Exclusive Breastfeeding Under Six Months

Outcome

% of infants aged 0-5 months who were fed exclusively with breast milk during the previous day and night

Exclusive breastfeeding means feeding an infant only breast milk, with no other food or drink, not even water. Prescribed medicines, oral rehydration solution, vitamins and mineral supplements are permitted. Exclusive breastfeeding during the first six months supports infant nutrition, health and survival. This indicator estimates the proportion of living infants aged 0–5 months who were fed exclusively with breast milk during the previous day and night. It does not show whether an individual infant was exclusively breastfed continuously from birth.

Collect the following data concerning a representative sample of living infants aged under 6 months. Interview the person who knows most about everything the infant was fed during the previous day and night. If several caregivers fed the infant, involve them where feasible.

       

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 water? 

Any infant formula, such as [insert local names of common formula]?

Any animal milk?

Any juice?

Any broth?

Any yogurt or sour milk?

Any thin porridge? 

Any tea, coffee or herbal drink, with or without milk?

Any other liquid, such as soda, sweetened drink, gripe water or ritual fluid?

A2: for all sub-questions, use one of the following answers: yes / no / does not know 

Q3: Yesterday, during the day or at night, did [baby’s name] eat any solid, semi-solid or soft food? This includes family foods and foods prepared for infants, such as thick porridge, thick soup or stew, mashed, puréed or soft foods.

A3: yes / no / does not know   

Interviewer instruction: Before data collection, adapt the examples to include locally common drinks / types of food and locally used names. Do not count prescribed medicines, oral rehydration solution, vitamins or mineral supplements as liquids or foods for this indicator.

   

To calculate the indicator’s value, divide the number of living infants aged under 6 months of age who received breast milk and received no other liquid and no solid, semi-solid or soft food during the previous day and night by the total number of living infants aged under 6 months of age. Multiply the result by 100 to convert it to a percentage.

The numerator includes infants for whom Q1 = ‘yes’, every Q2 item = ‘no’ and Q3 = ‘no’. Include every age-eligible infant in the denominator. If the breastfeeding, liquid or food information is missing, invalid or recorded as ‘does not know’, the infant does not enter the numerator but remains in the denominator.

This data can be disaggregated by infant age group (0–1, 2–3 and 4–5 months) and sex, and, if relevant and feasible, also by household wealth, place of residence, displacement status or programme exposure.

1) In addition to measuring the prevalence of exclusive breastfeeding, also assess to what extent mothers experience common barriers that prevent them from feeding only breastmilk (including household, health-service, workplace and wider social barriers), as well as the enabling factors that make it easier. Such insights will help you focus your activities on addressing the most prevalent barriers and key enabling factors, making your behaviour change efforts more effective. Use IndiKit’s Focus 4 Impact tool, which provides survey questions to measure the prevalence of key barriers and enablers.

2) Breast milk includes milk received directly from the infant’s mother or another breastfeeding woman, as well as expressed breast milk or donor human milk given by cup, spoon, bottle or another method. If these practices are common in the survey area, ensure that respondents understand that they should also report breast milk given in these ways. An optional probe is: “Yesterday, during the day or at night, did [baby’s name] receive breast milk in any other way, such as from a cup, spoon or bottle, or from another woman?”

3) For a standalone survey measuring only this indicator, the general question above about any solid, semi-solid or soft food is a practical option and follows the approach used in UNHCR SENS. It establishes whether any food was consumed but does not identify the food group. If the survey is collecting the wider set of WHO/UNICEF infant and young child feeding indicators, use the complete, locally adapted WHO/UNICEF food module. The standard WHO/UNICEF calculation is based on responses to all food-group questions. Use the same questionnaire format between survey rounds, as different recall formats may not produce directly comparable results. 

4) To reduce the risk that earlier questions influence responses, ask Q1–Q3 before any other questions about breastfeeding knowledge, attitudes or recommended practices.

  

5) Correct age classification is essential. Define the eligible group as living infants aged under 6 months / 183 days, equivalent to 0–5 completed months. Use the full date of birth and interview date where available. If the month and year of birth are known but the exact day is unknown, apply and document a consistent rule for assigning the day of birth during data processing. Where documentary evidence is unavailable, use careful caregiver recall supported by a local events calendar. Do not exclude an infant solely because documentary proof of age is unavailable. See FAO’s guidance below for preparing and using local events calendars.

     

6) The previous-day recall period estimates current exclusive breastfeeding prevalence, not continuous exclusive breastfeeding since birth. An infant who receives another liquid or food intermittently may still be classified as exclusively breastfed if none was given during the recall day. State this limitation when interpreting results. The indicator is intended for population-level measurement and should not be used to determine whether an individual infant has been exclusively breastfed throughout the first six months. The previous-day method is the standard approach for estimating current population prevalence and is less affected by long-term recall than asking when exclusive breastfeeding stopped.

  

7) Because infants aged 0–5 months usually make up only a small part of a survey sample, the result for this indicator may be based on relatively few infants. This can make the estimate less precise. When planning the survey, ensure that the sample is large enough to include a sufficient number of infants in this age group. Report the result with a 95% confidence interval. WHO and UNICEF recommend not presenting an estimate when fewer than 25 infants are included in the denominator.

 

8) UNHCR SENS sets a target of at least 75% for exclusive breastfeeding among infants aged 0–5 months in refugee settings. Treat this as a UNHCR programme target rather than a universal emergency threshold. WHO’s global nutrition target for 2030 is to increase exclusive breastfeeding in the first six months to at least 60%. The WHO target is intended for global and national monitoring and should not be treated as a project-level pass/fail threshold. Interpret programme results against the baseline, programme target, national policy and the estimate’s confidence interval.

 

9) 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. 

Also consider using the following indicators:

• Exclusively Breastfed for the First Two Days After Birth (captures early feeding practices that can affect the establishment of exclusive breastfeeding)

• Early Initiation of Breastfeeding (measures an important early breastfeeding practice)

• Access to Skilled Breastfeeding Counselling (measures access to professional support that can enable exclusive breastfeeding)

• Addressing Breastfeeding Difficulties (assesses whether common practical barriers are being managed)

• Mixed Milk Feeding Under Six Months (identifies formula or animal-milk supplementation among breastfed infants)