Trends, inequalities and factors associated with infant and young child feeding practices: mixed-methods research in Indonesia

Abstract

Background: Indonesia’s progress in achieving infant and young child feeding (IYCF) recommendations has been slow over the last decade despite socioeconomic improvement. Aim: To examine trends, inequalities, and factors associated with IYCF practices in Indonesia. Methods: This study used a mixed-methods design. For quantitative methods, I used data from 2007, 2012 and 2017 Indonesia Demographic and Health Surveys and the 2018 Basic Health Research. Quantitative data analyses included multiple logistic regression and decomposition analysis of the concentration index. For the qualitative methods, I conducted in-depth interviews with caregivers and key informant interviews in rural and urban Central Java. To analyse the qualitative data, I used thematic analysis. Results: The minimum dietary diversity (MDD) trend stagnated from 2007 to 2017. The child’s age, maternal education, access to media, paternal occupation, antenatal care visits, household wealth, living residency, and geographic area were associated with MDD. The MDD proportion was more concentrated in children with wealthier households and higher education mothers. The contributory factors to pro-rich and pro-educated inequalities in MDD were household wealth, maternal education, paternal occupation, and antenatal care visits. Breastfeeding duration, MDD, and animal-source food were associated with stunting. IYCF knowledge and perceptions were more favourable in urban, but exclusive and continued breastfeeding were more typical in rural. Urban children consumed more varied animal-source foods, pulses, and fruits. Different factors had specific roles in influencing IYCF practices in each area. Conclusions: Multiple-level factors affect IYCF practices. These factors are contextually specific and may interact with each other. A well-coordinated multilevel and multisectoral approach is needed to improve IYCF in Indonesia, thus optimal child nutrition.