Exclusive Breastfeeding Under Six Months
English: % of infants of less than 6 months of age who received only breast milk during the previous day and night
French: % de nourrissons de moins de 6 mois qui ont reçu exclusivement du lait maternel le jour et la nuit précédents
Portuguese: % de crianças com menos de 6 meses de idade alimentados apenas com leite materno durante o dia e noite anteriores
Czech: % kojenců mladších 6 měsíců, kteří během uplynulého dne a noci konzumovaly pouze mateřské mléko
What is its purpose?
Exclusive breastfeeding (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.
How to Collect and Analyse the Required Data
Collect the following data by conducting individual interviews with caregivers of (a representative sample of) children aged 0-5.99 months:
RECOMMENDED SURVEY QUESTION (Q) AND POSSIBLE ANSWERS (A)
Q1: Yesterday, during the day or at night, was [baby's name] given any breast milk?
A1: yes / no / does not know
Q2: 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 infant formula, such as [insert local names of common formula]?
Any animal milk?
Any yogurt or sour milk?
Any thin porridge?
Any tea or coffee with milk?
Any other water-based liquids?
A2: for all sub-questions, use one of the following answers: yes / no / does not know
To calculate the indicator's value, divide the number of children aged 0-5.99 months who received only breast milk (see comment below) during the previous day and night by the total number of children aged 0-5.99 months (excluding those where "does not know" answer was provided). Multiply the result by 100 to convert it to a percentage.
Disaggregate the data by gender, wealth, and other relevant criteria.
1) Breastfeeding by a wet nurse, feeding of expressed breast milk, and feeding human donor milk all count as being fed breast milk. Prescribed medicines, oral rehydration solution, vitamins and minerals are not counted as fluids or foods. However, herbal fluids and similar traditional medicines are counted as fluids, and infants who consume these are not exclusively breastfed.
2) In order to prevent the answer to this question from being influenced by other questions (e.g. on the importance of early initiation of breastfeeding), ask it as the first breastfeeding-related question.
3) This indicator relies on an 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.
4) Using the "yesterday recall period" 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).
5) 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. If you want to make this clearer, you can include the following question: "Sometimes babies are fed breast milk in different ways, for example by a spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Did [baby's name] consume breast milk in any of these ways yesterday during the day or at night?" (source: UNICEF/WHO 2010)
6) Most likely, the sampling of your survey will be representative for "households with children aged 0 - 24/ 59 months", not for "0-5 months", resulting 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).
7) According to UNHCR's standards, the proportion of exclusively breastfed infants (0-5 months) in emergency contexts should be ≥ 70%.
8) BHA phrases the indicator differently, as "percent of infants 0–5 months of age who are fed exclusively with breast milk", although the meaning and the methodology are the same.
Access Additional Guidance
- FAO (2008) Guidelines for Estimating the Month and Year of Birth of Young Children (.pdf)
- WHO/UNICEF (2021) Indicators for Assessing IYCF Practices (.pdf)