Exclusive Breastfeeding

Exclusive breastfeeding (i.e. feeding infants only with breastmilk and no other fluids or food except medicines) for the first 6 months of a baby's life is one of the most effective measures for ensuring a child's health and survival. Breastmilk alone satisfies the nutritional and fluid requirements of an infant for the first complete six months of life. The indicator measures the proportion of children following this recommended practice.

Collect the following data by conducting individual interviews with mothers of (a representative sample of) children aged 0 - 5 months:

RECOMMENDED SURVEY QUESTION (Q) AND POSSIBLE ANSWERS (A)

Q1: Now I would like to ask you about liquids that [baby's name] may have had yesterday during the day and at night. I am interested in whether your child had the item even if it was combined with other foods. Yesterday, during the day or at night, did [baby's name] receive any of the following?

Any water? 

Any infant formula?

Any animal milk?

Any juice?

Any broth?

Any yogurt or sour milk?

Any thin porridge? 

Any tea or coffee with milk?

Any other water-based liquids?¨

A1: for all sub-questions, use one of the following answers: yes / no / does not know 

If the answer to any of the choices is "yes", then the child was not exclusively breastfed.

To calculate the indicator's value, divide the number of children aged 0 - 5 months who were exclusively breastfed by the total number of children aged 0 - 5 months (excluding those where

"does not know" answer was provided). Multiply the result by 100 to convert it to percentages.

Disaggregate the data by gender, wealth, and other relevant criteria.

1) This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should never rely only on the information provided by caregivers and always verify the child’s age. This can be done by reviewing the child’s birth certificate or other documents; however, since many caregivers do not have such documents, it is essential that your data collectors are able to determine the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.

2) Using the recall period “yesterday" causes the proportion of exclusively breastfed infants to be overestimated, as some infants who are given other liquids irregularly may not have received them in the day before the survey. At the same time, the proposed question represents the best option for estimating exclusive breastfeeding and is more precise than asking, for example, "Until what age did you exclusively breastfeed your child?" (WHO, 2010).

3) Breastfeeding can include receiving breast milk from another woman, even if the breastmilk was given by spoon, cup or bottle in case the child's own mother had difficulty breastfeeding.

4) Most likely, the sampling of your survey will be include "households with children aged 0 – 23 / 59 months", not only "0-5 months". If so, this will result in a lower representativeness of data for this indicator (as only part of your sample will be children aged 0-5 months). Unless you have a separate (representative) sample for this age group, the best thing you can do is to ensure that your survey uses a larger sample of respondents (e.g. by using 95% confidence level and 4 - 4.5% margin of error), so that the data is sufficiently accurate.

5) According to UNHCR's standards, the proportion of exclusively breastfed infants (0-5 months) in emergency contexts should be ≥ 70%.