income countries. PLoS ONE. 2018 doi:10.1371/journal.pone.0190443 PubMed
30. Gupta A., Chhabra P.. Infant and young child feeding practices and its determinants in an urbanized village of Delhi. Int. J. Med. Public Health. 2015 doi:10.4103/2230-8598.161536
31. Jayant D.D., Purushottam A.G., Deepak B.P., Vaishali D.P., Piyush K., Aarif S.M.M.. Socio-cultural practices in relation to breastfeeding, weaning and child rearing among Indian mothers and assessment of nutritional status of children under five in rural India. Australas. Med. J.. 2010
32. Pariya A., Das A.. Exploring Barriers for Early Initiation of Breastfeeding among Mothers in the Post-Natal Ward: A Cross-sectional Study. J. Clin. Diagn. Res.. 2020 doi:10.7860/JCDR/2020/43041.13437
33. Patel A., Banerjee A., Kaletwad A.. Factors associated with prelacteal feeding and timely initiation of breastfeeding in hospital-delivered infants in India. J. Hum. Lact.. 2013 doi:10.1177/0890334412474718 PubMed
34. Prasad K., Ahamed N.. Community based study on initiation of breast feeding and determining factors in rural area of Pondicherry. Int. J. Contemp. Pediatrics. 2015 doi:10.18203/2349-3291.ijcp20150528
35. Senanayake P., O’Connor E., Ogbo F.A.. National and rural-urban prevalence and determinants of early initiation of breastfeeding in India. BMC Public Health. 2019 doi:10.1186/s12889-019-7246-7 PubMed
36. Sharma A., Thakur P.S., Tiwari R., Kasar P.K., Sharma R., Kabirpanthi V.. Factors associated with early initiation of breastfeeding among mothers of tribal area of Madhya Pradesh, India: A community based cross sectional study. Int. J. Community Med. Public Health. 2016 doi:10.18203/2394-6040.ijcmph20151561
37. Bhanderi D., Choudhary S.. A community based study of feeding and weaning practices in under five children in semi urban community of Gujarat. Natl. J. Community Med.. 2011
38. Sultania P., Agrawal N.R., Rani A., Dharel D., Charles R., Dudani R.. Breastfeeding knowledge and behavior among women visiting a tertiary care center in India: A cross-sectional survey. Ann. Glob. Health. 2019 doi:10.5334/aogh.2093 PubMed
39. Choudhary A.K., Bankwar V., Choudhary A.. Knowledge regarding breastfeeding and factors associated with its practice among postnatal mothers in central India. Int. J. Med. Sci. Public Health. 2015 doi:10.5455/ijmsph.2015.10022015201
40. Kumar N., Unnikrishnan B., Rekha T., Mithra P., Kulkarni V., Papanna M.K. et al. Infant feeding and rearing practices adapted by mothers in coastal south india. Int. J. Collab. Res. Intern. Med. Public Health. 2012
41. Randhawa A., Chaudhary N., Gill B.S., Singh A., Garg V., Balgir R.S.. A population-based cross-sectional study to determine the practices of breastfeeding among the lactating mothers of Patiala city. J. Fam. Med. Prim. Care. 2019 doi:10.4103/jfmpc.jfmpc_549_19 PubMed
42. Radhakrishnan S., Balamuruga S.S.. Prevalence of exclusive breastfeeding practices among rural women in Tamil Nadu. Int. J. Health Allied Sci.. 2012 doi:10.4103/2278-344X.101667
43. Tiwari R., Mahajan P.C., Lahariya C.. The determinants of exclusive breast feeding in urban slums: A community based study. J. Trop. Pediatr.. 2009 doi:10.1093/tropej/fmn037 PubMed
44. Chandhiok N., Singh K.J., Sahu D., Singh L., Pandey A.. Changes in exclusive breastfeeding practices and its determinants in India, 1992–2006: Analysis of national survey data. Int. Breastfeed. J.. 2015 doi:10.1186/s13006-015-0059-0 PubMed
45. Panigrahi A., Sharma D.. Exclusive breast feeding practice and its determinants among mothers of children aged 6-12 months living in slum areas of Bhubaneswar, eastern India. Clin. Epidemiol. Glob. Health. 2019 doi:10.1016/j.cegh.2018.11.004
