The Crisis of Children'S Diets in Early Life: 2021 Child Nutrition Report

THE CRISIS OF
CHILDREN’S
DIETS IN
EARLY LIFE
2021 Child Nutrition Report

2021 | Child Nutrition Report i
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September 2021
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Suggested citation: United Nations Children’s Fund (UNICEF). Fed to Fail? The Crisis of
Children’s Diets in Early Life. 2021 Child Nutrition Report. UNICEF, New York, 2021.
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ii Fed to Fail?
THE CRISIS OF
CHILDREN’S
DIETS IN
EARLY LIFE
2021 Child Nutrition Report

Acknowledgements
This publication was prepared by the UNICEF Nutrition Section at Programme Group
in collaboration with the Data and Analytics Section at Data, Analytics, Planning and
Monitoring Division.
Report team
Authors: Aashima Garg, Vrinda Mehra, Harriet Torlesse, Jessica White, Grainne Moloney,
France Bégin, Chika Hayashi and Víctor Aguayo.
Data analysis: Louise Mwirigi, Julia Krasevec, Richard Kumapley and Kendra Siekmans.
Editing and design: Julia D’Aloisio (editing), Vicky Bell (copy editing), and Nona Reuter (design).
Internal Advisory Group (in alphabetical order)

Maaike Arts, Jessica Blankenship, Kudawashe Chimanya, David Clark, Elizabeth Drummond,
Yvette Fautsch, Cristina Hayde Perez Gonzalez, Nemat Hajeebhoy, Annette Imohe, Jo Jewell,
Roland Kupka, Anne-Sophie Le Dain, Joan Matji, Zivai Murira, Siméon Nanama, Mara Nyawo,
Manuela Radelsboeck, Dolores Rio, Christiane Rudert, Joseph Senesie, El Hassane KP Tou,
Vilma Tyler, Marjorie Volege, Amirhossein Yarparvar, Noel Marie Zagre and Charity Zvandaziva.
External Advisory Group (in alphabetical order)

Shawn K. Baker, United States Agency for International Development; Camila Corvalan and
Saskia de Pee, World Food Programme; Judith Kimiywe, Kenyatta University; Adelheid Onyango,
World Health Organization; Rafael Perez-Escamilla, Yale School of Public Health; Abi Perry,
United Kingdom Foreign Commonwealth and Development Office; Ellen Piwoz, Independent
Advisor, Maternal and Child Nutrition; Alissa Pries, Helen Keller International; Juan Rivera,
National Institute of Public Health of Mexico; Tina Sanghvi, Alive & Thrive; Cesar Víctora, Federal
University of Pelotas.
UNICEF is grateful for the support received by its partners – the European Union and the German
Federal Government through the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ),
the Bill & Melinda Gates Foundation, the Government of the Netherlands, and the Government of
Norway – for the development and dissemination of this report.
iv Fed to Fail?
Contents
Foreword vii
Executive summary 1
1. Our research: Why diets matter in early childhood 4

How many children are malnourished? 5
How do poor diets drive malnutrition? 8
What and who influences children’s diets? 10
What does this report aim to contribute? 11
2. Our findings: The crisis of young children’s diets 14

Finding 1: Children are not fed enough of the right foods at the right time 15
Finding 2: Children’s diets have seen little or no improvement in the last decade 17
Finding 3: Poor diets are not affecting all children equally across and within regions 19
Finding 4: Disparities in children’s diets persist within countries and have not narrowed 23
Finding 5: Families struggle to find and afford nutritious foods for their young children 26
Finding 6: Children’s diets are constrained by social, cultural and gender barriers 31
Finding 7: Unhealthy processed foods are widely accessible and heavily marketed 33
Finding 8: Policies and programmes to improve young children’s diets are not prioritized –
and are being further eroded by the COVID-19 pandemic 36
3. Our analysis: Barriers to good diets for young children 40

Millions of children are fed to fail 41
Good diets: unavailable, inaccessible, unaffordable 43
Traditional values and a changing world 44
A response that is not fit for purpose 46
4. Our recommendations: Bolder action and greater accountability for children’s diets 48
Food system 51
Health system 51
Social protection system 52
Multi-system governance 52
Endnotes 54
Annexes 57
Annex 1: Indicators of young children’s diets and feeding practices 58
Annex 2: Notes on the figures 59
2021 | Child Nutrition Report v

vi Fed to Fail?
Foreword
Across the globe, millions of families are struggling to The report draws on a range of evidence sources,
provide their children with nutritious food to support including regional analyses and the lived experiences
their growth and development. of mothers across different countries, to highlight
the most prominent barriers to good diets for young
The challenges they face are wide-ranging: parents children. It also charts a way forward to support
living in poverty may not be able to afford quality food; governments in upholding the right to food and
those living in hard-to-reach communities or areas nutrition for every child. Several countries have
affected by conflict or climate change may not have made significant progress in improving the quality of
access to fresh fruits and vegetables; meanwhile many children’s diets in the previous decade. Through their
markets are flooded with low-cost baby food that is examples, we learn that the crisis of children’s diets
high in sugar and over-processed. The drivers of poor must be solved through a systems-based approach –
diets for the world’s youngest children – inequality, leveraging the power and potential of food, health and
globalization, urbanization, conflict, the socioeconomic social protection systems – and driven by collective and
costs of the COVID-19 pandemic – lie beyond the decisive will and investment.
control of individual families, yet families are largely left
alone to bear the consequences. The crisis of children’s diets and what this crisis
means to children, families, and nations, calls for a
We know that what and how children are fed before 2 new vision and response. We must build a world
years of age shapes their growth, development, and where food systems deliver the nutritious and safe
learning – all of which will set the course for the rest of foods that children need to grow, develop and learn to
their lives. But so many children do not have access to their full potential; where essential nutrition and social
nutritious and safe foods during the time in their lives protection services are in reach; and where nutritious
when good nutrition matters most. and safe foods and essential nutrition services are
available and affordable for every child — no matter
The consequences of poor diets hit young children who they are or where they live.
the hardest. That is because delays in growth and
development occur mostly during the first two years Women and families everywhere play a critical role
of life, often because of inadequate nutrition. Without in ensuring that their children are fed nutritious diets,
nutritious diets, supportive nutrition services and good but they cannot do it alone. We must support them
feeding practices during this critical period, children with the right policies, programmes, institutions, and
under two are at heightened risk of all forms of resources. Governments, together with civil society
malnutrition, including stunting, wasting, micronutrient organizations, development and humanitarian partners,
deficiencies, being overweight and obesity. and private sector actors, should step forward together
to make healthy diets in early childhood a reality for all
This global report – ‘Fed to Fail?’ – sounds the alarm children, everywhere. Children, women, and families
on the crisis of children’s diets during the critical are counting on us. We must not fail them.
developmental period between six months, when
children begin eating their first solid foods, and 2 years
of age. It presents the most recent UNICEF data and
evidence that shows the alarming state of children’s
diets globally and the inequities affecting the youngest Henrietta H. Fore
and most marginalized children. The report makes clear Executive Director, UNICEF
that the world has failed to truly improve the way that
most young children are fed in early life.
2021 | Child Nutrition Report vii

viii Fed to Fail?
Executive summary
Poor-quality diets are one of the greatest obstacles Children are not fed enough of the right foods at
to the survival, growth, development and learning the right time. Currently, 27 per cent of children aged
of children today. The stakes are highest in the first 6–8 months are not fed solid food. Among children
two years of life, when insufficient dietary intake of aged 6–23 months, 48 per cent are not fed with the
nutrients can irreversibly harm a child’s rapidly growing minimum meal frequency, and 71 per cent do not
body and brain. Meanwhile, foods high in sugar, fat have minimally diverse diets. The low consumption of
or salt can set children on the path to unhealthy food nutritious foods is especially troubling: about half of
preferences, overweight and diet-related diseases. children are missing the lifelong benefits of the most
nutrient-rich foods, such as fruits and vegetables (41
Children can carry the scars of poor diets for the rest per cent) and eggs, fish and meat (55 per cent).
of their lives. The Convention on the Rights of the
Child states that governments have a legal obligation Children’s diets have seen little or no
to protect and fulfil the right to food and nutrition for improvement in the last decade. In the 50 countries
all children. This makes it vital to understand why we with trend data, the percentage of children consuming
are failing to feed children well in early childhood and a minimally diverse diet has remained low: 21 per
what it will take to address the barriers to nutritious, cent in 2010 and 24 per cent in 2020. Only 21 of
safe and age-appropriate diets in early life – when it these countries have seen statistically significant
matters most. improvements in the diversity of children’s diets.
Further, millions of families have struggled to feed
Our research: Why diets matter in early their children nutritious and diverse diets during the
childhood COVID-19 pandemic due to lost income and reduced
household purchasing of nutritious foods.
This global report examines the latest data and
evidence on the status, trends and inequities in the Poor diets are not affecting children equally across
diets of young children aged 6–23 months, and the and within regions. The child feeding crisis affects
barriers to nutritious, safe and age-appropriate diets. all regions, but young children in poorer countries and
regions are in greater crisis than others. Almost two
The analyses used data from the UNICEF Global thirds (62 per cent) of children aged 6–23 months in
Database on Infant and Young Child Feeding, Latin America and the Caribbean are fed a minimally
comprising data from 607 nationally representative diverse diet compared with less than one in four of
surveys conducted in 135 countries and territories young children in Eastern and Southern Africa (24 per
and representing more than 90 per cent of all children cent), South Asia (19 per cent) and West and Central
under 2 years of age globally. We also examined Africa (21 per cent).
evidence obtained through focus group discussions
with mothers in 18 low-, middle- and high-income Disparities in children’s diets persist within
countries, and through reviews of national policies and countries and have not narrowed. Children living
programmes across regions worldwide. In addition, in rural areas, poorer households and disadvantaged
the report shares UNICEF research on the impact of regions within countries have the least diverse diets.
COVID-19 on young children’s diets and access to For example, the percentage of children fed a minimally
nutrition services. diverse diet is almost double in urban areas (39 per
cent) than in rural areas (23 per cent). During the
Our findings: The crisis of young last decade, the equity gaps in meal frequency and
children’s diets dietary diversity between children living in poorer and
wealthier households have not narrowed.
Our findings shed light on how children’s diets are
falling short of global recommendations, the inequities Families struggle to find and afford nutritious foods
that impact the most marginalized children, and the for their children. Shortages in national supplies,
multiple, interacting barriers that underlie the crisis of seasonal scarcities and poor road infrastructure constrain
young children’s diets. physical access to nutritious foods, particularly in rural
2021 | Child Nutrition Report 1

sub-Saharan Africa, and in remote settings and countries caused severe disruptions to essential services for
affected by fragility, conflict or climate shocks. Physical young children. Our data show that in April 2020, at the
access is also problematic in poor urban communities peak of the first wave of the pandemic, nearly 83 per
where there are fewer shops selling nutritious foods cent of countries reported considerable disruptions in
and limited demand for these foods. In all settings, the coverage of services to promote nutritious and safe
the relatively high cost of nutritious foods is one of the diets for young children.
greatest obstacles, as reported by almost 80 per cent of
mothers in the focus group discussions. When income Our analysis: Barriers to good diets for
is limited, families tend to prioritize the frequency of young children
feeding and fuller stomachs over the quality of foods for
young children. Young children around the world are being fed to fail
– deprived of the diets they need at the time in their
Children’s diets are constrained by social, cultural life when it matters most. Children’s diets are failing in
and gender barriers. Mothers remain primarily timeliness, meal frequency and diet diversity. Indeed,
responsible for the feeding and care of young children. there has been next to no improvement in the foods
Yet, in some societies, patriarchal norms and unequal they eat and way they are fed in the last decade. Our
power relations within the family mean that mothers analysis finds that the crisis of young children’s diets
lack the autonomy to decide what foods are purchased is driven by multiple, interacting barriers that vary
or fed to their young children. Mounting time pressures according to the contexts in which families live.
on mothers influence their child feeding decisions:
two in three mothers (62 per cent) in our focus From rural villages to urban megacities, access to
group discussions were constrained by insufficient affordable nutritious foods is the most pressing
time. Working mothers often compromise their own concern, especially among poorer families. These
health or self-care to save time, and many turn to nutritious foods are either simply not available or
the convenience of processed and fast foods to feed affordable. And they are increasingly crowded-out by
their children. unhealthy processed and ultra-processed foods that
are cheap, convenient and aggressively marketed to
Unhealthy processed foods and drinks are widely children and their families.
accessible and heavily marketed. Our discussions
with mothers found that about one in three young Mothers continue to shoulder the responsibility for
children in Australia, Ethiopia, Ghana, India, Mexico, child feeding. Yet unequal divisions of household
Nigeria, Serbia and the Sudan were fed at least one responsibilities, mounting time pressures and enduring
processed or ultra-processed food or drink daily. These social and cultural norms leave many mothers with
products are highly available, cheap and convenient, insufficient time and autonomy to feed their young
and some are marketed with misleading nutrition children well. Evidence consistently shows that when
claims because legislation to prevent inappropriate women have more decision-making power and control
marketing is missing, inadequate or poorly over the household income, they tend to choose
implemented. healthier foods and feeding practices for their children.
Policies and programmes to improve young For far too long, these barriers have been tackled
children’s diets are not prioritized – and are being with fragmented national policies and programmes
further eroded by the COVID-19 pandemic. No that fail to reach most children and address the
country has a comprehensive set of policies, legal difficulties that caregivers face. The health system
measures and programmes to improve young children’s has the longest history of supporting young child
diets. Countries are missing vital opportunities to feeding practices, but the coverage and quality
leverage the food, health, and social protection of its nutrition services, including caregiver
systems to increase young children’s access to counselling on child feeding, remain inadequate.
affordable nutritious foods, deliver essential nutrition Missed opportunities within food and social
services, and improve child feeding practices. protection systems mean that families are unable to
access nutritious, affordable foods and act on the
The COVID-19 pandemic has put food, health and counselling they receive from health workers on how
social protection systems under serious strain, and to feed their young children.
2 Fed to Fail?
The state of young children’s diets remains a persistent Health system
bottleneck to greater progress on nutrition and
• Expand caregiver access to quality counselling and
achievement of the 2030 Sustainable Development
support on young child feeding by investing in the
Goal nutrition targets for child stunting, wasting and
recruitment, training, supervision and motivation of
overweight.
community-based counsellors and health workers.
Yet change is possible, even in the poorest contexts. • Deliver dietary supplements, home fortificants and
Ten countries – Bangladesh, Burkina Faso, Cambodia, fortified complementary foods to young children
Côte d’Ivoire, the Gambia, Kyrgyzstan, Maldives, at risk of micronutrient deficiencies, anaemia and
Nepal, Sierra Leone and Timor-Leste – have increased growth and development failure.
the percentage of children receiving a minimally diverse
diet by at least 10 percentage points in the last decade. Social protection system
And more countries will follow with investments that
focus on the barriers that are holding back progress. • Design social transfers – cash, food and/or vouchers
– that support, and do not undermine, nutritious
The case for prioritization and investments in young and safe diets in early childhood, including in fragile
children’s diets has never been more urgent. As the settings and in response to humanitarian crises.
COVID-19 pandemic continues to exacerbate the • Use social protection programmes to improve
difficulties that families face in feeding their young caregivers’ knowledge about young child
children and threatens to shrink government budgets, it feeding by providing education and counselling
is crucial that every possible action be taken to protect and by encouraging the use of health and
the diets of the most vulnerable children. nutrition services.
Our recommendations: Bolder action and Multi-system governance

greater accountability for children’s diets
• Position young children’s right to nutritious and
Governments must take the lead in upholding every safe diets as a priority in the national development
child’s right to food and nutrition. Together with national agenda and ensure coherent policy support and
civil society, development partners and the private legislation across sectors and systems.
sector, governments must mobilize the food, health and • Strengthen public accountability for young children’s
social protection systems to deliver nutritious, safe and diets by setting targets and tracking progress
affordable diets, essential nutrition services and positive through sector-specific monitoring systems and
nutrition practices for every child. Ten key actions are household surveys.
needed across these three systems and to strengthen
nutrition governance for young children’s diets: • Conduct research to understand context-specific
barriers, enablers and pathways to improving the
Food system quality of young children’s diets including – but
not limited to – their availability, affordability and
• Increase the availability and affordability of desirability.
nutritious foods – including fruits, vegetables, eggs,
fish, meat and fortified foods – by incentivizing their The need to transform how we tackle poor-quality diets
production, distribution, and retailing. in early childhood is urgent. If activated in the right
• Implement national standards and legislation to way and held accountable, the food, health and social
protect young children from unhealthy processed protection systems – and their public and private sector
and ultra-processed foods and beverages and actors – can ensure that children benefit from the
harmful marketing practices targeting children and nutritious, safe and affordable diets and the essential
families. nutrition services and practices they need to grow and
develop to their full potential.
• Use multiple communication channels, including
digital media, to reach caregivers with factual
information and advice on young child feeding and
increase the desirability of nutritious and safe foods.

