Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study

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ABSTRACT

Background:

In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs).

Objective:

This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs.

Methods:

We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0–5 mo, and for continued breastfeeding at ages 12–15 mo through graphical presentation of coverage wealth quintiles.

Results:

Between-country analyses showed that log GDP was inversely correlated with exclusive (r= -0.37, P < 0.001) and continued breastfeeding (r= -0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r= -0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r= -0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ~30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries.

Conclusions:

BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

Keywords:

breast feeding
infant and young child feeding
breastmilk substitutes
socioeconomic factors
economic status
health equity

Abbreviations used:

BMS
breastmilk substitute
DHS
Demographic and Health Surveys
GDP
gross domestic product
IYCF
infant and young child feeding
LMIC
low- and middle-income country
MICS
Multiple Indicator Cluster Surveys

Cited by (0)

This study was supported by The Bill & Melinda Gates Foundation, through the WHO (OPP1148933) and Associação Brasileira e Saúde Coletiva (Brazilian Association of Collective Health). PARN received scholarships from the Brazilian National Council for Scientific and Technological Development—CNPq (grant number 155541/2018-8). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.

Author disclosures: The authors report no conflicts of interest. Two of the authors (NCR, EP) are affiliated with the funding sources for the analyses, but their respective institutions have no commercial interests in the marketing of infant and young child feeding products. The views expressed are of the authors alone and do not necessarily reflect the views or policies of their respective institutions or organizations.