Consumption of breast milk, formula and other non-human milk by children aged under two years: analysis of 86 low and middle-income countries.

OBJECTIVE To investigate the prevalence and socioeconomic inequalities in breastmilk, breastmilk substitutes (BMS) and other non-human milk consumption, by children under two years in low- and middle-income countries (LMICs). DESIGN We analyzed the prevalence of continued breastfeeding at one and two years, and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-hour dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socioeconomic inequalities. SETTING Nationally representative surveys from 2010 onwards from 86 LMICs. PARTICIPANTS 394,977 children aged under two years. RESULTS Breastfeeding declined sharply as children became older in all LMICs, especially in upper-middle income countries. BMS consumption peaked at six months of age in low/lower-middle income countries, and at around 12 months in upper-middle income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breastfeeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breastfeeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breastfeeding. CONCLUSIONS Breastfeeding falls sharply as children become older, especially in wealthier families in upper-middle income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.