46. Bhanderi D.J., Pandya Y.P., Sharma D.B.. Barriers to exclusive breastfeeding in rural community of central Gujarat, India. J. Fam. Med. Prim. Care. 2019 doi:10.4103/jfmpc.jfmpc_329_18 PubMed
47. Chhetri S., Rao A.P., Guddattu V.. Factors affecting exclusive breastfeeding (EBF) among working mothers in Udupi taluk, Karnataka. Clin. Epidemiol. Glob. Health. 2018 doi:10.1016/j.cegh.2018.06.008
48. Nishimura H., Krupp K., Gowda S., Srinivas V., Arun A., Madhivanan P.. Determinants of exclusive breastfeeding in rural South India. Int. Breastfeed. J.. 2018 doi:10.1186/s13006-018-0178-5 PubMed
49. Bagul A.S., Supare M.S.. The infant feeding practices in an urban slum of Nagpur, India. J. Clin. Diagn. Res.. 2012 doi:10.7860/JCDR/2012/4622.2549 PubMed
50. Chudasama R.K., Patel P.C., Kavishwar A.B.. Determinants of exclusive breastfeeding in South Gujarat region of India. J. Clin. Med. Res.. 2009 doi:10.4021/jocmr2009.06.1242 PubMed
51. Gogoi I., Mahanta T.G., Barua A.. Prevalence of exclusive breastfeeding in slums of Dibrugarh Town and factors affecting the breastfeeding practice. Clin. Epidemiol. Glob. Health. 2015 doi:10.1016/j.cegh.2015.10.009
52. Kunwar S., Faridi M.M., Singh S., Zahra F., Alizaidi Z.. Pattern and determinants of breast feeding and contraceptive practices among mothers within six months postpartum. Biosci. Trends. 2010 PubMed
53. Mathew A.C., Benny J.K., Philip D.M., Dhanya C., Joy M., Sandhiya V. et al. Socio-Demographic and Clinical Correlates of Exclusive Breastfeeding practices up to Six Months of Age. Nepal J. Epidemiol.. 2019 doi:10.3126/nje.v9i3.21179 PubMed
54. Das A., Chatterjee R., Karthick M., Mahapatra T., Chaudhuri I.. The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding—Findings from a Cross-Sectional Survey in India. PLoS ONE. 2016 doi:10.1371/journal.pone.0161186 PubMed
55. Kishore M.S.S., Kumar P., Aggarwal A.K.. Breastfeeding knowledge and practices amongst mothers in a rural population of North India: A community-based study. J. Trop. Pediatr.. 2009 doi:10.1093/tropej/fmn110 PubMed
56. Mahmood S.E., Srivastava A., Shrotriya V.P., Mishra P.. Infant feeding practices in the rural population of north India. J. Fam. Community Med.. 2012 doi:10.4103/2230-8229.98305 PubMed
57. Kakati R., Barua R., Borah M.. Complementary feeding practices and its determinants in rural areas of Kamrup district, Assam, India. Sch. J. Appl. Med. Sci.. 2016 doi:10.21276/sjams.2016.4.6.81
58. Rao S., Swathi P., Unnikrishnan B., Hegde A.. Study of complementary feeding practices among mothers of children aged six months to two years-A study from coastal south India. Australas. Med. J.. 2011 doi:10.4066/AMJ.2011.607 PubMed
59. Velusamy V., Premkumar P.S., Kang G.. Exclusive breastfeeding practices among mothers in urban slum settlements: Pooled analysis from three prospective birth cohort studies in South India. Int. Breastfeed. J.. 2017 doi:10.1186/s13006-017-0127-8 PubMed
60. Malhotra N.. Inadequate feeding of infant and young children in India: Lack of nutritional information or food affordability?. Public Health Nutr.. 2013 doi:10.1017/S1368980012004065 PubMed
61. Patel A., Pusdekar Y., Badhoniya N., Borkar J., Agho K.E., Dibley M.J.. Determinants of inappropriate complementary feeding practices in young children in India: Secondary analysis of National Family Health Survey 2005–2006. Matern. Child Nutr.. 2012 doi:10.1111/j.1740-8709.2011.00385.x PubMed
62. Malhotra R., Noheria A., Amir O., Ackerson L.K., Subramanian S.. Determinants of termination of breastfeeding within the first 2 years of life in India: Evidence from the National Family Health Survey-2. Matern. Child Nutr.. 2008 doi:10.1111/j.1740-8709.2007.00130.x PubMed