1 | OUR RESEARCH
WHY DIETS MATTER IN

EARLY CHILDHOOD
This chapter describes how poor diets and feeding
practices in early life are holding back progress FOCUS 1
to improve the survival, growth and development
of children globally. We outline the research and MALNUTRITION IN EARLY
analysis that UNICEF has undertaken to examine CHILDHOOD – FORMS, CAUSES
the status and drivers of young children’s diets and AND CONSEQUENCES
inform transformative solutions.
A child’s first bite of food is celebrated among families Stunting refers to a child who is too
short for her or his age. Stunting
around the world. It marks a new phase of discovery –
results from poor nutrition in utero,
new tastes, textures and smells. It also marks the start of
poor nutrient intake in early childhood and/
a crucial period from 6 months to 2 years of age, which
or infection and disease. Children affected
defines how well a child will grow, develop and thrive
by stunting may never attain their full
in life.
linear growth potential and their brains
may never develop to their full cognitive
Nutritious diets build strong immune systems, fuel capacity, with impacts on their school
growing bodies and nourish developing brains. Enriched readiness, learning performance and life
with the benefits of good nutrition, children are better opportunities.
able to realize their rights – to enjoy healthy lives, to
learn, to access opportunities and to embark on a path to Wasting refers to a child who is too
lifelong well-being and prosperity. thin for her or his height. Children
become wasted if they lose too
Nutritious diets in early childhood have the power to much weight or fail to gain sufficient
shape a healthier future – yet today, millions of young weight, often due to a recent period of
children around the world are being fed to fail. Despite inadequate dietary intake or disease.
an abundance of evidence on how best to feed young Children suffering from wasting have weak
children, caregivers lack the resources and support they immune systems and face an increased risk
desperately need. of disease and death. If they survive, they
are more susceptible to stunted growth and
This failure is exposed in the alarming numbers of long-term developmental delays.
children under 5 who are malnourished.
Micronutrient deficiencies occur
How many children are malnourished? when children lack adequate
quantities of the essential vitamins
and minerals – known as micronutrients –
The world is experiencing a triple burden of child
that their bodies need to grow and develop
malnutrition.1 The triple threats of undernutrition (stunting
to their full potential. Also known as
and wasting), micronutrient deficiencies, and overweight
‘hidden hunger’, micronutrient deficiencies
and obesity (see Focus 1) are occurring within the same
have serious consequences for children’s
country, city, community, household and child. survival, growth, immunity and brain
development.
Since 2000, the prevalence of stunting in children
under 5 has fallen by one third to 22 per cent, and the Overweight refers to a child who
number of children with stunted growth fell by almost 55 is too heavy for her or his height.
million, to 149.2 million (see Figure 1).2 This remarkable It occurs when children’s caloric
achievement proves that positive change for nutrition intake from food and drinks exceeds their
is possible on a considerable scale. But the progress is energy requirements. Children affected by
currently too slow to achieve the 2030 global nutrition overweight and obesity have an increased
target on stunting and is not shared equally among risk of poor self-esteem, poor mental
regions: the number of stunted children has decreased health, and diet-related non-communicable
significantly in Asia, while it has barely changed in diseases such as cardiovascular disease
Eastern and Southern Africa; and in West and Central later in life.
Africa, it has increased.

At least one in three children suffer from one or more of
the most visible forms of malnutrition
Stunting
86.8
203.6M
2000
53.8
Number (in millions)
41.2
2020*
29.3 27.6 28.0
22.8 20.7
9.0 7.7 10.2 149.2M
5.8 4.7 2.5
South Asia West and Eastern and East Asia Middle East and Latin America and Eastern Europe
Central Africa Southern Africa and the Pacific North Africa the Caribbean and Central Asia Global
FIGURE 1
Trends in number (millions) of children under 5 with stunting, by UNICEF region and global, 2000 and 2020*
Note: *The collection of household survey data on child height and weight were limited in 2020 due to the physical distancing measures required to prevent the spread of COVID-19. Only four
national surveys included in the database were carried out (at least partially) in 2020. The estimates are therefore based almost entirely on data collected before 2020 and do not take into
account the impact of the COVID-19 pandemic.
Wasting
South Asia 14.7%
West and Central Africa 7.2%
Middle East and North Africa 6.3%
Eastern and Southern Africa 5.3%
East Asia and the Pacific 3.7%
Eastern Europe and Central Asia** 1.9%
45.4 million
Latin America and the Caribbean 1.3%
children under 5
Global 6.7%
suffer from
0 5 10 15
wasting globally
Percentage
FIGURE 2
Percentage of children under 5 with wasting, by UNICEF region and global, 2020*
national surveys included in the database were carried out (at least partially) in 2020. The estimates are therefore based almost entirely on data collected before 2020 and do not take into
account the impact of the COVID-19 pandemic. **Eastern Europe and Central Asia does not include the Russian Federation due to missing data; consecutive low population coverage for the
2020 estimate (interpret with caution).
Overweight
15
14
13
12 12.0
11 10.9 2000 2020*
10 9.9 The global number
9 8.7
of children under
Percentage
8 7.8 7.5
7 6.8
5.6
5 with overweight
6
5.2 5.4 5.7
5 4.5 4.9 has increased from
4
3.4 3.2
3
2.2 33.3 to 38.9 million
2
1 in the last two
0
Middle East Eastern East Asia Latin America Eastern and West and South Asia Global decades
and North Europe and and the and the Southern Central
Africa Central Asia Pacific Caribbean Africa Africa
FIGURE 3
Trends in percentage of children under 5 with overweight, by UNICEF region and global, 2000 and 2020*
national surveys included in the database were carried out (at least partially) in 2020. The estimates are therefore based almost entirely on data collected before 2020 and do not take into account
the impact of the COVID-19 pandemic.
Source: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2021 Edition.
6 2021 | Child Nutrition Report

Wasting – the most life-threatening form of East Asia and the Pacific (5.2 per cent in 2000 to 7.8
malnutrition – affects the youngest and most per cent in 2020) and by more than 20 per cent in the
marginalized children. The prevalence and burden of Middle East and North Africa (9.9 per cent in 2000 to
wasting are unacceptably high, affecting 6.7 per cent 12.0 per cent in 2020) (see Figure 3).
of children under 5, or 45.4 million (see Figure 2).2
More than half of these children live in South Asia, the These troubling numbers do not reflect the impact
global epicentre of child wasting. The prevalence of of the COVID-19 pandemic because national data for
wasting often rises rapidly during conflict and other 2020 were available only for four countries when these
humanitarian crises; however, most children with estimates were developed. More children – particularly
wasting live in non-emergency settings where poverty the most vulnerable – are becoming malnourished as
is widespread and access to nutritious diets and the pandemic and its containment measures continue
essential nutrition services is constrained. to disrupt access to nutritious diets and essential
nutrition services. It is estimated that by 2022, the
Deficiencies in essential vitamins and minerals can pandemic could increase the number of children with
result in devastating consequences for children’s wasting by up to 13.6 million and result in productivity
survival, growth and development. UNICEF estimates losses of up to US$44.3 billion due to additional cases
that at least 340 million children under 5 – or at of child stunting and mortality – a threat to the futures
least one in two children – suffer from one or more of both children and nations.4
micronutrient deficiencies, including deficiencies in
vitamin A, iron, iodine and zinc.3 It is not too late to change course. As the world comes
to grips with the impact of the COVID-19 pandemic, it
The burden of overweight in children has risen steadily, has never been more urgent to re-commit to a future
and there are now 38.9 million children under 5 where the right to food and nutrition is a reality for
affected by overweight globally, compared with 33.3 every child. To do this, we need to tackle one of the
million in 2000.2 During this period, the prevalence greatest drivers of child malnutrition today: the poor
of overweight in children increased by 50 per cent in quality of young children’s diets.

How do poor diets drive malnutrition? three in five children worldwide were not fed nutrient-
rich eggs, fish or meat during the previous day, and
Enormous physiological changes take place between two in five children were not fed any vegetables or
birth and 2 years of age. A child’s brain grows to 75 fruit.3 At the same time, many young children were
per cent of adult size 5 and more than 1 million new consuming unhealthy processed snacks and drinks
neural connections are formed every second.6 Body that displace healthier alternatives13 and set children on
weight quadruples and height increases by 75 per cent a path to overweight.14, 15 The COVID-19 pandemic is
during this time.7 These vast changes mean that the intensifying these problems, as income losses mean
nutrient needs of children under 2 are extraordinarily that more and more families cannot afford a healthy
high. In fact, children have greater nutrient needs per diet and rely instead on less-expensive, nutrient-poor
kilogram of body weight between 6 months and 2 and heavily processed alternatives.16
years of age than at any other time in life.8
The consequences of poor diets and feeding practices
The recommended foods and feeding practices to in early life are visible in the age distribution of stunting
best match these nutrient needs are evidence-based and wasting. The prevalence of stunting increases
and clear (see Focus 2).9-11 Exclusive breastfeeding – rapidly between 6 months and 2 years of age as
feeding only breastmilk – provides all the vital nutrients children’s diets fail to keep pace with their growing
that infants need from birth to 6 months of age. Solid nutrient needs (see Figure 4). Recent evidence
foods should be introduced at 6 months of age, as suggests that, globally, about 70 per cent of the
breastmilk alone is no longer sufficient to meet energy shortfall in height accumulated by the age of 5 years
and nutrient requirements. In addition, breastfeeding is due to growth faltering that occurred before the age
remains an important source of nutrients for optimal of 2 years.17 UNICEF estimates that about half of all
growth and development and should continue until children under 5 with wasting are younger than 2 years
at least age 2.12 Infants and young children have very of age (see Figure 5). Although diarrhoea and other
small stomachs and so they need frequent meals diseases also cause undernutrition in early life, there
comprising diverse and nutrient-dense foods. As is clear evidence that poor diets and feeding practices
infants and young children grow, the frequency of play a major role. Studies have shown that children
meals and the amount of nutritious food offered at under 2 are more likely to be affected by stunting and
each feeding should increase. wasting if they eat their first solid foods too late, if
they consume too few meals, or if their diets are low
Caregivers and families everywhere want to feed their in diversity or nutrient-rich foods such as eggs, fish or
children well. But despite their best efforts, they are meat.18, 19
struggling to meet their children’s dietary needs. In
2019, the State of the World’s Children reported that Children carry the scars of poor diets and feeding
practices for the rest of their lives. Children with
undernutrition are more likely to die in early childhood
than their well-nourished peers.20 They start
school later in life, spend less time in school and
are more likely to repeat grades.21-23 In adulthood,
their overall work productivity and earning capacity
Poor-quality diets drive all may be impaired, constraining household incomes
forms of malnutrition in early and hindering national economic development.20
childhood Meanwhile, overweight predisposes children to obesity
and diet-related noncommunicable diseases later in
life,24 which place enormous strain on health systems.
This epidemic of malnutrition is robbing children of
their futures and draining US$3.5 trillion from the global
economy every year, according to 2013 estimates.25
8 Fed to Fail?
149 million children under 5
with stunting in 2020,
of which 51 million are
under 2 years of age

149 million with wasting in 2020,
< 5 years
under 2 years of age 33%
45 million31% 31%
STUNTING
51 million WASTING < 5 years
< 2 years 23 million
Stunting increases < 2 years 27%
rapidly between 6 and
23 months of age
18%
16%
FIGURE 4
Percentage of children under 5 affected by
stunting, by age in months, 2020*
Note: These estimates were generated using different methodology than
the Joint Malnutrition Estimates (see Notes on the figures, page YY). The
collection of household survey data on child height and weight was limited
in 2020 due to the physical distancing measures required to prevent the
spread of COVID-19. Only four national surveys included in the database
were carried out (at least partially) in 2020. The estimates are therefore
based almost entirely on data collected before 2020 and do not take into
account the impact of the COVID-19 pandemic.
Source: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates
Expanded Database: Stunting (Survey Estimates), 2021, New York
0–5 months 6–11 months 12–23 months 24–35 months 36–47 months 48–59 months
More
Onethan halfchildren
in three of all children with
affected by wasting
stunting andare
moreyounger than
than half of all
2 years of affected
children age by wasting are under the age of 2.

with stunting in 2020,

149 million with wasting in 2020,
< 5 years
45 million
STUNTING
51 million WASTING < 5 years
< 2 years 23 million
< 2 years
FIGURE 5
Estimated number of children under 2 affected by stunting and wasting out of all affected children under 5 years of age
Based on internal UNICEF estimates. For details on methodology, see Notes on the figures on page YY.

What and who influences children’s The Convention on the Rights of the Child states that
diets? governments have a legal obligation to protect the
right to food and nutrition for all children, beginning
Children’s diets reflect the food available in their in early childhood. To improve young children’s diets,
communities, the resources at their family’s governments and partners need to work together to
disposal, and the knowledge, beliefs and culture of identify and address the range of barriers – both within
the people who care for them. and outside of the household – that shape what, when
and how young children are fed. Efforts to improve
Caregivers everywhere face economic, political, children’s diets must focus on delivering adequate
physical, social and cultural barriers to providing foods, services and practices11 (see Figure 6):
children with enough nutritious, safe and age-
• Adequate foods: Nutritious, safe and age-
appropriate food. The barriers vary considerably
appropriate foods must be available, accessible,
across and within countries and are constantly
affordable and desirable to young children and their
evolving as the contexts in which families live
families.
change. For example, millions of families are
moving to cities and shifting from traditional • Adequate services: Quality nutrition services must
whole-food diets to processed foods that are be available, accessible and affordable to young
higher in salt, sugar and fat and low in essential children and their caregivers through facility- and
nutrients.3 Further, an increasing number of community-based programmes.
mothers now work outside the home – while
• Adequate practices: The feeding, dietary and
continuing to shoulder the lion’s share of
hygiene behaviours and norms of caregivers,
caregiving duties – creating significant time
families and communities should support good
constraints and contributing to a shift towards
diets for young children.
convenience foods.
The barriers to children’s diets are even greater

in settings gripped by conflict, climate-related
disasters, economic shocks and public health ADEQUATE
crises. Today, as the fall-out of the COVID-19 FOODS
pandemic continues, we are witnessing how
the shocks to already-vulnerable systems are
further eroding the poor quality of children’s
diets worldwide.26
Although many of the driving factors behind

children’s poor diets lie outside the control of Good diets
individual households, it is often families – and
especially mothers – who are expected to bear for young
sole responsibility for the quality of children’s diets. children
Historically, efforts to improve young children’s 6–23 months
diets were narrowly focused on improving
caregiver knowledge and practices, usually through
information and counselling. These services are
an important part of the solution, but they will not
change diets and practices unless nutritious foods
are locally available, accessible, affordable, and
desirable to families. FIGURE 6
Determinants of young children’s diets
10 Fed to Fail?
What does this report aim to contribute? (which are used to annually track progress against the
results and targets in UNICEF’s Strategic Plan).
Governments and their partners need data, information
3. Focus group discussions with mothers of
and evidence to assess and monitor children’s diets
young children: In 2018–2019, UNICEF supported
and take decisions on how to accelerate progress. Yet
a series of focus group discussions with mothers
today, there are considerable gaps in what we know
of children under the age of 2 in partnership with
about the status of diets and feeding practices in early
Western Sydney University.30 The discussions
childhood, the progress being made and, crucially, the
were conducted in 18 countries across the world,
barriers that persist. In 2021, UNICEF set out to answer
including low-, middle- and high-income contexts
three questions to close these gaps:
and in countries affected by humanitarian crises. We
listened to mothers’ perceptions of what they feed
1. What, when and how are children aged 6–23
their children, what influences their food and feeding
months being fed globally, and have there been
choices, and the challenges they face in improving
improvements over time?
the quality of their children’s diets.
2. What are the main barriers that prevent caregivers
4. Research on children’s nutrition services and
and families from feeding young children nutritious,
diets during the COVID-19 pandemic: In 2020–
safe and age-appropriate diets?
2021, UNICEF introduced a COVID-19 monitoring
3. How can we transform systems – including the system to track the situation of children during the
food, health and social protection systems – to COVID-19 pandemic, including the impact on child
remove these barriers and better support caregivers nutrition services.31 In addition, UNICEF investigated
and families? the impact of the pandemic and its containment
measures on household food purchases and
We used five sources of data, information and children’s diets. This research was conducted using
evidence to answer these questions: remote data collection methods, including phone
surveys and online data collection platforms, such as
1. Quantitative data on young children’s diets: the UNICEF U-Report.
UNICEF is the custodian of the Global Database on
5. Review of global literature: In 2020, we
Infant and Young Child Feeding, which comprises
conducted a literature review to fill gaps in the
data from 607 nationally representative surveys
information and evidence from the analysis of
conducted in 135 countries and territories,
quantitative data on feeding practices, the review
representing more than 90 per cent of all children
of national policies and programmes, the focus
under 2 years of age globally.27 These data were
group discussions with mothers, and the research
analysed in March 2021 to produce global and
on children’s diets during the COVID-19 pandemic.
regional estimates for the year 2020 and examine
Sources included peer-reviewed publications and
the trends for a subset of countries with comparable
major reports, such as the State of the World’s
estimates for two time periods: around 2010 (2005–
Children and the State of Food and Nutrition Security
2013) and around 2020 (2014–2020).
in the World.3, 16
2. Regional analyses of national policies and
programmes: In 2019–2020, UNICEF regional The following chapters present the findings of the
offices, together with institutional and academic synthesis of data, information and evidence from these
partners, conducted a series of regional analyses five sources. They describe what and how children are
on the determinants and drivers of young children’s being fed and the key barriers that prevent caregivers
diets.28 These analyses examined the availability, and families from feeding nutritious, safe and age-
accessibility and affordability of nutritious diets for appropriate foods to their young children. We situate
young children and the status of national policies, the findings within the context of wider global, regional
legislation and programmes related to diets and and country efforts to improve young children’s diets
feeding practices. Additional information on relevant and feeding practices. Finally, we conclude with a set
policies and programmes was extracted from of recommended actions to transform the agenda
NutriDash29 (UNICEF’s online platform to track on children’s diets in pursuit of the Sustainable
country progress on essential nutrition interventions), Development Goals and an end to hunger and
and UNICEF’s internal Strategic Monitoring Questions malnutrition.

