Exclusively Breastfed for the First Two Days After Birth

Outcome

% of children born in the last 24 months who were fed exclusively with breast milk for the first two days after birth

It is common in many countries to give newborns other foods and liquids apart from breastmilk in the first few days after birth, such as sugar water, honey, alternative milks or tea. This practice can delay newborns' first critical contact with their mother, and can make it more difficult to establish breastfeeding over the long term. Therefore, this population-level indicator measures the proportion of children fed only breast milk during the first two days after birth. It does not show whether exclusive breastfeeding continued beyond those two days or whether any non-breast-milk feeding was clinically indicated.

Collect the following data through individual interviews with all women of reproductive age in sampled households who had a live birth in the 24 months preceding the survey. Identify eligible respondents through household screening or a birth history, not by selecting households because a living child aged 0–23 months is present.

      

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

Q1: Was [baby's name] ever breastfed?

A1: yes / no / does not know

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Ask the following question only if the previous answer is "yes".

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Q2: In the first two days after delivery, was [child’s name] given anything other than breast milk to eat or drink – anything at all like water, infant formula, or [insert common drinks and foods, including ritual feeds, that may be given to newborn infants]?

A2: yes / no / does not know

 

If the respondent has had more than one live birth in the last 24 months, ask Q1–Q2 about each live birth, including children who have died.

 

To calculate the indicator’s value, divide the number of live births in the last 24 months for which Q1 = ‘yes’ and Q2 = ‘no’ by the total number of live births in the last 24 months. Include births with ‘does not remember’ and births that were never breastfed in the denominator, but not in the numerator. Multiply the result by 100 to convert it to a percentage. 

This data can be disaggregated by sex of the child, and, if relevant and feasible, also by place of residence, household wealth, maternal education, place of delivery and type of birth attendant.

1) According to WHO/UNICEF (see below), exclusive breastfeeding is defined as breastfeeding with no other food or drink, not even water. Breastfeeding by a wet nurse, feeding of expressed breast milk, and feeding of 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. Infant formula, animal milk and other foods or liquids count as non-exclusive feeding even when they were given for a medical reason. This classification describes the feeding practice and should not be used to judge whether an individual clinical decision was appropriate.

2) Because the standard denominator also includes children who have died, train interviewers to ask relevant questions sensitively and in private, without pressuring bereaved respondents.

In addition to this indicator, consider also using:

• Early Initiation of Breastfeeding (measures whether the child was put to the breast within one hour and can be collected through the same retrospective birth-feeding module)

• Ever Breastfed (helps distinguish children who were never breastfed from children who were breastfed but also received other foods or liquids)

• Exclusive Breastfeeding Under Six Months (measures current exclusive breastfeeding and shows whether the practice continued beyond the first two days)

• Mixed Milk Feeding Under Six Months (identifies subsequent use of formula or animal milk alongside breast milk, a practice not captured by this indicator after the first two days)