63. Oakley L., Baker C.P., Addanki S., Gupta V., Walia G.K., Aggarwal A. et al. Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parents study. BMJ Open. 2017 doi:10.1136/bmjopen-2017-016331 PubMed
64. Mehta A.R., Panneer S., Ghosh-Jerath S., Racine E.F.. Factors Associated with Extended Breastfeeding in India. J. Hum. Lact.. 2017 doi:10.1177/0890334416680179 PubMed
65. Al Amin A.S., Debnath S.C., Galib A., Rouf M.A., Haque M.E., Rabby M.F. et al. Socio-economic status and feeding practices among the mothers of under-five children in an urban slum of Bangladesh: A cross-sectional study. Asian J. Med. Biological. Res.. 2018 doi:10.3329/ajmbr.v4i3.38470
66. Chowdhury M.R.H.K., Rahman M.M., Naher S., Islam M.A., Islam M.A., Hoshen M.S.. Identifying the Associations of Currently Breastfeeding Status and Socio-Demographic Factors of Children Aged 6 to 23 Months of Age in Bangladesh. Int. J. Percept. Public Health. 2017 doi:10.29251/ijpph.2017129
67. Khan G.N., Ariff S., Khan U., Habib A., Umer M., Suhag Z. et al. Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh, Pakistan: A cross-sectional survey. Int. Breastfeed. J.. 2017 doi:10.1186/s13006-017-0131-z PubMed
68. Ijaz S., Ijaz T., Afzal R.K., Afzal M.M., Mukhtar O., Ijaz N.. Infants-feeding practices and their relationship with socio-economic and health conditions in Lahore, Pakistan. Adv. Life Sci.. 2015
69. Graziose M.M., Downs S.M., O’Brien Q., Fanzo J.. Systematic review of the design, implementation and effectiveness of mass media and nutrition education interventions for infant and young child feeding. Public Health Nutr.. 2018 doi:10.1017/S1368980017002786 PubMed
70. Meshram I.I., Mallikharjun Rao K.M., Balakrishna N., Harikumar R., Arlappa N., Sreeramakrishna K. et al. Infant and young child feeding practices, sociodemographic factors and their association with nutritional status of children aged <3 years in India: Findings of the National Nutrition Monitoring Bureau survey, 2011–2012. Public Health Nutr.. 2019 doi:10.1017/S136898001800294X PubMed
71. Karim F., Khan A.N.S., Tasnim F., Chowdhury M.A.K., Billah S.M., Karim T. et al. Prevalence and determinants of initiation of breastfeeding within one hour of birth: An analysis of the Bangladesh Demographic and Health Survey, 2014. PLoS ONE. 2019 doi:10.1371/journal.pone.0220224 PubMed
72. Hazir T., Senarath U., Agho K., Akram D.-S., Kazmi N., Abbasi S. et al. Determinants of inappropriate timing of introducing solid, semi-solid or soft food to infants in Pakistan: Secondary data analysis of Demographic and Health Survey 2006–2007. Matern. Child Nutr.. 2012 doi:10.1111/j.1740-8709.2011.00383.x PubMed
73. Hazir T., Akram D.-S., Nisar Y.B., Kazmi N., Agho K.E., Abbasi S. et al. Determinants of suboptimal breast-feeding practices in Pakistan. Public Health Nutr.. 2013 doi:10.1017/S1368980012002935 PubMed
74. Sarwar H.N., Kamal A., Khan T.. Factors Affecting Exclusive Breastfeeding Duration in Pakistan: Parametric Survival Models. Proceedings of the 17th International Conference on Statistical Sciences
75. Acharya P., Khanal V.. The effect of mother’s educational status on early initiation of breastfeeding: Further analysis of three consecutive Nepal Demographic and Health Surveys. BMC Public Health. 2015 doi:10.1186/s12889-015-2405-y PubMed
76. Perera P.J., Ranathunga N., Fernando M.P., Sampath W., Samaranayake G.B.. Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study. Int. Breastfeed. J.. 2012 doi:10.1186/1746-4358-7-21 PubMed
