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

Paulo A R Neves; Giovanna Gatica-Domínguez; Nigel C Rollins; Ellen Piwoz; Phillip Baker; Aluísio J D Barros; Cesar G Victora

doi:10.1093/jn/nxz327

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

J Nutr. 2020 Apr 1;150(4):910-917. doi: 10.1093/jn/nxz327.

Authors

Paulo A R Neves¹, Giovanna Gatica-Domínguez¹, Nigel C Rollins², Ellen Piwoz³, Phillip Baker⁴, Aluísio J D Barros¹, Cesar G Victora¹

Affiliations

¹ International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul State, Brazil.
² Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland.
³ Global Development Program, The Bill & Melinda Gates Foundation, Seattle, WA, USA.
⁴ Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia.

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

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Feeding
Developed Countries*
Developing Countries*
Female
Global Health
Humans
Income*
Infant
Infant Formula*
Infant, Newborn
Male
Mothers
Social Class
Socioeconomic Factors
Surveys and Questionnaires

Grants and funding

001/WHO_/World Health Organization/International