FOCUS 2
WHAT DO GOOD DIETS FOR YOUNG

CHILDREN LOOK LIKE AND HOW DO WE
MEASURE THEM?
WHAT DO GOOD DIETS FOR YOUNG CHILDREN LOOK LIKE?
What, when and how young children are fed during the first two years of life lays the foundation for survival,
growth and development. Children’s diets must provide adequate quantities of energy, protein, vitamins, minerals
and other nutrients to fuel their growing bodies and brains and keep them healthy, active and strong. UNICEF and
WHO recommend the following diets and feeding practices for infants and young children up to 2 years of age.9-11
When should young children be fed their first foods?
• From birth to the age of 6 months, infants should consume only breastmilk, which satisfies all their
nutritional needs.
• At 6 months of age, children should begin eating their first solid foods while continuing to breastfeed until
age 2 years or longer. Introducing food too early may increase an infant’s exposure to pathogens and displace
nutritious breastmilk. Introducing foods too late deprives children of the vital nutrients their bodies need to grow
and develop.
What should young children be fed?
• Diverse foods from a variety of food groups help • Vegetables and fruits are a nutrient-rich source
ensure young children consume all the nutrients, of vitamins, minerals, dietary fibre and antioxidants
vitamins and minerals they need to grow, develop and should be introduced early and fed often.
and thrive. These food groups include grains, roots
• Fortified foods and supplements help fill vitamin
and tubers; legumes, nuts and seeds; dairy; eggs;
and other micronutrient gaps in children’s diets in
fish, poultry and meat; and colourful vegetables
settings where nutrient-dense and diverse foods
and fruits.
are not regularly available or affordable.
• Animal-source foods such as dairy, eggs, fish,
• Breastmilk should continue to be part of children’s
poultry and meat are nutrient-dense and maximize
diets until 2 years of age or longer. Continued
the nutritional value of each bite. Non-breastfed
breastfeeding safeguards children’s survival,
children should be fed plain milk or yogurt from 6
growth, development and provides essential fats,
months of age.
proteins and other nutrients that are important to
lifelong health in all settings.
What should young children not eat?
• Foods high in sugar, salt and trans and saturated fats – such as confectionary, cookies, chips, sweet
drinks and sweetened purees and juices – provide energy but lack nutrients. Inappropriate levels of sugar, salt
and unhealthy fats can also be found in some commercially prepared foods targeted to young children. The
consumption of these foods can displace more nutritious food, set lifelong taste preferences and contribute to
overweight and obesity.
12 Fed to Fail?
How should young children be fed?
• Frequently: Young children need to eat often • Safely: Meals should be prepared and fed with
because they can consume only small amounts of clean hands, dishes and utensils; served with
food at each feeding. Breastfed children should be safe drinking water; and stored safely away
fed at least two meals or snacks a day from the age from animals and insects, at an appropriate
of 6 months and at least three meals or snacks from temperature.
the age of 9 months. Non-breastfed children should
• Responsively: Caregivers should interact with
be fed at least four times a day.
the child and respond to her or his hunger and
• Adequately: Caregivers should gradually increase satiety cues; these interactions stimulate brain
the quantity of food in each meal, from a few development and make food more likely to
tablespoons at 6 months of age to a full cup by be accepted.
2 years of age.
• During and after illness: Meals, snacks,
• Appropriately: Food consistency should transition breastmilk and other fluids should be offered
from soft or mashed, to semi-solid, to solid foods more frequently during and after illness to help
consumed by the family, by the time children are children recover.
aged 12 months. Children with disabilities that make
eating and drinking difficult may need pureed food,
but otherwise, the extended use of pureed foods
can make babies less likely to accept foods of varied
textures and consistencies.
HOW DO WE MEASURE WHETHER YOUNG CHILDREN ARE EATING WELL?
We need reliable data to assess whether young non-breastfed children; and continued breastfeeding).
children are being fed according to global However, the definitions for some of these indicators
recommendations. These data are critical for identifying have been revised over time. New indicators have also
and targeting interventions to the populations at been introduced, including an indicator for egg and/
risk; evaluating the impact of these interventions; or flesh food consumption and three indicators that
informing policy decisions and resource allocations; and examine how many children are exposed to unhealthy
monitoring progress over time. feeding practices: zero vegetable or fruit consumption;
sweet beverage consumption; and consumption of
In 2021, UNICEF and WHO published a set of updated unhealthy foods such as cookies, sweets, and fried
indicators for assessing infant and young child feeding or salty snacks. As these indicators are new, most
practices.32 Countries should aim to generate estimates countries do not have data, but this is expected to
for the full set of indicators every three to five years, change in the coming years.
using large-scale surveys.
These indicators are not intended to meet all
Ten indicators are aligned with global recommendations needs in programme monitoring and evaluation
on the diets and feeding practices of children aged and cannot track some dimensions of good diets,
6–23 months (see full list in Annex 1). Six of these such as responsive feeding and safe preparation of
indicators have been in use for more than a decade foods. These dimensions can be investigated using
(introduction of solid, semi-solid or soft food; minimum additional quantitative indicators or qualitative studies
dietary diversity; minimum meal frequency; minimum and research.
acceptable diet; minimum milk feeding frequency for

2 | OUR FINDINGS
THE CRISIS OF YOUNG

CHILDREN’S DIETS
This chapter describes the findings of our analysis Young children’s diets are failing in timeliness,
of quantitative data and qualitative evidence on frequency and diversity
the diets of young children. We find that globally,
young children’s diets are worryingly poor, and We found that most children aged 6–23 months
progress to improve diets and feeding practices were not given their first foods at the right age,
Global indicators of diets of young
has been slow and uneven over the past decade.
children 6–23 months of age
were not offered sufficient meals or snacks each
The regions of South Asia and sub-Saharan day, and were not fed a variety of foods to meet
introduced to solids 72%
Africa – as well asmonths)
(6–8 poorer children in all regions their nutritional needs in 2020 (see Figure 7). One
and countries – bear the brunt of poor diets. This in four children aged 6–8 months (27 per cent)
chapter examines the evidence
continuing on some of the
breastfeeding were not fed any solid, semi-solid or soft food –
65%
most pressing(12–23
drivers of poor diets globally.
months) the indicator referred to as introduction of solid,
semi-solid or soft foods, hereafter abbreviated as
FINDING 1 minimum dietary diversity introduction of solid foods. One in two children
29%
Children are(12–23
notmonths)
fed enough of the right aged 6–23 months (48 per cent) were not
foods at the right time fed the minimum number of meals or snacks
minimum meal frequency recommended each day – the indicator referred
52%
Our analysis of(12–23
dietsmonths)
and feeding practices, using data to as minimum meal frequency. More than two
from UNICEF’s Global Database on Infant and Young in three children aged 6–23 months (71 per
Child Feeding, minimum
shows thatacceptable diet
in 2020, worldwide, most cent)
18%were not fed foods from at least five of the
(6–23 months)
children aged 6–23 months were not fed according eight recommended food groups – the indicator
to global recommendations. Far too many were not referred to as minimum dietary diversity.
egg and/or flesh-food
fed at the right time or with the right frequency and 45%
consumption (6–23 months)
dietary diversity needed to grow and develop to their
full potential.
Zero vegetable or fruit
42%
consumption (6–23 months)
Diets and feeding practices of infants

and young children
Vegetable and/or
fruit consumption Minimum meal
(6–23 months) frequency
(6–23 months)
Continued
breastfeeding 59%
(12–23 months)
52%
Egg, fish and/or
65% meat consumption
(6–23 months)
45%
Introduction
of solids
(6–8 months) 73% Minimum
29% dietary
diversity
(6–23 months)
FIGURE 7
Percentage of children receiving: solid foods; continued breastfeeding; minimum meal frequency; minimum dietary diversity;
eggs, fish and/or meat; and vegetables and/or fruits, 2020
Source: UNICEF global databases, 2021, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative sources.

The youngest children were most exposed to poor- months (41 per cent) did not consume these nutritious,
quality diets. Globally, one in five infants aged 6–11 vitamin-rich foods during the previous day. In the
months (20 per cent) had minimally diverse diets, second year of life, breastmilk remains an important
compared with one in three children aged 20–23 source of essential nutrients, yet our findings indicate
months (35 per cent). Of concern, only 1 in 10 infants that one in three children aged 12–23 months (35 per
aged 6–11 months in South Asia was fed a minimally cent) were not breastfed during the previous day – the
diverse diet (see Figure 8). indicator referred to as continued breastfeeding.
Too many children are missing the lifelong UNICEF collaborated with the Global Alliance for
benefits of nutritious foods Improved Nutrition (GAIN) to investigate micronutrient
gaps in children’s diets in 14 countries across Eastern
Some of the most nourishing foods – such as and Southern Africa and South Asia.34, 35 Analysis of
vegetables and fruit; eggs, fish and meat; and various data sources36 found that young children’s
breastmilk – were not part of young children’s diets. diets in all countries do not supply adequate quantities
Despite the recommendation that children aged of vitamins and minerals. The micronutrient gaps
6–23 months be fed eggs, fish or meat on a daily vary by country, but moderate- or high-burden gaps
basis, more than half of children (55 per cent) did not were consistently identified for iron (13 countries),
consume any of these nutrient-rich foods during the zinc (11 countries), calcium (11 countries), vitamin A
previous day – the indicator referred to as egg and/ (10 countries), vitamin B12 (10 countries) and folate (9
or flesh food consumption.33 These foods can provide countries).
a variety of micronutrients that are difficult to obtain
in adequate quantities from plant-source diets alone. Regional- and country-level estimates for all indicators
Vegetables and fruit were also severely lacking in can be found in the data tables available online.
children’s diets: almost half of children aged 6–23
The youngest children – those aged 6–11 months – have the

least diverse diets
80
20–23
71 months
70
70 68
16–19
months
60
51 12–15
49 50 months
50 47 48
46
Percentage
41 6–11
40 months
34 35
33
31
30 29
26 27 26
25 24 25
23 22 22
20
20 18
15
10
10
0
Latin America East Asia and Middle East and Eastern and West and South Asia WORLD
and the Caribbean the Pacific North Africa Southern Africa Central Africa
FIGURE 8
Percentage of children aged 6–23 months with minimum dietary diversity, by age group and UNICEF region, 2020
Source: UNICEF global databases, 2021, based on MICS, DHS and other nationally representative sources.
16 Fed to Fail?
100
2019'
FINDING
90 2 minimum number of meals or snacks throughout the
Children’s diets have seen little or no day has barely improved in the last decade: 51 per
80 2009'
improvement in the last decade cent in 2010 and 54 per cent in 2020. Similarly, the
70 percentage of children consuming a minimally diverse
Our analysis of quantitative data about what, when diet – a key indicator of diet quality – has remained low
and how60young children are fed found almost no over the past decade: 21 per cent in 2010 and 24 per
improvement
50 over the last decade, with minimal cent 2020.
changes in timeliness, feeding frequency, dietary
diversity40and continued breastfeeding. Only a few Children’s consumption of nutritious foods has also
countries have made progress in improving young increased only marginally over the past 10 years. The
30
children’s diets. percentage of children aged 6–23 months consuming
20 eggs, fish and/or meat during the previous day was
The quality of children’s diets has remained 32 per cent in 2010 and 36 per cent in 2020, while the
10
persistently poor percentage consuming vegetables and/or fruit during
0 the previous day was 48 per cent in 2010 and 53 per
Globally, the percentage of children
ISSSF Continued aged Meal
Breastfeeding
Minimum 6–8Frequency
months cent inor2020.
Minimum Dietary Diversity
Eggs Meanwhile,
Flesh Foods the percentage of children
Any Fruit and Vegetables
introduced to solid foods increased from 66 per cent in aged 12–23 months who were fed breastmilk has
2010 to 72 per cent in 2020 (see Figure 9). However, also stagnated (69 per cent in 2010 and 66 per cent
the percentage of children aged 6–23 months fed the in 2020).
How has the quality of children’s diets changed in the last

decade?
2010 2020
Introduction
of solid foods
(n=84) 66 72
Continued
breastfeeding
(n=86) 66 69
Minimum meal
frequency
(n=55) 51 54
Vegetables
and/or fruits
(n=50) 48 53
Eggs, fish
and/or meat
(n=50) 32 36
Minimum dietary
diversity
(n=50) 21 24
0 10 20 30 40 50 60 70 80 90 100
Percentage
FIGURE 9
Trends in percentage of children receiving: solid foods (6–8 months); continued breastfeeding (12–23 months); minimum meal
frequency, minimum dietary diversity, eggs, fish and/or meat, and vegetables and/or fruits (6–23 months), around 2010 and
around 2020

Only two in five countries have made any progress Even in the 21 countries reporting improvements
in improving the diversity of children’s diets in 2020, the percentage of children benefiting from
a minimally diverse diet was still alarmingly low: in
An analysis of trends in minimum dietary diversity in 10 of these 21 countries, less than 30 per cent of
individual countries shows just how few countries have children were fed a minimally diverse diet. These
made progress in diversifying children’s diets over figures make clear that even where there has been
time. Of the 50 countries with trend data available, less some progress, significant gaps remain in ensuring
than half (21 countries) made statistically significant that young children receive enough of the diverse
improvements, 19 have seen no meaningful improvement and nutritious foods they need during the most
at all, and 10 have experienced a statistically significant critical time in their development.
drop in the percentage of children consuming a minimally
diverse diet (see Figure 10).
Where has the diversity of children’s diets improved in the

last decade?
100
2010
significant no significant change significant increase 2020
90
decrease
80
70
60
Percentage
50
40
30
20
10
0
Congo
Cameroon
United Republic of Tanzania
Kiribati
Malawi
Tajikistan
Ghana
Sao Tome and Principe
Egypt
Armenia
Liberia
Senegal
Burundi
Democratic Republic of the Congo
Pakistan
Zimbabwe
Madagascar
Mali
Haiti
Uganda
Benin
Jordan
Eswatini
Mongolia
Dominican Republic
Guyana
Indonesia
Albania
Montenegro
Ethiopia
Burkina Faso
Guinea
Côte d'Ivoire
Niger
Gambia
Lesotho
India
Sierra Leone
Nigeria
Zambia
Timor-Leste
Bangladesh
Rwanda
Nepal
Cambodia
Kyrgyzstan
Maldives
Colombia
Bolivia (Plurinational State of)
Peru
FIGURE 10
Trends in percentage of children aged 6–23 months with minimum dietary diversity, by country, around 2010 and around 2020
18 Fed to Fail?
The five countries with the largest absolute
improvement in minimum dietary diversity between
2010 and 2020 were Burkina Faso, Côte d’Ivoire,
Kyrgyzstan, Maldives and Timor-Leste.
These trends do not take into account the impact of

the COVID-19 pandemic because the collection of
nationally representative data on children’s diets using
standard tools was very limited in 2020.37 However,
several countries are tracking children’s diets using
remote methods, such as phone surveys, which have
revealed worrying signs that diet quality has fallen
during the pandemic. For example, a study in urban
slums in Jakarta found that children aged 12–23
months were fed fewer meals and had less diverse
diets in 2020 than in 2018: minimum meal frequency
fell from 94 per cent to 79 per cent, and minimum
dietary diversity fell from 81 per cent to 55 per cent.38
Regional- and country-level estimates and trends for

all indicators can be found in the data tables available
online.
FINDING 3
Poor diets are not affecting all children
equally across and within regions
Our analysis of quantitative data reveals wide

inequalities in the quality of children’s diets across children in the two sub-Saharan African regions and
regions and among countries within the same region. only 24 per cent of children in South Asia. Similarly,
Young children in three regions – Eastern and Southern almost 80 per cent of children in Latin America and
Africa, South Asia, and West and Central Africa – the Caribbean consumed vegetables and/or fruit
have the lowest meal frequency, dietary diversity and during the previous day, compared with fewer than
consumption of nutritious foods. half of young children in South Asia (see Figure 11).
The quality of children’s diets varies widely Three regions – East Asia and the Pacific, Latin
among regions America and the Caribbean, and the Middle East
and North Africa – rank highest for the percentage
The percentage of children benefiting from the of children benefiting from nearly all recommended
recommended foods and feeding practices varies child feeding practices. Another three regions –
by region, with some regions in greater crisis than South Asia and the two sub-Saharan African regions
others. For example, 62 per cent of children aged – consistently rank lowest, with far fewer children
6–23 months in Latin America and the Caribbean were benefiting. The one exception is the percentage
fed a minimally diverse diet in 2020 compared with of children who were breastfed in the second year
less than 25 per cent of young children in South Asia of life, which was highest in South Asia and the
and the two sub-Saharan African regions (Eastern two sub-Saharan African regions (>66 per cent)
and Southern Africa, and West and Central Africa). and lowest in the Middle East and North Africa
Children’s consumption of egg, fish and/or meat also (42 per cent).
differs by region: more than 70 per cent of children in
Latin America and the Caribbean and East Asia and
the Pacific consumed these nutritious foods during the
previous day compared with less than 50 per cent of

Percentage
0
10
20
30
40
50
60
70
80
90
100
FIGURE 11
Latin America and the Caribbean 87
East Asia and the Pacific 84
20 Fed to Fail?
Middle East and North Africa 81
Eastern Europe and Central Asia 76
Eastern and Southern Africa 77
(6–8 months)
West and Central Africa 73
Introduction
South Asia 58
of solid foods
Global 73
Latin America and the Caribbean excludes Brazil.

