Social equity in Ethiopian infants’ breastfeeding and complementary feeding practices: a birth cohort study

Monitoring social equity in infant feeding is essential to track countries’ progress towards global child nutrition and survival targets. We aimed to examine social equity in Ethiopian infants’ early initiation of breastfeeding, exclusive breastfeeding at five months, and quality of complementary foods at 12 months. This study was a secondary analysis of the Ethiopia Performance Monitoring for Action panel data, prospectively collected from July 2020 to August 2021. A total of 1,850 infants were followed from birth to 12 months in five Ethiopian regions: Addis Ababa City Administration, Oromia, Amhara, Afar, and Southern Nations, Nationalities, and Peoples Regions. We analyzed social equity in infants’ early initiation of breastfeeding, exclusive breastfeeding at five months of age, and dietary diversity at 12 months of age, calculated slope and concentration indices and using mixed-effect regression models. Most infants started breastfeeding within one hour of birth (67%, 95% CI 63, 71) and were exclusively breastfed (69%, 95% CI 67, 71) at five months of age. Few (16%, 95% CI 13, 19) infants aged 12 months had complementary foods meeting the minimum quality criterion, i.e., from five or more food groups. Half (49%, 95% CI 44, 55) of infants aged 12 months consumed sugary foods or beverages. There was no inequity in early initiation and exclusive breastfeeding practices by mothers’ education and household wealth levels. There was social inequity in infants’ dietary diversity at 12 months of age, favoring educated (slope index: 0.368, p-value < 0.001) and better-off (concentration index: 0.350%, p-value < 0.001) families. The high coverage of early initiation of breastfeeding and exclusive breastfeeding at five months of age were equitably distributed by mothers’ education and household wealth. Few 12-month-old infants had a diverse diet, while half consumed sugary foods or beverages. The quality of complementary food was inequitable, favoring better-off and more educated families. Ensuring optimal access to infant feeding support for socially disadvantaged families is critical to improving the quality of complementary food and maintaining or further increasing appropriate breastfeeding.