77. Batal M., Boulghourjian C., Akik C.. Complementary feeding patterns in a developing country: A cross-sectional study across Lebanon. EMHJ East. Mediterr. Health J.. 2010 doi:10.26719/2010.16.2.180 PubMed
78. Ghosh S., Ghosh N.. Son Preference and Hindu–Muslim Fertility Differentials in ‘Ultra-low’ Fertility Context in Kolkata, India. Population Dynamics in Eastern India and Bangladesh. 2020
79. Subedi N., Paudel S., Rana T., Poudyal A.. Infant and young child feeding practices in Chepang communities. J. Nepal Health Res. Counc.. 2012 PubMed
80. Holland C., Rammohan A.. Rural women’s empowerment and children’s food and nutrition security in Bangladesh. World Dev.. 2019 doi:10.1016/j.worlddev.2019.104648
81. Po J.Y.T., Bukania Z., Muhammad L., Hickey G.M.. Associations between maternal participation in agricultural decision-making and child nutrition in semiarid Kenya. J. Hunger. Environ. Nutr.. 2019 doi:10.1080/19320248.2019.1617214
82. Naik S.N., Verma A., Dhumal G.G.. Knowledge, attitudes and practices regarding breastfeeding in postpartum mothers at a tertiary care institute during a public health awareness campaign. Breastfeed. Rev.. 2017
83. Na M., Aguayo V.M., Arimond M., Dahal P., Lamichhane B., Pokharel R. et al. Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014. Matern. Child Nutr.. 2018 doi:10.1111/mcn.12564 PubMed
84. Essilfie G., Sebu J., Annim S.K.. Women’s empowerment and child health outcomes in Ghana. Afr. Dev. Rev.. 2020 doi:10.1111/1467-8268.12428
85. Jones R., Haardörfer R., Ramakrishnan U., Yount K.M., Miedema S., Girard A.W.. Women’s empowerment and child nutrition: The role of intrinsic agency. SSM Popul. Health. 2019 doi:10.1016/j.ssmph.2019.100475 PubMed
86. Anees M., -Ur-Rehman A., Ahmad A.M.R., Bukhari S., Siddique M.H., Farooq U. et al. Persistent Inadequacies in Infant and Young Child Feeding Practices and Their Determinants. J. Food Nutr. Res.. 2020 doi:10.12691/jfnr-8-7-6
87. Chen J., Xin T., Gaoshan J., Li Q., Zou K., Tan S. et al. The association between work related factors and breastfeeding practices among Chinese working mothers: A mixed-method approach. Int. Breastfeed. J.. 2019 doi:10.1186/s13006-019-0223-z PubMed
88. Rana M.M., Islam M.R., Karim M.R., Islam A.Z., Haque M.A., Shahiduzzaman M. et al. Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic based study. PLoS ONE. 2020 doi:10.1371/journal.pone.0232027 PubMed
89. Hassan M., Yasmeen B.N., Ahmed T.U., Begum M., Rob A., Ahmed A.U. et al. Practice of giving exclusive breastfeeding among the babies of working mothers and house wife mothers-a comparative study. North. Int. Med. Coll. J.. 2014 doi:10.3329/nimcj.v5i2.23131
90. AffifaTanny S., Mamun A., Sabiruzzaman M., Hossain M.G.. Factors influencing exclusive breastfeeding practice in Bangladesh: Multiple logistic regression analysis. Proceedings of the 7th International Conference on Data Science and SDGs
91. Tariku A., Alemu K., Gizaw Z., Muchie K.F., Derso T., Abebe S.M. et al. Mothers’ education and ANC visit improved exclusive breastfeeding in Dabat Health and Demographic Surveillance System Site, northwest Ethiopia. PLoS ONE. 2017 doi:10.1371/journal.pone.0179056 PubMed
92. Dafursa K., Gebremedhin S.. Dietary Diversity among Children Aged 6–23 Months in Aleta Wondo District, Southern Ethiopia. J. Nutr. Metab.. 2019 doi:10.1155/2019/2869424 PubMed
93. Alebel A., Dejenu G., Mullu G., Abebe N., Gualu T., Eshetie S.. Timely initiation of breastfeeding and its association with birth place in Ethiopia: A systematic review and meta-analysis. Int. Breastfeed. J.. 2017 doi:10.1186/s13006-017-0133-x PubMed