Latin America and the Caribbean 71*
Eastern Europe and Central Asia -No data
Minimum
(6–23 months)
South Asia 45
Global 52
meal frequency
greater challenges than others
vegetables and/or fruits; continued breastfeeding, by UNICEF region, 2020

Eastern Europe and Central Asia No data
Vegetable
(6–23 months)
and/or fruit
South Asia 46
consumption
Global 59

(6–23 months)
South Asia 24
Global 45
Egg, fish and/or
Percentage of children receiving: solid foods; minimum meal frequency; minimum dietary diversity; eggs, fish and/or meat; and
meat consumption
Children’s diets are poor across regions – but some regions face
Source: UNICEF global databases, 2021, based on MICS, DHS and other nationally representative sources. *To meet adequate population coverage, East Asia and the Pacific excludes China and
Percentage

0
10
20
30
40
50
60
70
80
90
100



5+
Minimum
(6–23 months)
Eastern and Southern Africa


24
West and Central Africa

21
dietary diversity
South Asia 19
Global 29

East Asia and the Pacific 58*
Eastern Europe and Central Asia 50
Continued
(12–23 months)
South Asia 78
breastfeeding
Global 65
foods
and Southern Africa,
dietary diversity and

Central Africa have the
lowest meal frequency,
Young children in Eastern
South Asia, and West and
consumption of nutritious

Within the same region, the quality of children’s Similarly, in West and Central Africa, where 21 per cent
diets differs significantly among countries of children were fed a minimally diverse diet, country
estimates range from 8 per cent in Guinea-Bissau to 36
There is a considerable range in the percentage per cent in Burkina Faso (see Figures 12 and 13). Even
of children who were fed a minimally diverse diet in Latin America and the Caribbean, the region with the
among countries in the same region. For example, highest percentage of children with minimum dietary
while nearly half (42 per cent) of children in East diversity (62 per cent), country estimates range from
Asia and the Pacific consumed a minimally diverse as low as 19 per cent in Haiti to as high as 84 per cent
diet in 2020, country estimates in the region vary in Peru.
widely – from 9 per cent in Kiribati to 69 per cent in
Thailand. Regional- and country-level estimates for all indicators
can be found in the data tables available online.
How does the diversity of children’s diets vary between

countries within the same region?
100
%
90 80 or greater
80
70 60 to 79.9
60
Percentage
50 40 to 59.9
40
30 20 to 39.9
20
10 Less than 20
0
Latin America and East Asia and Middle East and Eastern and West and South Asia Eastern Europe
the Caribbean the Pacific North Africa Southern Africa Central Africa and Central Asia
FIGURE 12
Percentage of children aged 6–23 months with minimum dietary diversity, by UNICEF region and country, 2020
22 Fed to Fail?
FINDING 4 nutritious foods, access to quality nutrition services
Disparities in children’s diets persist within and socio-cultural practices.
countries and have not narrowed
Figure 13 presents the gap in the percentage of
Our analysis of national data reveals wide disparities in children aged 6–23 months fed a minimally diverse diet
the quality of children’s diets among subnational areas in the best- and worst-performing areas in selected
within countries. In addition, children living in poorer countries. In Peru, a country where a high percentage
households and rural areas are least likely to consume of children (84 per cent) received a minimally diverse
sufficient meals and diverse diets but are more likely diet, there is a nearly 30-percentage-point gap
to be breastfed in the second year of life. Disparities in between the best and worst-performing areas of the
child feeding practices between poorer and wealthier country: 90 per cent in Ica versus 65 per cent in Loreto.
households have not changed over the last decade. Similarly in Ethiopia, where only 13 per cent of children
were fed diets with the minimum dietary diversity,
Poor diets are not affecting all children equally there is a 28-percentage-point gap between the best-
and worst-performing areas of the country: 29 per cent
National-level estimates hide glaring disparities in in Addis Ababa versus 1 per cent in Somali.
young children’s diets among areas within a country.
These disparities are due to economic, environmental
and social differences between geographic areas,
such as household income, access to markets selling
National averages mask variations in children’s diets within countries

West and Eastern and South Asia Latin America and East Asia and Eastern Europe Middle East
Central Africa Southern Africa the Caribbean the Pacific and Central Asia and North Africa
100
90 90
85
86
84 82
80 78
80 74
69
65 63
60 58 57
Percentage
58
56
47
48 52
40 37
36 39
35
29 28
25
30
23
20 17 23 19
15 12
13 16
8 12 9
1 7
2 5
0
Guinea Burkina Ethiopia Eswatini Pakistan Sri Lanka Haiti Peru Kiribati Thailand Tajikistan Serbia Egypt Tunisia
Bissau Faso
Sub-region with highest minimum dietary diversity
Country average
Sub-region with lowest minimum dietary diversity
FIGURE 13
Percentage of children aged 6–23 months with minimum dietary diversity, by subnational region of a country, 2020
Source: UNICEF global databases, 2021, based on MICS, DHS and other nationally representative sources. Note: This is an illustrative example showing subnational disparities among
countries with the highest and lowest national prevalence of minimum dietary diversity in each UNICEF region.

Globally, the quality of children’s diets also varies by However, the diets of children in wealthier households
urban or rural residence and household wealth (see were still far from optimal – less than 40 per cent
Figure 14). Minimum meal frequency among children consumed nutritious foods such as eggs or flesh
aged 6–23 months was higher in urban areas (57 foods during the previous day. Furthermore, only 40
per cent) than rural areas (48 per cent) and among per cent had minimally diverse diets, and continued
wealthier households (57 per cent) than poorer breastfeeding was lower in wealthier households than
households (45 per cent). The disparities in minimum in poorer households (see Figure 14).
dietary diversity are even greater: the percentage of
children fed a minimally diverse diet was about twice Disparities in children’s diets today are the same
as high in urban areas (39 per cent) than rural areas as they were a decade ago
(23 per cent) and in wealthier households (40 per
cent) compared with poorer households (19 per cent). Although economies have grown substantially during
In contrast, continued breastfeeding in children aged the last decade, the equity gaps between the diets of
12–23 months was higher in rural areas (73 per cent) children living in poorer and wealthier households have
and poorer households (75 per cent) compared with not closed (see Figure 16). Disparities between poorer
urban areas (57 per cent) and wealthier households and wealthier households have remained the same
(56 per cent). No disparities in diet quality are seen with respect to minimum dietary diversity and widened
boy 67.8 67.7
between girls and boys. for minimum meal frequency over the past decade. For
urban 57.6 73.5 continued breastfeeding, the gap between the poor
rich
Household wealth 76 the types
influences 56.1 of foods and wealthier has narrowed slightly, but only because
that children consume. Young children in wealthier the percentage of children aged 12–23 months who
households were more likely to consume nutritious were breastfed has fallen among children in poorer
foods than those in poor households. For example, the households.
percentage of children who consumed dairy, eggs and
flesh foods (fish, poultry or meat) during the previous Regional- and country-level estimates and trends for
day in wealthier households was almost double the all indicators can be found in the data tables available
percentage in poorer households (see Figure 15). online.
Children’s diets vary significantly by area of residence and

wealth quintile – but not between boys and girls
Minimum dietary diversity Minimum meal frequency Continued breastfeeding
(6–23 months) (6–23 months) (12–23 months)
29% 29% 52% 52% 67% 68%

Girl Boy
23% 39% 48% 57% 57% 73%

Rural Urban
19% 40% 45% 57% 56% 75%

Poorest Wealthiest
% 0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80
FIGURE 14
Percentage of children with minimum dietary diversity, minimum meal frequency, continued breastfeeding, by sex of child, rural
and urban residence, and poorest and wealthiest wealth quintile, 2020
24 Fed to Fail?
Children from the wealthiest households have better diets than
their peers from the poorest households
Wealthiest Poorest Global
Grains, roots
79% 75 83
& tubers
Breastmilk 75% 66 81
Dairy 47% 36 64
Vitamin A-rich 44 51
fruits & vegetables 47%
Flesh foods 32% 25 39
Other fruits
29% 21 36
& vegetables
Legumes, 19 23
22%
& nuts
Eggs 22% 17 30
0 10 20 30 40 50 60 70 80 90 100
Percentage
FIGURE 15
Percentage of children aged 6–23 months consuming food groups, by type and by poorest and wealthiest wealth quintile, 2020
Disparities in Minimum dietary diversity

(6–23 months)
Minimum meal frequency
(6–23 months)
Continued breastfeeding
(12–23 months)
100
the quality
of young
children’s diets 80 80
between poorer 76
and wealthier Poorest
households 60 60
59
58
Percentage
56
have not closed 48
Wealthiest
Wealthiest
47
over time 40
Poorest Wealthiest
34
Figure 15 32
Wealthiest Poorest
20
15
13
Poorest
0
2010 2020 2010 2020 2010 2020
FIGURE 16
Trends in the percentage of children with minimum dietary diversity, minimum meal frequency and continued breastfeeding, by
poorest and wealthiest wealth quintile, 2010 and 2020

FINDING 5 a mother explained that “the roads are poor so we
Families struggle to find and afford have no easy access to shops” and in rural Ghana a
nutritious foods for their young children mother told us, “It is difficult to get a vehicle to go to
other communities to buy foodstuff.” Adverse weather
Families are becoming increasingly dependent on conditions can also seasonally cut road access to
foods bought or traded in markets and shops, rather markets in countries, such as Kazakhstan and Tajikistan
than those produced at home. Evidence from the in Central Asia.44
voices of mothers and regional analyses shows that
families, especially lower-income families, struggle Poor families cannot afford nutritious foods for
to find, access and afford nutritious foods for their their young children
young children.
Families can include nutritious foods in their diets only
Supply and physical access constraints put if these foods are affordable. Many nutritious foods
nutritious foods out of reach for those who need – including vegetables, fruits, dairy, eggs, fish and
them most meat – are far more expensive than starchy staples
because they cost more to produce, transport and
Young children cannot survive or thrive on calories store, especially in low-income countries.45-47 In fact,
alone; they need a range of nutritious foods to nutritious diets are five times more expensive than
supply all essential nutrients for optimal growth those that meet only energy needs, putting them
and development.11 Advances in agriculture and beyond the financial reach of more than 3 billion people
the livestock sector mean that national supplies of worldwide.16
vegetables, fruits, eggs, fish, meat and other nutritious
foods are greater than ever, but they still fall short of Although the nutrient needs of young children are
population nutrient requirements, particularly in low- much higher per kilogram body weight than those of
income countries and in regions affected by climate their family members, the quantities of nutritious foods
shocks and conflict.16 they need are relatively small because of their small
body size. This raises the question: are nutritious foods
The regional analyses found that families are too expensive for families even in the quantities that
increasingly purchasing their food in markets and shops young children need?
rather than producing it in the home, even in rural
areas.39-41 This means that families are reliant on the To answer this question, UNICEF collaborated with
foods that are available in these markets and shops. GAIN to assess the affordability of nutritious foods
for young children in nine countries in Eastern and
We asked more than 570 mothers in 18 countries Southern Africa, and South Asia. The study identified
about the challenges they experience in finding locally available nutritious foods in each country and
nutritious foods for their young children.30 Most assessed how affordable they were in the quantities
mothers (88 per cent) reported that they purchase food needed to meet 50 per cent of a young child’s nutrient
from local markets or shops. Some mothers struggled needs.48, 49 The analysis found several affordable
to find any food at times, mainly in African countries, food sources of vitamin A in all countries, but few
where seasonal gaps in the availability of vegetables affordable food sources of iron and calcium and no
and fruits are common.42,43 However, the more affordable food sources of zinc in any country. For
pressing challenge was finding the nutritious foods poorer households, there were very limited options for
they wanted for their children: one in three mothers meeting any micronutrient needs other than vitamin A.
reported that nutritious foods were very limited in their
local markets and shops. As a mother in rural Indonesia The regional analyses also found evidence that
put it, “Sometimes the market does not have enough nutritious foods are beyond the financial reach of poor
healthy food, so I don’t know what healthy food I can households in all seven regions examined.41-44, 50-52 For
give to my child.” example, a recent study reported that the percentage
of households unable to afford a nutritious diet was
Rural mothers also described how physical barriers 21 per cent in Cambodia, 51 per cent in Ecuador and
and limited transport options prevented their families up to 56 per cent in Tajikistan.53 Household wealth
from travelling to find nutritious foods. In rural Ethiopia, significantly predicted minimum dietary diversity in our
26 Fed to Fail?
analysis of household survey data from sub-Saharan Nutritious foods become even less affordable if they
Africa (Democratic Republic of the Congo, Ghana, rise sharply in cost or if household income declines.
Kenya, Malawi, the Niger, Nigeria, Rwanda, Senegal Both these conditions can occur simultaneously when
and United Republic of Tanzania),42, 43 Middle East and conflict, natural disasters or public health crises reduce
North Africa (Egypt, the State of Palestine and the the supply of nutritious foods and damage livelihoods.
Sudan),51, 54 and South Asia (Afghanistan, Bangladesh
and Pakistan).55-57 UNICEF, together with its partners, is investigating
the impact of the COVID-19 pandemic on household
These findings were echoed in conversations with income, food purchasing patterns and diets: the
mothers of young children in low- and middle- income findings are alarming. Phone-based surveys in
Employment
countries, who16 spoke of the constant struggle to afford Indonesia,38 Kenya, Lesotho, Malawi and Nepal
Access 20
nutritious foods.30 A far greater percentage of mothers found that households suffered income losses, food
Relationship/support
(79 per cent) reported23affordability constraints to shortages and drastically cut their purchases of
Knowledge/preferences 25 or physical access
healthy diets than poor availability nutritious foods due to the pandemic containment
Availability 30
to nutritious food (<30 per cent) (see Figure 17). A measures (see Spotlights 1, 2 and 3). As a result,
Time mother
pressure 62 Guatemala told us, “If I had money,
in rural young children were fed fewer meals, less diverse
Affordability 79 and prepare food [like] the mother
I would purchase diets and/or smaller quantities of nutritious foods.
that I want to be,” while in rural Zimbabwe, another
mother explained, “I cannot even afford to give my Our regional analyses also found that families coped
baby unhealthy foods as I do not have the money.” A with rising food costs by resorting to cheaper
mother in rural Ghana described how poor affordability staples for their young children, such as rice in
and physical access can overlap: “There is not enough East Asia and the Pacific, and porridge in West and
money in our house to buy different foods for my Central Africa.41, 42
child, and even if I did have the money, the food is
not available.”
Evidence from the voices of

Families, especially lower-
mothers and regional
income
analyses families,
shows struggle
that families,
to find, lower-income
especially access and afford
Affordability
nutritious
families, foods
struggle for their
to find, 79%
young children.
access and afford nutritious
foods for their young children. Time pressure
62%
Knowledge/
Availability preferences
30% 25%
Relationship/
support
Employment
23% 16%
Access
20%
FIGURE 17
Percentage of mothers of young children reporting barriers to a healthy diet in 18 countries
Source: Schmied, V. et al. (2020). Food and nutrition: Mothers’ perceptions and experiences. The State of the World’s Children 2019 Companion Report. Western Sydney University and UNICEF,
Sydney.

