Mixed Milk Feeding Under Six Months

Outcome

% of infants aged 0-5 months who were fed formula and/or animal milk in addition to breast milk during the previous day

This indicator measures the prevalence of feeding formula and/or animal milk in addition to breast milk among infants aged 0–5 months. This is not a recommended population feeding practice because non-human milks may displace breast milk. Use this indicator for population-level assessment, advocacy and monitoring. It does not explain why mixed milk feeding occurred and should not be used to assess or judge the feeding of an individual infant or caregiver.

Collect the following data by conducting individual interviews with caregivers of (a representative sample of) children aged less than 6 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] had yesterday during the day or at night. Please tell me about all drinks, whether [baby’s name] had them at home or somewhere else. Yesterday during the day or at night, did [baby’s name] have:

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

Any milk from animals, such as fresh, tinned or powdered [insert locally relevant animal milks]?

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

   

To calculate the indicator’s value, divide the number of infants aged 0–5 months for whom Q1 = ‘yes’ and either the infant formula item or the animal milk item in Q2 = ‘yes’ by the total number of infants aged 0–5 months in the sample. Multiply the result by 100 to convert it to a percentage. 

Include all eligible infants in the denominator, even when a response is missing or ‘does not know’. If Q1 is missing or ‘does not know’, treat the infant as not breastfed for this calculation. If either Q2 item is answered ‘yes’, the infant can still be included in the numerator even if the other Q2 item is missing or ‘does not know’. If neither Q2 item is answered ‘yes’, the infant does not count in the numerator.

This data can be disaggregated by sex and age group (0–1, 2–3 and 4–5 months), and, if relevant and feasible, also by wealth quintile, location and displacement status.

1) According to WHO/UNICEF (see below), mixed milk feeding includes any formula (e.g. infant formula, follow-on formula, “toddler milk”) or any liquid animal milk other than human breast milk, (e.g. cow’s milk, goat’s milk, evaporated milk or reconstituted powdered milk). Breastfeeding by a wet nurse, feeding of expressed breast milk and feeding of donor human milk all count as being fed breast milk. Yogurt, whether liquid or solid, is not counted here because it is not generally given as a substitute for breast milk.

2) This indicator describes feeding during one previous day; it does not establish an individual infant’s usual feeding pattern. Feeding practices can change rapidly with age. Where sample size permits, report results for infants aged 0–1, 2–3 and 4–5 months as well as the overall 0–5-month estimate.

3) Because this indicator includes only infants under six months, the sample size may be small, especially for subgroups. Do not report results for a subgroup if it includes fewer than 25 infants before survey weights are applied.

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4) For interviewer training, define ‘yesterday during the day or at night’ as the period from when the infant woke on the day before the interview until the infant woke on the interview day, approximately 24 hours.

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5) Only the infant formula and animal milk items are used to calculate this indicator. If the same questionnaire will also be used to calculate other IYCF indicators, use the complete WHO/UNICEF 2021 liquid and food modules after local adaptation, translation, pretesting and piloting; do not treat this shortened question set as a complete IYCF module.   

Also consider using the following indicators:

• Exclusive Breastfeeding Under Six Months (direct complementary outcome showing the proportion receiving only breast milk)

• Access to Skilled Breastfeeding Counselling (enabling indicator for access to support that can prevent or address mixed feeding)