94. Mya K.S., Witvorapong N.. Determinants of breastfeeding practices in Myanmar: Results from the latest nationally representative survey. PLoS ONE. 2020 doi:10.1371/journal.pone.0239515 PubMed
95. Owais A., Suchdev P.S., Schwartz B., Kleinbaum D.G., Faruque A.S.G., Das S.K. et al. Maternal knowledge and attitudes towards complementary feeding in relation to timing of its initiation in rural Bangladesh. BMC Nutr.. 2019 doi:10.1186/s40795-019-0272-0 PubMed
96. Mother and Child Nutrtition-Mother, Infant and Young Child Nutrition & Malnutrition: India’s Primary Policy Response: The Integrated Child Development Services (ICDS) Program. 1975
97. Five Year Strategic Plan (2011–2016). 2011
98. The Pradhan Mantri Surakshit Matritva Abhiyan. In Ministry of Health and Family Welfare—Maternal Health Division, Editor. New Delhi: Ministry of Health and Family Welfare. 2016
99. Pradhan Mantri Matru Vandana Yojana. 2017
100. LaQshya -Labour Room Quality Improvement Initiative—National Health Mission. 2017
101. World’s Largest Nutrition Education Program Launches in India, Courtesy of the Mobile Phone. New Delhi, India. 2015
102. Janani Suraksha Yojna. 2018
103. D’Cunha J.. India’s Bold Maternity Benefit Act Can Become a Game Changer if it Addresses Current Limitations. Econ. Political Wkly.. 2018
104. Rekha S., Roy A.. Practices related to exclusive breast feeding among mothers of Bengaluru: A cross sectional Study. IP J. Paediatr. Nurs. Sci.. 2019
105. Godakandage S.S.P., Senarath U., Jayawickrama H.S., Siriwardena I., Wickramasinghe S.W.A.D.A., Arumapperuma P. et al. Policy and stakeholder analysis of infant and young child feeding programmes in Sri Lanka. BMC Public Health. 2017 doi:10.1186/s12889-017-4342-4 PubMed
106. Sustainable Development Goals 2015
107. Arrested Development: 5th Report of Assessment of India’s Policy and Programmes on Infant and Young Child Feeding. 2018
108. Sahu M.. Exclusive breastfeeding-mothers absolute affection. Acta Sci. Med. Sci.. 2018
109. POSHAN Abhiyaan—PM’s Overarching Scheme for Holistic Nourishment. 2018
110. Martin S.L., McCann J.K., Gascoigne E., Allotey D., Fundira D., Dickin K.L.. Mixed-Methods Systematic Review of Behavioral Interventions in Low-And Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition During the First 1000 Days. Curr. Dev. Nutr.. 2020 doi:10.1093/cdn/nzaa085 PubMed
111. Athavale P., Hoeft K., Dalal R.M., Bondre A.P., Mukherjee P., Sokal-Gutierrez K.. A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India. J. Health Popul. Nutr.. 2020 doi:10.1186/s41043-020-00215-w PubMed
112. Ogbo F.A., Akombi B.J., Ahmed K.Y., Rwabilimbo A.G., Ogbo A.O., Uwaibi N. et al. Breastfeeding in the Community—How Can Partners/Fathers Help? A Systematic Review. Int. J. Environ. Res. Public Health. 2020 doi:10.3390/ijerph17020413 PubMed
113. Kerr R.B., Dakishoni L., Shumba L., Msachi R., Chirwa M.. “We grandmothers know plenty”: Breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi. Soc. Sci. Med.. 2008 doi:10.1016/j.socscimed.2007.11.019 PubMed
114. Davies-Adetugbo A.A.. Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria. Soc. Sci. Med.. 1997 doi:10.1016/S0277-9536(96)00320-6 PubMed
115. Negin J., Coffman J., Vizintin P., Raynes-Greenow C.. The influence of grandmothers on breastfeeding rates: A systematic review. BMC Pregnancy Childbirth. 2016 doi:10.1186/s12884-016-0880-5 PubMed
116. Home Based Care for Young Child (HBYC): Strengthening of Health & Nutrition through Home Visits: Operational Guidelines 2018
117. Grant M.J., Booth A.. A typology of reviews: An analysis of 14 review types and associated methodologies. Health Inf. Libr. J.. 2009 doi:10.1111/j.1471-1842.2009.00848.x PubMed