SPOTLIGHT 1
THE COVID-19 PANDEMIC – IMPACT ON HOUSEHOLD FOOD PURCHASES AND

CHILDREN’S DIETS IN INDONESIA
The COVID-19 pandemic is having The data were collected remotely by of households (<5 per cent) reported
a dramatic impact on families phone and compared with survey purchasing less of a food item
throughout the world. The strategies data collected by UNICEF in the same because of challenges in physically
to prevent virus transmission location in 2018. accessing markets or shops.
– including lockdowns, travel
restrictions and physical distancing The survey found that 81 per cent Young children’s diets suffered
– have devastated livelihoods and of households experienced a fall in in response to these changes in
disrupted access to affordable income after the onset of COVID-19 purchasing patterns. In particular, the
nutritious foods and essential containment measures. The stress minimum dietary diversity in children
nutrition services. Families are on these families was evident: 66 aged 12–23 months fell by one-third
struggling to buy their usual range per cent of households were worried from 81 per cent in 2018 to 55 per
of foods, and young children’s diets about food in the previous month – cent in 2020 (see Figure 19). Children
and nutritional status are predicted an increase of more than 50 per cent aged 12–23 months were less likely
to suffer.4, 26, 58 from 2018 (42 per cent). to consume eggs, fish and/or meat in
2020 than in 2018 (62 per cent versus
UNICEF is monitoring the impact of Many households reported that they 83 per cent), dairy products (48 per
the pandemic on households and had reduced, stopped or replaced cent versus 75 per cent), and pulses
young children. In September and their purchases of nutritious foods and/or nuts (22 per cent versus 51 per
October 2020, UNICEF, the United because of financial difficulties. cent). The decline in minimum meal
Nations Food and Agriculture This included purchases of fish, frequency (15 percentage points)
Organization and the World Food poultry and/or meat (55 per cent of was smaller than for minimum
Programme conducted a survey in households); fruit (35 per cent); dairy dietary diversity (26 percentage
urban slums in Jakarta, Indonesia, (31 per cent); eggs (22 per cent); points), suggesting that households
to examine the impact of the beans, pulses and/or tofu (15 per prioritized the frequency of feeding –
COVID-19 pandemic on household cent); and vegetables (11 per cent) and fuller stomachs – over the quality
food security and children’s diets.38 (see Figure 18). A small percentage of food for their children.
FIGURE 18 Fish, poultry

Percentage 55% Purchased less
and/or meat
of urban poor
households Fruit 35% Replaced with cheaper items
reporting changes
in food purchases Dairy 31% Stopped purchases
due to affordability
barriers, Jakarta, Eggs 22%
2020
Beans, pulses
and/or tofu 15%
Vegetables 11%
0 10 20 30 40 50 60
Percentage
FIGURE 19
Minimum 55% 2020
Percentage of
dietary
children aged diversity 2018
81%
12–23 months with
minimum meal
frequency and
minimum dietary Minimum 79%
diversity in urban meal
slums in Jakarta, frequency 94%
2018 and 2020
0 20 40 60 80 100
Percentage
28 Fed to Fail?
SPOTLIGHT 2
THE COVID-19 PANDEMIC – A FALL IN THE QUALITY OF CHILDREN’S DIETS IN

EASTERN AND SOUTHERN AFRICA
The devastating health and June and August 2021, phone-based months in Lesotho (29 per cent) and
socioeconomic impacts of the surveys were conducted in more half in Kenya (47 per cent) were fed
COVID-19 pandemic are being felt by than 1,300 households in Kenya, with the minimum dietary diversity
economies, households and children Lesotho and Malawi using computer (see Figure 20).
across Eastern and Southern Africa. assisted telephone interviewing.
By the end of 2020, the region had The survey module for caregivers Caregivers were asked to report any
recorded more than 1.1 million cases of children aged less than 2 years changes to the frequency or type of
of COVID-19; however, the actual included questions on household foods fed to their children because
number was likely considerably food insecurity and children’s recent of the COVID-19 pandemic. One in
higher due to low testing capacity. consumption of food and beverages. five children in Lesotho (20 per cent)
The pandemic has pushed millions and at least one in three children in
more households into extreme More than half of caregivers in Kenya Kenya (43 per cent) and Malawi (33
poverty and exacerbated the impact (53 per cent), Lesotho (52 per cent) per cent) were fed fewer meals in the
of existing humanitarian crises in the and Malawi (77 per cent) reported previous month due to the pandemic.
region on child nutrition. that their households had lower In addition, at least 40 per cent of
income at the time of the survey children in Lesotho and at least 20
The UNICEF Eastern and Southern than in January 2020, before the per cent of children in Kenya and
Africa Regional Office conducted pandemic. Only one in three children Lesotho were fed smaller quantities
research to examine the secondary in Malawi (36 per cent) and Lesotho of nutritious foods, such as vitamin
impacts of the pandemic on the (39 per cent) were fed with the A-rich fruits and vegetables, pulses,
diets of young children, adolescents minimum meal frequency, and less dairy, eggs, meat, poultry and fish
and women in the region. Between than one in three children aged 6–23 (see Figure 21).
FIGURE 20
61% Malawi
Percentage of children Minimum
29% 61% Malawi
aged 6–23 months fed with dietary diversity Lesotho
Minimum 47%
29%
minimum meal frequency dietary diversity Lesotho
47% Kenya
and minimum dietary
36%
diversity in Kenya (n=835), Minimum Kenya
39%
Lesotho (n=823) and meal frequency 36%
Minimum 51%
39%
Malawi (n=1178), June to meal frequency
August 2021 0 10 20 30 40 50 51% 60 70
Percentage
0 10 20 30 40 50 60 70
Percentage
Fish and 34%

41% Malawi
seafood 32%34%
FIGURE 21 Fish and
41% Malawi
Lesotho
Percentage of children seafood 32% 42%
Meat and Lesotho
aged 6–23 months fed poultry
48% Kenya
Meat and 34% 42%
smaller quantities of 48% Kenya
poultry
nutritious foods due to 27% 34%
Eggs 45%
the COVID-19 pandemic 27%29%
in Kenya (n=1321), Eggs 45%
29% 42%
Lesotho (n=1303) and Dairy
46%
Malawi (n=1563), June to products 36% 42%
Dairy
August 2021 46%
products 36%
Pulses, beans, 23%
45%
peas and nuts 23% 33%
Pulses, beans, 45%
peas and nuts 33%
Other fruits 18%
42%
and vegetables 18% 28%
Other fruits 42%
Vitamin A-rich fruits 44%
Vitamin A-rich fruits 44%
Cereals, roots 50%
and tubers 31% 39%
Cereals, roots 50%
and tubers 0 10 20 30 39%
40 50 60
0 10 20 Percentage
30 40 50 60
Percentage
Source: Remote surveys on the potential impacts of COVID-19 on the diets of young children, adolescents, and pregnant and breastfeeding mothers in Eastern and Southern Africa region,
UNICEF Eastern and Southern Africa Regional Office, unpublished data, August 2021.

SPOTLIGHT 3
THE COVID-19 PANDEMIC – TRACKING CHANGES IN YOUNG CHILDREN’S DIETS IN NEPAL

The COVID-19 pandemic brought months were asked whether they were with income losses fell from 45 per
many countries to a near standstill, as experiencing any difficulties in feeding cent in October 2020 to 19 percent in
governments imposed tight restric- their young children, and if so, the January 2021, and the percentage that
tions on movement to halt the spread single most pressing problem. struggled to provide sufficient food for
of the virus. The Government of Nepal family members fell from 19 per cent
announced a nationwide lockdown in The survey in May 2020 found that to 8 per cent. During the same period,
March 2020, prohibiting non-essential 55 per cent of households suffered there was a sharp decline in the per-
movement, closing international bor- income losses due to the lockdown, centage of households experiencing
ders, and suspending non-essential and 28 per cent experienced food challenges in feeding their children.
services. This posed unprecedented shortages. One in five caregivers of Children’s dietary diversity remained
challenges for families throughout the young children (21 per cent) reported the most pressing concern through-
country; many struggledReducedto maintain
quantity of foodthat children’s
or number of mealsmeals were lower Reducedin
diversity ofout the eight-month period, and still
meals
May 2020 (n=1105) 5 21
livelihoods, earn a decent income
July 2020 (n=926) 4
and diversity
Reducedthan before
quantity of foodthe onset
or number of the
17 of meals
affected 1 in 10
Reduced children
diversity in January
of meals
access essential health
August 2020and nutrition
(n=1034) 4 May 2020pandemic,
(n=1105) and
5 5 per cent reported
22 2021, despite
21 the removal of lockdown
October 2020 (n=1044) 2 July 2020 (n=926) 4 22 17
services. December 2020 (n=962) 3 Augustthat children4were given less
2020 (n=1034) 14
food or measures.
22
January 2021 (n=942) 1 Octoberfewer
2020 (n=1044)
meals 2(see Figure 22).12House- 22
December 2020 (n=962) 3 14
In response to concerns about the Januaryholds with
2021 (n=942) 1lower income were more A rapid 12assessment of young child
effect of the pandemic on Nepal’s likely to experience difficulties in feed- feeding practices was conducted in
children and their families, UNICEF ing their children (see Figure 23). June 2021 following another wave
conducted a series of six nationally of COVID-19 and further lockdown
representative phone-based surveys More than one in five caregivers measures. It found that only one in
between May 2020 and January 2021 reported feeding their children fewer three children aged 6–23 months (38
to monitor the socioeconomic im- meals, less food or meals with lower per cent) were fed at least four out
pacts, including on the diets of young diversity in July, August and October of seven food groups, indicating that
children. In each survey, at least 900 2020. As lockdown measures were caregivers continued to struggle to
caregivers of children aged 6–23 relaxed, the percentage of households feed their children diverse diets.
Reduced quantity
FIGURE 22 May 2020 5% 21% of food or number
Percentage of caregivers of (n=1105) of meals Reduced qu
May 2020 5% 21% of food or n
children aged 6–23 months (n=1105) of meals
July 2020 4% 17% Reduced diversity
reporting changes in feeding (n=926) of meals
practices in Nepal, May 2020 July 2020 4% 17% Reduced di
(n=926)
to January 2021 August 2020
of meals
(n=1034)
4% 22%
August 2020
(n=1034)
4% 22%
October 2020
(n=1044)
2% 22%
October 2020
2%
(n=1044)
22%
December 2020
(n=962)
3% 14%
December 2020
(n=962)
3% 14%
January 2021
(n=942) 1% 12%
January 2021
0 5 (n=942)10 1% 15
12% 20 25 30
Percentage
0 5 10 15 20 25 30
Percentage
35
32%
FIGURE 23 30% 35
30 32%
Percentage of caregivers whose children aged 30%
6–23 months were fed fewer meals, less food 25%
Percentage of caregivers
30
25
or meals with lower diversity, by household 22% 25%
Percentage of caregivers
income in Nepal, May 2020 (n=942) 20 25

22%
20
15
12%
15
10 12%
10
5
5
0 <10 10–20 20–30 30–50 50+
0
Monthly income in <10
1,000 Nepalese10–20
Rupees 20–30 30–50 50+
(US$ 1 = NPR 115)
Monthly income in 1,000 Nepalese Rupees
Sources: (US$ 1 = NPR 115)
United Nations Children’s Fund. Child and Family Tracker Surveys, Nepal, May 2020 to January 2021.
Infant and Young Child Feeding Technical Working Group, National Nutrition Cluster, Nepal. Infant and Young Child Feeding in COVID-19 Context. Rapid Assessment Report, June 2021.
30 Fed to Fail?
FINDING 6
Children’s diets are constrained by social,
cultural and gender barriers
Even when food is available, accessible and affordable, social

and cultural influences and gender norms can constrain the
best intentions of caregivers to feed their young children
nutritious diets. Our regional analyses and conversations with
mothers and nutrition specialists expose the tension between
mothers’ desires to feed their children well and the lack of
autonomy and time to do so.
Many mothers have the burden but not the autonomy to

feed children well
In most settings, mothers are still primarily responsible for

the feeding and care of young children. This remains a deeply
embedded social norm, connected in part to the breastfeeding
relationship between mother and child and entrenched gender
roles that apportion domestic duties to women. As a nutrition
specialist working in urban India explained, “Mothers bear the
burden of all efforts towards making their children’s diets more
nutritious. These mothers perceived it was their job to ensure
that their child ate healthy food.”30
But the responsibility for feeding children is not always

accompanied by the autonomy to decide what foods their
children eat. We asked mothers and nutrition specialists in
18 countries how decisions are made on what to feed young
children.30 We found that mothers in Afghanistan, Bangladesh
and India experience powerful social norms that exclude
them from food-purchase decisions. A nutrition specialist in
rural India explained that “some of the young mothers [are]
not allowed to step out of the house at all.” In Afghanistan, a
mother explained that “in most instances, food for cooking [is]
collected from the market by a male member of the family,” and
in rural Bangladesh, a nutrition specialist reported that food-
related decisions are taken by the older generation of women;
specifically, “Mothers/mothers-in-law are usually in charge of
daily food purchasing.”
Some mothers also lack control over which foods are fed to young
children, including a mother in rural Bangladesh: “My husband and
mother-in-law make the decisions about what the baby will eat.”
These family members sometimes impose restrictions based on
enduring food taboos or gender biases. For example, a mother
in urban Bangladesh explained: “According to the mother-in-law
… fish will give [the child] worms.” Patriarchal norms were also
reported by a mother in rural Guatemala: “Husbands don’t want to
give us money [for healthy food].” In contrast, mothers in high-
income countries reported greater autonomy to take charge of
decisions on what to purchase and feed to their young children.

The regional analyses found that mothers in other But challenges also remain in rural settings. Caregivers
regions where patriarchal norms and multigenerational report difficulty finding adequate time to feed their
households prevail are also unable to make children the way they want to, often as a result of
independent decisions on what their children are fed, household and agricultural work. Mothers in diverse
including in sub-Saharan Africa (Burkina Faso, Mali, contexts from the Plurinational State of Bolivia to Uganda
the Niger, Nigeria and Senegal),42, 43 the Middle East say that shouldering the heavy burden of household
and North Africa (Egypt, the State of Palestine and the chores and farm work is a major barrier to feeding
Sudan) 51 and Central Asia (Tajikistan).44 Young and first- their children frequently and responsively.59, 60 These
time mothers often experience the least control over struggles are becoming more common in countries where
these decisions. increasing numbers of rural men are migrating to other
countries for work, such as Tajikistan, leaving mothers
Child feeding decisions are influenced by time and behind to cope with the dual responsibilities of agriculture
work pressures on mothers production and domestic duties.44
Across the world, the time pressures on mothers are Some mothers find strategies to manage the time crunch
mounting. Many mothers now work outside the home, by selecting nutritious foods that require less preparation,
while continuing to shoulder most of the childcare and preparing meals ahead of time, or relying on family
household responsibilities. members and paid caregivers for help.
Almost two in three mothers (62 per cent) we spoke However, many mothers struggle in the absence of
with found themselves constrained by insufficient adequate support and often compromise their own health
time.30 These pressures were particularly common in or self-care for their children: “I feel that I don’t have time
urban areas, where mothers were more likely to have to shop and prepare healthy meals as much as I’d like. If
paid work and live in nuclear households, without the limited on time, I provide a healthy meal for my children
support of other family members. Similar frustrations but not for myself,” explained a mother in urban United
were expressed by mothers in urban Indonesia (“I have States. Others turn to the convenience of processed
to hunt for time [to prepare food]”), urban Ghana (“You and fast foods. Mothers know these foods are not ideal
are late coming home from work and have to prepare for children – but are worn down by time pressures.
the meal”) and urban Australia (“My husband works As a mother in urban Indonesia explained: “Since I am
long hours, and my child has lots of needs, so I find I a working mother, I do not have much time, and as a
am the one juggling my own work and what my child consequence, I often buy food which sometimes is not
needs. It’s really hard some days”). healthy but is quick.”
32 Fed to Fail?
FINDING 7 than 570 mothers in 18 countries30 shows that they
Unhealthy processed foods are widely take a prominent place in young children’s diets.
accessible and heavily marketed
We found that processed and ultra-processed foods
The global consumption of unhealthy processed and drinks were provided to some infants at a very
and ultra-processed foods and drinks is increasing. young age (see Figure 24). Between the ages of 4
We examined evidence from our conversations and 6 months, before the recommended period of
with mothers, analyses of retail data, and published exclusive breastfeeding ends, 8 per cent of children
research to examine the extent of the problem in were introduced to processed bread, 6 per cent to
young children, and how gaps in legislation are juice, and 3 per cent to breakfast cereals and sugar.
failing to protect families and their children from
inappropriate marketing. The consumption of processed and ultra-processed
foods was considerably higher in children aged 6–23
Unhealthy processed foods and drinks are months. One in three children in Australia and one in
entering children’s diets from a very young age two children in Serbia consumed processed bread
daily; one in three consumed biscuits or cake daily;
Diet patterns throughout the world are shifting towards and one in four consumed breakfast cereals daily
processed and ultra-processed foods and drinks that (see Figure 25). These foods were also common in
are often energy-dense, nutrient-poor and high in salt, the diets of children in low and lower-middle income
sugar and unhealthy fats. There are insufficient data countries: one in three children in India were fed
to estimate how many young children are consuming confectionary daily, one in four children in Nigeria
these foods and drinks, globally or regionally. However, were fed instant noodles daily, and two in five
evidence gathered from our discussions with more children in Ethiopia were fed processed bread daily.
Some children are fed processed foods and drinks

before 6 months of age
15
14
6–8 months
4–6 months
12
12
2–4 months
0–1 months
9
Percentage
7 7
6
6
5
4
33 3 3 3
3
2 2 2 2 2 2 2
1 1 1 1 1
0 0 0 00 0 0
0
Sugar Processed Juice Sweet Processed Breakfast Confectionary Soft
infant foods drinks bread cereal drinks
Processed foods and drinks Ultra-processed foods and drinks
FIGURE 24
Percentage of children introduced to processed and ultra-processed foods and drinks by age
Source: Schmied, V. et al. (2020). Food and nutrition: Mothers’ perceptions and experiences. The State of the World’s Children 2019 Companion Report. Western Sydney University
and UNICEF, Sydney.
Child Nutrition Report 33

Young children across high-, middle- and low-income countries
are consuming ultra-processed foods and drinks on a daily basis
Biscuits/cake Processed bread Confectionary
Australia 32% Serbia 50% India 30%
Nigeria 31% Ethiopia 39% Egypt 20%
Serbia 30% Australia 32% Australia 16%
Mexico 29% Kyrgyzstan 12% Nigeria 14%
Breakfast cereal Instant noodles Sugar

Australia 27% Nigeria 28% Serbia 20%
Serbia 27% China 10% Bangladesh 10%

China 15% India Australia 5%
5%
Ghana 13% Mexico 5% India 5%
Juice Sweet drinks Soft drinks

