# Feeding Practices and Nutritional Status of Last-Born Children Aged 0–23 Months in India: Evidence From the National Family Health Survey, 2019-21

## TL;DR

This study examines how feeding practices and socioeconomic factors affect the nutritional status of young children in India, finding that early breastfeeding and maternal education are key to preventing underweight.

## Contribution

The study provides new evidence on the impact of feeding practices and socioeconomic factors on child undernutrition in India using recent national survey data.

## Key findings

- Children who started breastfeeding more than an hour after delivery had an 8% higher chance of being underweight.
- Children from the richest wealth index were 62% less likely to be underweight than those from the poorest.
- Children of mothers with high school education had a 49% lower risk of being underweight compared to those with no education.

## Abstract

Introduction

Child-feeding practices in the first two years of life play an important role in children's overall growth. India has started many countrywide initiatives to encourage improved nutrition and care for women and children. However, important obstacles like limited health system capacity and behavioral resistance still must be addressed. Therefore, this study aims to investigate how child-feeding practices affect the nutritional status of children in India.

Materials and methods

The publicly available data used in this study were obtained from the latest round of the National Family Health Survey (NFHS-5) conducted in 2019-2021. The Z-score method of anthropometric indicator weight-for-age (underweight) was used to assess the nutritional status of last-born children aged 0-23 months. Child-feeding, biodemographic, and socioeconomic variables were used as the risk factors for low weight-for-age. Univariate, bivariate, and multivariate statistical analyses were carried out to fulfill the study's objectives. The regression results were reported by unadjusted odds ratio (UOR) and adjusted odds ratio (AOR) with 95% CI and p-value.

Results

Children who started breastfeeding more than an hour after delivery had an 8% (95% CI: 1.03 to 1.09) higher chance of being underweight than children who started breastfeeding within an hour. Children who were breastfed for more than 18 months had a 62% (95% CI: 1.54 to 1.70) higher risk of being underweight than children who were breastfed for less than six months. The likelihood of being underweight was lower among female children (OR=0.77; 95% CI: 0.75 to 0.80) as compared with male children. Children from the richest wealth index were 62% (95% CI: 0.36 to 0.39) less likely to be underweight than those from the poorest wealth index. Children of mothers with an education of high school and above had a (OR: 0.51, 95% CI: 0.36 to 0.39) lower risk of being underweight compared to children of mothers with no education. The predicted probability of low weight-for-age among children was also greater (0.58, 95% CI: 0.56 to 0.60) if breastfeeding began more than an hour after delivery than within an hour of birth (0.57, 95% CI: 0.56 to 0.60).

Conclusion

Our study highlights the complex interplay of child-feeding practices, biodemographic, and socioeconomic factors influencing low weight-for-age among Indian children aged 0-23 months. The key findings emphasize the importance of the initiation of breastfeeding within one hour in preventing undernutrition. Socioeconomic disparities, particularly among marginalized communities, significantly increase the risk of children being underweight. The unexpected associations with prelacteal and bottle feeding suggest the need for deeper exploration into cultural and contextual feeding practices. Strengthening maternal education and improving access to nutrition and healthcare, especially for disadvantaged groups, can play a crucial role in addressing underweight prevalence among children in India.