Mexico 38% Ghana 31% Nigeria 10%
Sudan 34% Zimbabwe 29% Mexico 5%
Serbia 33% Kyrgyzstan 15% Serbia 3%
Nigeria 28% India 15% Ghana 3%
FIGURE 25
Percentage of children aged 6–23 months consuming processed and ultra-processed foods and unhealthy drinks daily in select countries
Source: Schmied, V. et al. (2020). Food and nutrition: Mothers’ perceptions and experiences. The State of the World’s Children 2019 Companion Report. Western Sydney University and UNICEF, Sydney
Sweetened drinks or juice were consumed daily by quick to prepare, convenient and accepted by young
about one in three children in Ghana,
50 Mexico, Serbia, children.41,42,44,50, 52 As such, caregivers frequently offer
50
the Sudan and Zimbabwe. Very few mothers reported them to children even if they know these foods are
daily consumption of carbonated soft drinks in young unhealthy.50, 52 As a key informant in a review of national
children, except in Mexico (5 per cent) and Nigeria policies and programmes in Mali explains: “Everywhere,
40 38
(10 per cent). it doesn’t matter in which neighbourhood – [even] very
34
33 32 removed, at two hours from the centre of Bamako – you
31
These findings are troubling
30
29 on four levels: first, infants are going to find chips and soda. And the second thing is
30 28
should not consume anything other than breastmilk that these items are not expensive.”42 The growth of food
before 6 months of age; second, unhealthy foods distribution networks, and the relatively long shelf-life of
and
20
drinks can displace more nutritious foods from these products, means that they20can penetrate deep into
children’s diets and increase the risk of micronutrient rural communities.
deficiencies; third, these foods can also set preferences
10
for
10 sweet tastes that persist into later life; and fourth, Unregulated marketing of unhealthy foods and
diets that are high in processed and ultra-processed drinks is a threat to young children’s
5 5diets
foods can increase the risk of childhood obesity.13, 61, 62
0 A thriving processed food and beverage industry lies
The regional analyses explored the reasons why
Mexico
Sudan
Serbia
Nigeria
Australia
Nigeria
Serbia
Mexico
Serbia
Ethiopia
Australia
Kyrgyzstan
Ghana
Zimbabwe
Kyrgyzstan
India
India
Egypt
Australia
Nigeria
Australia
Serbia
China
Ghana
Nigeria
China
India
Mexico
Serbia
Bangladesh
Australia
India
Nigeria
Mexico
Serbia
Ghana
behind the rising consumption of unhealthy foods and

caregivers feed these unhealthy processed foods and drinks. In the Philippines, for example, UNICEF’s analysis
drinks to young children. Some caregivers in countries of Euromonitor International marketing reports found that
such as the Democratic Republic of Congo and GhanaConfectionary
between Cereal
2014 and 2019, per capita
Instant sales of processed
Sugar Soft
Juice Biscuits/ Bread Sweet
perceive that processed
cake foods are nutritious
Processed and
Drinks and ultra-processed foods increased
Noodles by 12 perDrinks
cent for
aspire to feed them to their young children.42 Most formula, 20 per cent for salty snacks, and 8 per cent for
caregivers find these foods are highly available, cheap, carbonated drinks.63
34 Fed to Fail?
Some commercial ‘baby foods’, such as fortified to fully incorporate the provisions of WHA 69.9. For
infant cereals, are prepared and fortified to meet example, an in-depth analysis of national legislation by
children’s high nutrient needs. But many other baby UNICEF and Helen Keller International for 20 countries
foods, as well as processed snacks and sweet drinks, in Eastern and Southern Africa found that none had
are nutritionally inferior products that are sometimes fully integrated all WHO recommendations into national
marketed with inappropriate nutritional claims. For laws and policies.67
example, our regional analyses in Eastern Europe and
Central Asia and in West and Central Africa found These gaps leave children and their families exposed
that the labels of some unhealthy processed foods to persuasive, misleading and unethical marketing
confuse consumers by promoting the vitamin and practices.68 Recent research in Cambodia, Nepal and
mineral content.42, 44 Senegal found that a high percentage of urban mothers
of children aged 6–23 months had seen promotions
In 2016, the World Health Assembly (WHA) adopted for commercially produced snacks (>80 per cent) and
resolution 69.9 urging Member States to implement complementary foods (20–29 per cent).13 Inappropriate
the WHO Guidance on Ending the Inappropriate marketing practices play to mothers’ concerns about
Promotion of Foods for Infants and Young Children. the health and nutrition needs of their children and are
The guidance covers commercial foods and drinks a threat to young children’s diets: there is evidence that
that are marketed as ‘suitable’ for children aged 6–36 marketing encourages early introduction of solid foods
months and calls for an end to advertising, promotions, and displaces suitable home-prepared foods.68
labelling, packaging and claims designed to encourage
purchase or consumption.64, 65 By 2020, 81 countries
had included these foods in legislation to prevent
inappropriate marketing of foods for infants and
young children.66 However, most countries have yet

FINDING 8 systems – are needed. However, the regional analyses
Policies and programmes to improve young of young children’s diets found that no country had a
children’s diets are not prioritized – and comprehensive set of policies, strategies or plans that
are being further eroded by the COVID-19 fully incorporate all relevant global recommendations
pandemic and guidance.41-44, 50-52
Despite the persistently poor quality of young children’s The health system has historically led national efforts
diets, our analysis of UNICEF’s programme monitoring to improve young children’s diets and has the strongest
data and the regional analyses show that actions to set of polices, strategies and plans, but missed
improve access to nutritious and affordable diets in opportunities within food and social protection systems
early childhood have not been adequately prioritized may hinder multi-system action. For example, the
in national policies and programmes. Since 2020, regional analysis in South Asia found that six out of
essential services to improve children’s diets have eight countries had comprehensively included actions
been further derailed due to the COVID-19 pandemic. to improve young children’s diets in health system
policies, strategies or plans, but only two countries
No country has a comprehensive set of had included such actions in food systems frameworks
policies and programmes to improve young (agriculture and food security) and two countries for
children’s diets social protection.52 Meanwhile, the analysis in six
countries in Eastern Europe and Central Asia identified
To ensure children have access to nutritious and no policies and strategies designed to improve
affordable diets, policy and programme actions young children’s diets through agriculture or social
that leverage the potential of multiple systems – protection.44
particularly the food, health and social protection
Most countries are providing counselling to improve feeding

practices – but too few have programmes to increase access
to nutritious food
Education and/or counselling on

diverse diets 88%
Education and/or counselling on responsive

parenting, feeding and stimulation 80%
Programmes to improve availability, access

and affordability and use of nutritious 71%
foods at household level
National social and behaviour change

communication strategy on children's diets 60%
Regulations on inappropriate promotion

of foods for young children
49%
Access to and promotion of

47%
micronutrient powders
Social protection services to increase

access to and affordability of diverse and 45%
nutritious food baskets
Access to and promotion of fortified,

commercially prepared foods for 30%
young children
0 10 20 30 40 50 60 70 80 90 100
Percentage
FIGURE 26
Percentage of countries implementing programmes to improve the quality of children’s diets by type of programme in 2020
Source: UNICEF Strategic Monitoring Questions data, 119 countries.69
36 Fed to Fail?
The range of national programmes to improve young The COVID-19 pandemic has derailed essential
children’s diets reflects the national policy environment, services to improve children’s diets
with health system-led programmes being dominant
(see Figure 26). According to UNICEF’s programme The COVID-19 pandemic has put countries’ food,
monitoring data, almost 90 per cent of countries health and social protection systems under serious
provided education and counselling services to improve strain.58 Closure of health facilities and services,
caregiver knowledge and practices through the health gaps in service providers and supplies, lockdown
system in 2020.69 Although counselling services have restrictions on mobility, and/or fear of infection have
been delivered for longer than most other interventions meant that child nutrition services in many countries
to improve young child feeding, the coverage and were suspended, curtailed or underutilized.
quality of counselling remains suboptimal. The
regional analyses reported constraints within the UNICEF has been monitoring the impact of
health workforce, including inadequate numbers, the pandemic on nutrition services in countries
training, supervision, incentives and motivation of throughout the world.31 In April 2020, at the peak of
service providers at facility and community levels, and the first wave of the pandemic, nearly 83 per cent
excessive workloads that limit the time to counsel of countries reported considerable disruptions in the
caregivers.41-44, 50-52 These constraints reflect the failure coverage of services to promote nutritious and safe
to adequately prioritize and institutionalize counselling diets for young children. Further analysis based on 39
within primary health care services. For example, in countries with data collected every six months over
East Asia and the Pacific, the accountability of service a one year period found that the situation normalized
providers to deliver counselling is unclear in four out of in most countries by April 2021; however, 1 in 10
six countries because counselling is not included in the countries reported that coverage was at least 25 per
package of basic services in health facilities.41 cent lower than normal (see Spotlight 4).
Fewer countries had programmes to improve access Meanwhile, social protection systems have
to nutritious and affordable diets for young children struggled to provide the lifeline needed by escalating
through the food and social protection systems in numbers of impoverished families. Food assistance
2020: 71 per cent of countries promoted access to and programmes in 8 countries provided unhealthy foods
use of affordable, diverse, local nutritious foods at the in September 2020, and this rose to 12 countries
household level; 45 per cent provided social protection by April 2021, potentially causing more harm than
services that aim to improve access to affordable good.31
nutritious food; and 30 per cent promoted access
to fortified foods for children.69 There is insufficient Service disruptions related to COVID-19 should
evidence on the extent to which these programmes resolve as the pandemic dissipates. However, the
improve access to affordable diets for young children. pandemic’s economic fall-out could have long-term
However, various studies have highlighted important repercussions for the financing of health and social
design considerations, including the coverage of protection systems, with lasting implications for the
nutritionally vulnerable households, the size and services that are so urgently needed to protect child
predictability of food and cash transfers within social nutrition. This will compound the difficulties that poor
protection programmes, and convergence with other families continue to face in accessing nutritious and
essential health and nutrition services.16, 70 affordable diets for their young children.
Services to improve young children’s diets are tracked

only in the health system – and even then, only in
half of countries. According to NutriDash data, 49
per cent of countries included an indicator to monitor
the provision of counselling services on children’s
diets in their national health or nutrition information
system in 2020.71 The absence of robust information
systems compromises efforts to monitor progress and
hold relevant authorities accountable for the delivery
of services.

SPOTLIGHT 4
THE COVID-19 PANDEMIC – DISRUPTIONS TO NUTRITION SERVICE DELIVERY

UNICEF has been monitoring children’s diets (see Figure 27). were still experiencing disruptions
the impact of the pandemic on Almost half of countries (45 in coverage, and 1 in 10 countries
children’s services globally, per cent) reported moderate (10 per cent) reported that coverage
including services to improve or high levels of disruption to was at least 25 per cent lower
young children’s diets. Data are primary health care centres and than normal.
drawn from the best available almost two thirds (59 per cent) to
sources in each country, outreach services delivered by The coverage of services to protect
including administrative data community health workers at the and promote breastfeeding (see
or representative survey data community level. By April 2021, Figure 28b) and to distribute home
collected in the previous three these percentages had fallen to 26 fortificants (micronutrient powders)
months; or extrapolations from per cent for primary health care to children aged 6–59 months
reliable localized quantitative centres and 42 per cent for outreach (see Figure 28c) followed a similar
and/or qualitative reports. Given services, but the level of disruption pattern. All these nutrition services
the challenges of traditional data remained considerable. share the same service delivery
collection efforts during the platforms, through primary health
pandemic, these data offer an In April 2020, at the peak of the first centres and outreach services, and
early indication of impacts on the wave of the pandemic, 85 per cent therefore were similarly affected by
disruption of essential services. of countries reported a fall in the the disruptions to these platforms.
As of mid-2021, three rounds of coverage of services to promote
data were available, reflecting nutritious and safe diets for young This analysis is based on a small
service coverage around April 2020, children, highlighting the massive subset of countries with data
September 2020 and April 2021. scale of disruption (see Figure 28a). available for all rounds and is
At that time, almost one in four not representative of service
Data collected in September 2020 countries (28 per cent) reported disruptions in all low- and middle-
show considerable disruption to that the coverage of these services income countries.
primary health care centres and had declined by at least 25 per cent.
outreach services, which are the By April 2021, these services had
main health delivery platforms resumed in most countries, but
for services to improve young one third of countries (36 per cent)
September
2020 10 35 36 18
Primary health
care centres
(n=119) April
2021 7 19 52 21
September
2020 19 40 28 13
Outreach
services
(n=119) April
2021 8 34 43 14
0 10 20 30 40 50 60 70 80 90 100
Percentage
High disruption: Medium disruption: Low disruption: No disruption

>50% drop in coverage >10% and <50% drop in <10% drop in coverage
coverage
FIGURE 27
Percentages of countries experiencing disruptions to primary health care centres and outreach services during the COVID-19
pandemic, by level of disruption, in September 2020 and April 2021
Source: UNICEF COVID-19 monitoring system to track the situation of children during the COVID-19 pandemic 31
38 Fed to Fail?
5%
a) Promotion of nutritious and safe diets for young children (n=39) Change in coverage:
No change or increase
April-20 3 5 21 15 41 15
<10% drop
September-20 5 28 5 62 10–24% drop

25–49% drop
April-21 3 3 5 13 12 64 50–74% drop
75–100% drop
0 20 40 60 80 100
Percentage
b) Protection and promotion of breastfeeding (n=45)
April-20 7 16 18 33 26
September-20 4 27 7 62
April-21 4 13 18 65
0 20 40 60 80 100
Percentage
c) Home fortification with multiple micronutrient powders (n=33)
September-20 3 3 18 9 6 61
April-21 6 12 6 70
0 20 40 60 80 100
Percentage
FIGURE 28
Percentage of countries reporting change in the coverage of essential nutrition services during the COVID-19 pandemic from April
2020 to April 2021
Source: UNICEF COVID-19 monitoring system to track the situation of children during the COVID-19 pandemic; n values indicate number of reporting countries. 31

3 | OUR ANALYSIS
BARRIERS TO GOOD DIETS

FOR YOUNG CHILDREN
The unacceptably high prevalence and burden
of all forms of child malnutrition in the world
demonstrate that there is an urgent need to
transform how we tackle poor-quality diets
in early childhood. Our analyses shed light on
where children’s diets are falling short of global
recommendations and what roadblocks stand in
the way of delivering nutritious, affordable and
age-appropriate diets to every child.
We find that young children’s diets are failing in

timeliness, meal frequency and dietary diversity and
have barely improved in the last decade. Too many
young children are not fed their first foods at the right
age, are not given sufficient meals and snacks to meet
their needs, and are missing out on nutritious and
diverse foods. This feeding crisis affects every region,
but some young children – particularly those from poorer
households – are in much greater crisis than others.
The rapid rise in access to unhealthy processed foods
and drinks, the immense time pressures on mothers,
and enduring social, cultural and gender-related barriers
further compound the difficulties that families face.
National policies and programmes are falling far short
on what is needed to address these challenges, leaving
families with insufficient support to feed their children
well.
Millions of children are fed to fail
Young children’s diets are failing to meet their needs

from their first day of transitioning to solid food to
their second birthday. Our analysis of UNICEF’s Global
Database on Infant and Young Child Feeding found
that the percentage of children aged 6–8 months who
were fed any solids (73 per cent), the percentage of
children aged 6–23 months fed with the minimum
meal frequency (52 per cent) and those fed with the
minimum dietary diversity (29 per cent) was abysmally
low in 2020; as a result, more than two in three
children aged 6–23 months were not fed the minimum
diet they need to thrive.
Although all facets of young children’s diets are

problematic, the very low dietary diversity and
consumption of nutritious foods are most troubling.
Around half of all children aged 6–23 months were
not fed any eggs, fish and/or meat (55 per cent) and
vegetables or fruits (41 per cent) during the previous
day, and 35 per cent of children aged 12–23 months
were not breastfed. Without these concentrated
sources of essential nutrients – including vitamins and

other micronutrients – children are less likely to grow evidence that urban poor households in Indonesia,
and develop to their potential. At the same time, many Kenya, Lesotho, Malawi and Nepal have been unable to
children are fed unhealthy processed foods and drinks shield young children’s diets from the devastating loss
from an early age, which can displace more nutritious of household income. Several other studies have also
foods and set children on a path to unhealthy food reported harmful changes in food purchasing patterns,
preferences and overweight.61, 62 household diets and young children’s diets in low- and
middle-income countries.72-76
There are no global targets to benchmark the status of
young children’s diets from 6 months of age. However, It comes as no surprise that the most vulnerable
we can say with confidence that the slow progress in children have the poorest diets – namely, younger
improving children’s diets over the past decade is a key children, children living in poorer households and those
driver of the slow progress towards the Sustainable residing in disadvantaged or rural areas. These children
Development Goal targets, including an end to child are known to suffer multiple deprivations and are
malnutrition in all its forms by 2030. most likely to be affected by stunting and/or wasting.2
The inequities between children living in poorer and
Our analysis of trends found that the percentage of wealthier households have not narrowed over the
children aged 6–8 months who were fed solid foods last 10 years; in fact, the gaps in meal frequency
and the percentage of children aged 6–23 months fed between children from rich and poor households have
with the minimum meal frequency or minimum dietary widened, while the gaps in dietary diversity between
diversity has barely improved in the last 10 years. In the two groups have remained the same. Clearly, the
addition, there are signs that continued breastfeeding marginal progress in improving children’s diets has not
in the second year has stagnated. And this is before preferentially benefited the most vulnerable children.
we factor in the effects of the COVID-19 pandemic
on children’s diets. Although the full extent of the These findings are a damning indictment of the world’s
pandemic’s impact is yet to be understood, we found collective failure to protect the rights of all children to
42 Fed to Fail?
nutritious diets. The consequences of this failure are Mothers living in sub-Saharan Africa, particularly in
felt by children today and will continue throughout the rural areas, were unable to find nutritious foods – and
course of their lives. These are the children who fail sometimes any food – in their local markets. This may
to grow well – both physically and cognitively – and reflect shortages in the national supply of nutritious
suffer from stunting and wasting in early childhood. foods,16, 77 seasonal scarcities in availability, or inadequate
Deprived of nutrients, they often start late at school, road infrastructure and transportation to bring supplies
struggle academically and are likely to drop out early.21 closer to homes. Proximity to food markets and shops
As adults, they are destined for low-paid work,22, 23 matters for children’s diets because most families,
which rotates the cycle of poverty and poor diets to including farming families, are reliant on purchasing
the next generation. And then there are the children food rather than producing it in the home.40, 78 Nutritious
who follow a different but equally damaging course foods such as vegetables, eggs and meat tend to be
because they are fed diets that are high in calories and more perishable than staple cereals and tubers and are
low in nutrients. These children gain too much weight therefore more susceptible to distribution challenges and
and may carry the stigma and health consequences of other supply chain disruptions.46, 47
overweight and obesity into adulthood.3, 24
Poor families in middle-income countries, including
A different path is possible: one that prioritizes children’s families in Indonesia and Tajikistan, also experience
right to nutrition in the earliest years of life. The country physical access difficulties. These families often
examples of progress in young children’s diets show reside in areas where there is a scarcity of shops or
we can make significant strides towards better diets supermarkets that sell nutritious foods.30, 44 Similar
for children, even in some of the poorest and most ‘food deserts’ are found among poor communities in
challenging contexts. For example, our analysis of high-income countries, including the United States,
trends found that 10 countries – Bangladesh, Burkina where only nutrient-poor, high-calorie, ultra-processed
Faso, Cambodia, Côte d’Ivoire, the Gambia, Kyrgyzstan, foods are readily accessible.79 These countries have
Maldives, Nepal, Sierra Leone and Timor-Leste – have adequate national supplies of nutritious food, but poor
all increased minimum dietary diversity by at least 10 communities do not attract or demand shops and
percentage points since 2010. supermarkets that sell these foods.
To do this, we need to better understand and respond Even if nutritious foods are physically accessible, they are
to the barriers that hold back progress. Families and often too costly for poor families. Almost 80 per cent of
caregivers around the world strive to feed their young mothers in our study reported affordability constraints,
children to the best of their ability. This is not an innate making it the most common barrier to nutritious diets.
skill, and so they learn what to do by receiving or
seeking guidance from a variety of sources – relatives,
friends, health workers, books, the Internet and social
media. However, guidance will never be enough if
not matched by the resources and support that they
need to act on this knowledge. Our research has
uncovered some of the major barriers these families
and caregivers experience today.
Good diets: unavailable, inaccessible,

unaffordable
There is no greater anguish for a caregiver than

The most vulnerable children
knowing how best to feed a child but being unable to have the poorest diets – namely
do so because the nutritious foods they seek are too younger children, children living
expensive, out of reach or nowhere to be found. Our in poorer households, and those
regional analyses and conversations with mothers residing in disadvantaged or
in 18 countries show that these barriers persist, rural areas
although the nature and extent of the challenges
varies according to context.

Our affordability analysis in Eastern and Southern a fraction of the 340 million children at risk of vitamin
Africa and South Asia found that nutritious foods are and mineral deficiencies.3 The number reached fell to
prohibitively expensive, despite the relatively small 12 million in 2020, due to the impact of the COVID-19
portion sizes that young children require.48, 49 The relative pandemic on child nutrition services.
price of nutritious foods compared with staple foods is
much higher in low-income countries than in high-income Traditional values and a changing world
countries.45 This means that poor families in lower-
income countries experience the widest gap between Mothers are surrounded by competing pressures. In
the price of nutritious foods and their daily income. many countries, they remain primarily responsible for
the feeding and care of infants and young children. Yet,
Other studies have found that the high cost of dairy, in some societies, unequal power relations between
eggs, fish and meat are associated with less frequent mothers and other family members mean they are
consumption among young children.19, 80 Most poor disempowered to take decisions that are in their
families favour fuller stomachs over nutritious foods children’s best interests.
when income is tight. Indeed, our research among urban
poor communities in Indonesia during the COVID-19 We found evidence in several countries in Africa, Asia,
pandemic found that the diversity of young children’s Latin America and the Middle East about restrictions
diets fell as families made difficult decisions to cope on mothers’ free movement outside the home, or
with the loss of livelihoods and household income.38 their right to choose which foods were purchased
and fed to their young children. Although gender
The addition of vitamins and minerals to staple foods differences in the quality of young children’s diets
during processing (fortified foods) or to children’s are uncommon, even in South Asian countries,55-57
meals before feeding (micronutrient powders and other the gender inequalities and patriarchal norms that
food supplements) can help to fill gaps in children’s exclude mothers from food purchasing and feeding
dietary needs,81 but are not implemented at scale decisions can threaten the diets of girls and boys alike.
in the countries and populations that need them Evidence consistently shows that when women have
most. Fortified staple foods are usually produced more decision-making power and control over the
for the general population and do not have sufficient household’s income, they tend to choose healthier
concentrations of micronutrients to meet needs in foods and feeding practices for their children.3
early childhood. Meanwhile, fortified cereals that are
formulated for young children remain variable in quality, In today’s world, mothers are increasingly engaged
poorly distributed and promoted, and too costly for the in paid work outside the home but are still expected
poorest families in lower-income countries.82-86 These to shoulder the burden of domestic duties. Working
fortified infant foods are 7 times more expensive in mothers struggle to cope with these time pressures,
low-income countries than in high-income countries especially in contexts where fathers have migrated for
and are up to 30 times as expensive as unfortified work or other family members are unable to provide
staple cereals commonly fed to young children in support. Overwhelmed and overburdened, they resort
low-income contexts.45 According to NutriDash data, to negative coping strategies to meet all the demands
an estimated 16 million children aged 6-59 months expected of them. Some working mothers in our
were reached with micronutrient powders in 2019,71 study explained that they denied themselves healthy
meals so they could use their limited time to prepare
nutritious food for their young children. In other cases,
the diets of young children are suffering as families
are forced to opt for commercially produced foods and
drinks to save time, and often money.
Modern food systems are changing the food-purchase

behaviours of families. There has been enormous
growth in sales of processed and ultra-processed
Even if nutritious foods are physically foods and drinks that are high in sugar, fat and salt and
accessible, they are often too costly for low in essential vitamins and minerals.13, 50, 63
poor families We found that many caregivers know these foods
44 Fed to Fail?
are unhealthy but feed them to children because they sugar-sweetened drinks account for 13 per cent to 38
offer convenience and cheap calories, and are readily per cent of the total energy intake of young children.85
accepted by young children. Packaged, processed
products usually have a long shelf-life and can reach In contexts where commercial ‘baby foods’, such as
almost everywhere, filling kiosks in the remotest infant cereals, may play a role in young children’s diets,
villages, as well as shops and supermarkets in urban they should be prepared and fortified to meet children’s
areas. We heard that these foods and drinks are also high nutrient needs. But few affordable products are
heavily marketed, often with misleading nutrition appropriately formulated in lower-income countries.84, 86
claims that confuse caregivers,13, 68 because regulations There are even quality issues in Europe: a review of
to prevent inappropriate marketing are either absent or such foods for children revealed high levels of sugars,
poorly implemented. with some being nutritionally similar to confectionary.87
Our discussions with mothers confirmed that These unhealthy foods and drinks are undermining
unhealthy processed and ultra-processed foods recommended feeding practices, including the use of
and drinks are well-established in the diets of many traditional foods and food preparation skills.86 Young
infants and young children – in some cases before children who consume these products at the expense
the recommended period of exclusive breastfeeding of more nutritious foods are in triple trouble – at risk
ends. Young children in high-income countries were of stunting because the missing vitamins, minerals
most likely to consume ultra-processed foods regularly, and protein are the building blocks for linear growth;
but more than one in four children in Ethiopia, India, at risk of micronutrient deficiencies, owing to the low
Mexico and Nigeria were also consuming these foods. vitamin and mineral content; and at risk of overweight
Although there are no global or regional estimates with and obesity because of the high-calorie content and
which to compare these findings, a recent systematic propensity to develop long-lasting preferences for
review of the literature reported that snack foods and sweet foods.61, 62

A response that is not fit for purpose These issues require greater prioritization and
institutionalization of counselling on young children’s
Governments have the responsibility to take adequate diets within primary health care services, including
measures to combat all forms of child malnutrition greater investment in the community workforce.
as part of their obligation to respect, protect and Counselling services to improve child feeding practices
fulfil children’s rights.88 These measures include also need to be sensitive and responsive to women’s
the enactment and implementation of policies social and cultural settings and the changing demands
and legislation to enable young children to access of modern life.
and consume nutritious, safe, affordable and
sustainable diets.11 For too long, the health system has been largely left
alone to take responsibility for young children’s diets.
Our review of national policies, strategies and plans But as this report has shown, caregiver knowledge
found that there are government commitments to and skills are insufficient to change feeding practices
improve young children’s diets in all included countries. if families do not have access to affordable nutritious
However, no country has fully incorporated all relevant foods for their children to act on the advice and
global recommendations and guidance to leverage counselling they receive.
the potential of the food, health and social protection
systems. Legislation to prevent inappropriate marketing Countries throughout the world are missing vital
of foods for infants and young children is enacted in 81 opportunities to leverage the food and social protection
countries, but most countries have yet to integrate all systems to improve the availability, accessibility and
provisions of WHA 69.9 to protect young children from affordability of nutritious foods in early childhood. For
commercial influence. example, 3 in 10 countries are not promoting access
to and use of affordable, diverse and local nutritious
Young children’s diets are most firmly grounded in the foods at the household level, and more than half do not
policies, strategies and plans of the health system, have any social protection services that aim to improve
reflecting its longer history in supporting families the access of poor households to nutritious foods.
to improve child nutrition. More than 80 per cent Where these services do exist, we lack evidence on
of countries have services to educate and counsel their coverage, quality and effectiveness in improving
caregivers on young children’s diets through primary young children’s diets. Nevertheless, the guidance
health care platforms.69 There are insufficient data on how to make food and social protection systems
to estimate the percentage of children reached with more responsive to dietary needs in early childhood
these counselling services because they are rarely is growing.11, 89, 90 What we now need is to build the
tracked in health information systems. However, accountability of key actors – including governments,
evidence from the regional analyses suggests that civil society and the private sector – to strengthen
insufficient numbers, training, supportive supervision the capacity of these systems to improve access to
and motivation of frontline health workers impede the affordable and nutritious foods.
coverage and quality of counselling.
The case for prioritization and investments in young
children’s diets has never been more urgent. Measures
taken to contain the COVID-19 pandemic have
crushed livelihoods, disrupted food supply chains,
suspended or curtailed services, and put caregivers
under intense strain.58 The resilience of food, health
and social protection systems to function under these
conditions has been severely tested. Our data show
Many countries are missing vital that programmes promoting nutritious and safe diets
for children and breastfeeding and distributing home
opportunities to leverage the food and
fortificants to children have been interrupted, while
social protection systems to improve poor families continue to face immense difficulties in
the availability, accessibility and affording nutritious foods. As the financial fall-out of the
affordability of nutritious foods in early pandemic threatens to shrink government budgets, it is
childhood crucial that every possible action be taken to protect the
diets of the most vulnerable children.
46 Fed to Fail?
Our analysis of the status, trends and inequities of However, gaps remain in the body of evidence on
young children’s diets used data from the UNICEF drivers of quality diets in early childhood. In particular,
Global Database on Infant and Young Child Feeding we lack a sound understanding of how and why young
Database. The analysis used survey data on standard children’s diets improved in countries that have made
indicators of children’s diets from over 90 countries for impressive progress. A study in South Asia found that
the 2020 estimates, and between 50 to 86 countries most evaluated interventions have been small in scale
for the analysis of trends between 2010 and 2020. and narrow in scope, mainly involving educating or
The year 2020 has been especially challenging for counselling caregivers on feeding practices by frontline
household surveys owing to the COVID-19 pandemic, health workers in the health system.91 As we take
and as such, our analysis does not account for action to transform our approaches to improving young
the impact of the COVID-19 pandemic on young children’s diets, it is crucial that we invest in research
children’s diets. to identify the context-specific enablers and pathways
to better-quality diets across all relevant systems.
We combined evidence from the analysis of multiple
qualitative and quantitative sources to identify barriers
to quality diets in early childhood. These sources
allowed for a broad range of influences on children’s
diets to be explored and triangulated, providing a
comprehensive overview of the barriers facing families
and caregivers today.

4 | OUR RECOMMENDATIONS
BOLDER ACTION
AND GREATER
ACCOUNTABILITY FOR
CHILDREN’S DIETS
The world has made little progress in improving lives and threaten the future of families, communities,
the diets of its youngest citizens over the past economies and nations.
decade. Infants and young children around the
world are being fed to fail – deprived of the diets But change is possible. As our analysis indicates,
they need at the time in their life when it matters several countries have recorded significant
most. This situation stands to worsen as the improvements in the quality of young children’s
devastating impacts of the COVID-19 pandemic diets over the last decade, including 10 countries –
reverberate globally, threatening livelihoods and Bangladesh, Burkina Faso, Cambodia, Côte d’Ivoire,
the systems that contribute to good nutrition for the Gambia, Kyrgyzstan, Maldives, Nepal, Sierra
young children. Leone and Timor-Leste – where the percentage of
children fed a minimally diverse diet has increased
The state of children’s diets remains a persistent by at least 10 percentage points in the last decade.
bottleneck to greater progress on nutrition, including More will follow, with the right focus and investments.
achieving the 2030 Sustainable Development Goal Knowledge on the barriers that are holding back
targets for stunting, wasting and overweight. For far progress can help to ensure that resources are targeted
too long, young children’s diets have been tackled with to actions that will have greatest impact on the quality
fragmented actions that fail to reach most children of young children’s diets.
or to comprehensively address the challenges that
caregivers face in feeding children well. Children The crisis of children’s diets is driven by multiple,
are left paying the price for insufficient action, with interacting barriers that vary according to the contexts
consequences for their survival, growth, development in which families live. From rural villages to urban
and learning that endure across the trajectory of their megacities, access to affordable nutritious foods is the

most pressing concern, especially among
poorer families. These foods are either
simply not available or not affordable. And
nutritious and safe foods are increasingly
crowded-out by processed and ultra-
processed foods that are cheap, may be
perceived as convenient substitutes and
are often heavily marketed to children
and families.
Mothers continue to shoulder the

responsibility for child feeding. Yet unequal
divisions of household responsibilities, paid
work outside the home and enduring social
and cultural norms leave many mothers
without the time or autonomy to do what
they know is best for their young children.
Women, caregivers, and families must not be

left alone to deal with these challenges. Nor
can we expect the health system to take sole
responsibility for improving young children’s
diets or wait for the trickle-down effects
of economic growth to increase household
food budgets.
We must leverage the

policies, resources and
actors of the food, health
and social protection
systems to deliver better
diets for young children
50 Fed to Fail?
A SYSTEMS APPROACH TO IMPROVING i Implement national standards and legislation
CHILDREN’S DIETS to protect young children from unhealthy
processed and ultra-processed foods and
Governments must take the lead in upholding every harmful marketing practices: Governments
child’s right to food and nutrition. Together with must develop and enforce national standards for
national civil society, development partners and foods and beverages that are sold commercially or
the private sector, they must mobilize the policies, distributed through public programmes for young
resources and actors of three systems: food, health children. In addition, they must fully implement
and social protection.11 the International Code of Marketing of Breast-milk
Substitutes and subsequent WHA Resolutions (the
If activated in the right way and held accountable, Code), the Guidance on Ending the Inappropriate
these three systems can take complementary actions Promotion of Foods for Infants and Young Children,
to (1) improve the quality of children’s foods, through and the WHO-led global recommendations on the
actions in public policy and food supply chains; marketing of foods and non-alcoholic beverages
(2) improve the quality of children’s food environments, to children.65, 93, 94 The food industry must ensure
through actions in public policy and private sector that their policies, practices and products fully align
practice; and (3) improve the quality of child feeding with the Code, standards and legislation to protect
practices, through programmes that counsel and young children from unhealthy products and harmful
support families and promote positive child feeding marketing practices.
practices and social norms.92
i Use multiple communication channels to
Food system reach caregivers with factual information and
advice on young child feeding and increase the
The food system comprises the policies, services desirability of nutritious foods: Governments,
and actors involved in the production, processing, development partners and the food industry must
distribution and marketing of food. It influences increase the desirability of nutritious foods and
whether foods are available, accessible, affordable, ensure that caregivers are able to access accurate
nutritious, safe and sustainable, and can make it information and advice on child feeding. The use
easier – or more difficult – for caregivers to make of multiple communication channels – including
nutritious food choices for their young children. Three radio, television and digital media – increases the
actions are crucial to transform the food system so opportunities to reach caregivers. Given the rise in
that it better protects, promotes and supports young families’ access to processed products, it is vital
children’s diets: that public sector-led communication strategies
discourage the consumption of unhealthy foods and
i Increase the availability, accessibility and beverages. Further, communication efforts should
affordability of nutritious foods for young encourage and normalize the participation of fathers
children: Governments should identify locally in food preparation and feeding of young children, to
available and lower-cost nutritious foods – including reduce time pressures on women and contribute to
fruits, vegetables, legumes and animal-source foods gender equality.
– and make them the focus of national policies,
programmes and guidelines to close nutrient gaps in
young children’s diets. To increase the accessibility
and affordability of these nutritious foods, it is crucial
to create incentives that encourage their production,
distribution and retailing. Where nutrient-poor
diets and micronutrient deficiencies are common,
governments must also develop and implement
national programmes to support the production and
use of fortified foods for children aged 6–23 months.

Health system Social protection system
The health system provides multiple contact The social protection system forms a crucial safety
points at the facility and community levels to net to protect vulnerable children against poverty
inform, counsel and support caregivers on child and social exclusion, including in emergencies. It
feeding and care practices, and to distribute dietary can increase families’ physical or financial access
supplements and home fortificants, as appropriate, to nutritious diets by providing social transfers
where poor diets and micronutrient deficiencies (food, cash and/or vouchers), and offers a platform
are common. Two actions are crucial to mobilize for the delivery of essential nutrition services and
the full potential of the health system for young the promotion of positive nutrition practices. Two
children’s diets and make its contributions fit for actions by social protection systems are crucial to
purpose in today’s world: improve young children’s diets:
i Expand the access of caregivers to quality i Design social transfers that support, and
counselling and support on young child do not undermine, nutritious and safe
feeding: Community-based platforms are diets in early childhood, including in fragile
essential to increase access to counselling and settings and in response to humanitarian
support services on child feeding and close crises: Governments and development and
equity gaps in the coverage of essential nutrition humanitarian partners must ensure that social
interventions. Governments and development protection programmes provide food transfers
partners must invest in the recruitment, training, that are nutritionally adequate for young children
supervision and motivation of community-based (i.e., those containing essential nutrients that are
counsellors and health workers to deliver quality likely to be low in young children’s diets) and do
counselling and support on child feeding and care not include unhealthy foods and beverages. The
at scale. In contexts where mothers are excluded same applies to vouchers: families should be
from food purchasing or child feeding decisions, able to exchange vouchers for nutritious and safe
counselling and support services should also foods that are suitable for young children. Cash
engage other family members, while efforts to transfers should be large enough to allow families
transform these discriminatory social norms are to purchase not just any foods, but nutritious and
stepped up in parallel. safe foods for young children.
i Deliver dietary supplements, home i Use social protection programmes to

fortificants and fortified complementary improve caregivers’ knowledge about young
foods to children at risk of micronutrient child feeding: Governments and development
deficiencies, anaemia and growth and and humanitarian partners must integrate
development failure: Lipid-based food information, education and counselling on child
supplements, multiple micronutrient powders feeding into social protection programmes to
for home-based fortification and fortified increase the likelihood that social transfers are
complementary foods for young children can help used by caregivers to improve young children’s
address micronutrient gaps in children’s diets diets. This can be done in two ways: firstly,
in settings where micronutrient deficiencies, by directly providing these nutrition services
anaemia and growth and development failure to families who benefit from social protection
are prevalent. The health system must play a programmes; or secondly, by encouraging
crucial role in making dietary supplements, home families to make use of services that are
fortificants and fortified complementary foods delivered by the local health system.
available to all children who need them. The
distribution of these supplements should always
be accompanied by information on their use and
counselling on child feeding practices.
52 Fed to Fail?
Multi-system governance i Strengthen public accountability for young
children’s diets by setting targets and tracking
Some essential actions do not fall within the progress: Governments must set national targets
responsibilities of a single system, and instead facilitate on young children’s feeding practices using the
the overall agenda on young children’s diets. These standard UNICEF and WHO indicators, including
include actions to raise the policy prominence of the new indicators on consumption of unhealthy
young children’s diets, to ensure that the food, health, foods and beverages.32 All countries must collect
and social protection systems work synergistically household data on these indicators every three to
to address barriers to nutritious, safe and age- four years and include appropriate service coverage
appropriate diets, and to make data and evidence indicators in sector-specific monitoring systems
available to track progress and inform the design of to assess how well the food, health and social
policies, legislation and programmes. Three actions protection systems are delivering with respect to
under multi-system governance are crucial to improve young children’s diets.
young children’s diets:
i Conduct research to understand how systems
i Position young children’s right to nutritious succeed or fail in improving young children’s
and safe diets as a priority in the national diets: Governments and development partners
development agenda and ensure coherent must support research to identify the context-
policy support and legislation across sectors specific barriers and enablers to adequate food,
and systems: Governments, parliaments and services and practices for young children’s diets
development partners must position young – including the experiences of mothers and other
children’s diets as a national development priority, primary caregivers. They must also invest in
and include commensurate financial resources in research to identify the factors, processes and
their budgets and investments. Policies, legislation, innovations that enable multi-system action to
and programmes across the food, health and social secure nutritious, safe, affordable, desirable and
protection systems must be coherent, given the sustainable diets for young children. Learning
shared roles of these three systems in improving from failed experiences is as important as learning
young children’s diets. Coordination is essential to from success.
identify and implement mutually reinforcing policy
and programme actions.

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56 Fed to Fail?
Annexes
Annex 1
Indicators of young children’s diets and feeding practices
Annex 2
Notes on the figures
Annex 1
Indicators of young children’s diets and feeding practices
Indicator Age group Definition

Introduction of solid, Infants 6–8 Percentage of infants aged 6–8 months who consumed solid, semi-
semi-solid or soft foods months of age solid or soft foods during the previous day
Minimum dietary Children 6–23 Percentage of children aged 6–23 months who consumed foods and
diversity months of age beverages from at least five out of eight defined food groups during
the previous day
Minimum meal Children 6–23 Percentage of children aged 6–23 months who consumed solid,
frequency months of age semi-solid or soft foods (but also including milk feeds for non-
breastfed children) the minimum number of times or more during the
previous day
Minimum milk feeding Children 6–23 Percentage of non-breastfed children aged 6–23 months who
frequency for non- months of age consumed at least two milk feeds during the previous day
breastfed children
Minimum acceptable Children 6–23 Percentage of children aged 6–23 months who consumed the
diet months of age minimum acceptable diet during the previous day
Egg and/or flesh food Children 6–23 Percentage of children aged 6–23 months who consumed egg, fish,
consumption† months of age poultry and/or meat during the previous day
Sweet beverage Children 6–23 Percentage of children aged 6–23 months who consumed a sweet
consumption months of age beverage during the previous day
Unhealthy food Children 6–23 Percentage of children aged 6–23 months who consumed selected
consumption months of age sentinel unhealthy foods during the previous day
Zero vegetable or fruit Children 6–23 Percentage of children aged 6–23 months who did not consume any
consumption‡ months of age vegetables or fruits during the previous day
Continued breastfeeding Children 12–23 Percentage of children aged 12–23 months who were fed
12–23 months months of age breastmilk during the previous day
†In this report, we refer to egg and/or flesh food as egg, fish and/or meat consumption.
‡ In this report, we present on vegetable or fruit consumption during the previous day.
58 Fed to Fail?
Annex 2
Notes on the figures
A. General notes Figure 5: Estimated number of children under

2 affected by stunting and wasting out of all
Population weighted global and regional affected children under 5 years of age
estimates
While there are no official UNICEF/WHO/World
Bank Joint Child Malnutrition Estimates for stunting
All regional and global population-weighted estimates
or wasting among sub-age groups, rough estimates
were weighted using the annual population by
for the number of children under 2 years of age with
age interpolated datasets from the United Nations
stunting and the number of children under 2 years
Department of Economic and Social Affairs, Population
of age with wasting were generated using the steps
Division, 2019 Revision of World Population Prospects.
outlined below for stunting (the same approach was
applied for wasting).
Depending on the indicator, population-weighted
averages for any given region were generated by (a) i. First a global population-weighted stunting
multiplying the estimates of an indicator for each prevalence estimate for children under 2 years
country with available data in the required time period of age and for children 2 to 4 years of age was
by the number of children in the age range associated calculated for each age group using survey-based
with the indicator in that country; (b) summing all of the data as per description of analysis for Figure 4.
country specific products; and (c) dividing the sum of ii. Using the resulting stunting prevalence estimates
the products by the total population of children in the for children under 2 years of age and children 2 to 4
respective age range in all countries with data in the years of age, the number of affected children in each
required time period. sub-age group was calculated using the populations
for each one-year age grouping. Next, the number
Population coverage, or the share of the population for of stunted children under 2 years of age was divided
which an estimate is available in the UNICEF global by the number of stunted children aged 0–4 years
database, was calculated by dividing the population of to obtain the proportion of children with stunting
children in a given age range in countries with data by who were under 2 years of age. The resulting
the total population of children in that age range in each proportions (one-third of 0–1-year-olds with stunting
respective region. The standard used for minimum and two-thirds of 2–4-year-olds with stunting) were
population coverage (i.e., minimum population multiplied by the UNICEF/WHO/World Bank Joint
coverage required to display the regional estimate) Child Malnutrition Estimates global estimate of
is 50 per cent. 149.2 million stunted children under 5 years of age
to generate the rough estimate of 51 million under-
B. Notes on individual graphics two-year-olds with stunting (and 98 million 2–4-year-
olds with stunting).
Figure 4: Percentage of children under 5 affected
by stunting, by age in months, 2020 Figure 8: Percentage of children aged 6–23 months
with minimum dietary diversity, by age group and
Estimates are population-weighted and based on the
UNICEF region, 2020
most recent national survey between 2013 and 2020
for a subset of 103 countries with disaggregated data Estimates are population-weighted and based on the
by age group available in the UNICEF/WHO/World most recent national survey between 2014 and 2020
Bank Joint Child Malnutrition Estimates Expanded for a subset of 90 countries with disaggregated data
Database on Stunting, 2021 edition, covering 82 per by age group available in the UNICEF Global Databases
cent of the global under-five population. on Infant and Young Child Feeding (with the exception
of China, where the latest data are from the year
2013), covering 78 per cent of the global under-two
population.

Figure 9: Trends in percentage of children Figure 14: Percentage of children with minimum
receiving: solid foods (6–8 months); continued dietary diversity, minimum meal frequency,
breastfeeding (12–23 months); minimum meal continued breastfeeding, by sex of child, rural
frequency, minimum dietary diversity, eggs, fish and urban residence, and poorest and wealthiest
and/or meat, and vegetables and/or fruits (6–23 wealth quintile, 2020
months), around 2010 and around 2020
In the case of minimum dietary diversity, estimates
Trend analyses are population-weighted. Analysis for are population-weighted and based on the most
the indicator of introduction of solid, semi-solid or recent national survey between 2014 and 2020 for
soft foods is based on a subset of 84 countries with a subset of 91 countries with disaggregated data
comparable trend data covering 75 per cent of the by sex of the child, 88 countries with disaggregated
global population of children aged under 1 year for data by place of residence and 85 countries with
around 2010 (2005–2012) and 76 per cent of the global disaggregated data by wealth status available in the
population of children aged under 1 year for around UNICEF Global Databases on Infant and Young Child
2020 (2014–2020). Feeding (with the exception of China where the
latest data are from the year 2013), covering 78 per
Analysis for the indicator of continued breastfeeding cent of the global under-two population.
is based on a subset of 86 countries with comparable
trend data covering 65 per cent of the global population In the case of minimum meal frequency, estimates
for children aged 1 year for around 2010 (2005–2012) are population-weighted and based on the most
and 66 per cent of the global population for children recent national survey between 2014 and 2020 for
aged 1 year for around 2020 (2014–2020). a subset of 84 countries with disaggregated data
by sex of the child, 81 countries with disaggregated
Analysis for the indicators of minimum dietary data by place of residence and 79 countries with
diversity; any fruit or vegetable consumption; and egg disaggregated data by wealth status available in the
and/or flesh food consumption; are based on a subset UNICEF Global Databases on Infant and Young Child
of 50 countries with comparable trend data covering Feeding (with the exception of China where the
51 per cent of the global population for children aged latest data are from the year 2013), covering 77 per
under 2 years for around 2010 (2005–2012) and 52 per cent of the global under-two population.
cent of the global population for children aged under 2
years for around 2020 (2014-2020). In the case of continued breastfeeding, estimates are
population-weighted and based on the most recent
Analysis for the indicator of minimum meal frequency national survey between 2014 and 2020 for a subset
is based on a subset of 55 countries with comparable of 92 countries with disaggregated data by sex of the
trend data covering 50 per cent of the global child, 88 countries with disaggregated data by place
population (excluding Brazil, China, India and the of residence and 86 countries with disaggregated
Russian Federation) for children aged under 2 years data by wealth status available in the UNICEF Global
for around 2010 (2005–2012) and 53 per cent of the Databases on Infant and Young Child Feeding,
global population (excluding Brazil, China, India and the covering 72 per cent of the global population aged
Russian Federation) for children aged under 2 years for 1 year.
around 2020 (2014–2020).
Figure 10: Trends in percentage of children aged

6–23 months with minimum dietary diversity, by
country, around 2010 and around 2020
Country-level trends for minimum dietary diversity
are presented for a subset of 50 countries where
a baseline estimate between 2005 and 2012 was
available in addition to a recent data point between
2014 and 2020. The trend categories of ‘significant
decrease’, ‘no significant change’ and ‘significant
increase’ are based on standard errors.
60 Fed to Fail?
Figure 15: Percentage of children aged 6–23 Trends in minimum meal frequency by wealth
months consuming food groups, by type and by status are based on a subset of 51 countries with
poorest and wealthiest wealth quintile, 2020 comparable data covering 48 per cent of the global
population (excluding Brazil, China, India and the
Global estimates of the percentage of children
Russian Federation) for children aged under 2 years
consuming a food group are population-weighted
for around 2010 (2005–2012) and 51 per cent of the
and based on a subset of 89 countries available in
global population (excluding Brazil, China, India and the
the UNICEF Global Databases on Infant and Young
Russian Federation) for children aged under 2 years for
Child Feeding, with recent data between 2014 and
around 2020 (2014–2020).
2020, covering 66 per cent of the global under-two
population.
Trends in continued breastfeeding by wealth status are
based on a subset of 73 countries with comparable
Estimates of the percentage of children consuming a
data covering 58 per cent of the global population for
food group by wealth status are population-weighted
children aged 1 year for around 2010 (2005–2012) and
and based on the most recent national survey between
60 per cent of the global population for children aged 1
2014 and 2020 for a subset of 86 countries with
year for around 2020 (2014–2020).
disaggregated data available in the UNICEF Global
Databases on Infant and Young Child Feeding, covering
64 per cent of the global under-two population.
Figure 16: Trends in the percentage of children

with minimum dietary diversity, minimum meal
frequency and continued breastfeeding, by
poorest and wealthiest wealth quintile, 2010
and 2020
Trend analyses are population-weighted. Trends in
minimum dietary diversity by wealth status are based
on a subset 47 countries with comparable data covering
51 per cent of the global population for children aged
under 2 years for around 2010 (2005–2012) and 52 per
cent of the global population for children aged under 2
years for around 2020 (2014–2020).

© United Nations Children’s Fund (UNICEF)
September 2021
Permission is required to reproduce any part of this publication. Permissions

will be freely granted to educational or non-profit organizations.
Published by:
UNICEF
Nutrition Section, Programme Group
3 United Nations Plaza
New York, NY 10017, USA
Implemented by:
Kingdom of the Netherlands

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THE CRISIS OF

2021 Child Nutrition Report

Photo credits: page vi: © UNICEF/UN0150302/Dejongh; page viii: @ UNICEF/Valentina

2021 Child Nutrition Report

Internal Advisory Group (in alphabetical order)

External Advisory Group (in alphabetical order)

1. Our research: Why diets matter in early childhood 4

How do poor diets drive malnutrition? 8

What and who influences children’s diets? 10

What does this report aim to contribute? 11

2. Our findings: The crisis of young children’s diets 14

3. Our analysis: Barriers to good diets for young children 40

Good diets: unavailable, inaccessible, unaffordable 43

Traditional values and a changing world 44

A response that is not fit for purpose 46

Social protection system 52

Annex 2: Notes on the figures 59

2021 | Child Nutrition Report v

2021 | Child Nutrition Report vii

2021 | Child Nutrition Report 1

Our recommendations: Bolder action and Multi-system governance

2021 | Child Nutrition Report 3

WHY DIETS MATTER IN

2021 | Child Nutrition Report 5

Source: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2021 Edition.

6 2021 | Child Nutrition Report

2021 | Child Nutrition Report 7

45 million children under 5

149 million children under 5

45 million children under 5

2021 | Child Nutrition Report 9

The barriers to children’s diets are even greater

Although many of the driving factors behind

2021 | Child Nutrition Report 11

WHAT DO GOOD DIETS FOR YOUNG

When should young children be fed their first foods?

What should young children be fed?

What should young children not eat?

HOW DO WE MEASURE WHETHER YOUNG CHILDREN ARE EATING WELL?

2021 | Child Nutrition Report 13

THE CRISIS OF YOUNG

Diets and feeding practices of infants

2021 | Child Nutrition Report 15

The youngest children – those aged 6–11 months – have the

How has the quality of children’s diets changed in the last

2021 | Child Nutrition Report 17

Where has the diversity of children’s diets improved in the

These trends do not take into account the impact of

Regional- and country-level estimates and trends for

Our analysis of quantitative data reveals wide

2021 | Child Nutrition Report 19

Latin America and the Caribbean excludes Brazil.

Latin America and the Caribbean 80

vegetables and/or fruits; continued breastfeeding, by UNICEF region, 2020

Latin America and the Caribbean 73

Egg, fish and/or

Latin America and the Caribbean 45

dietary diversity and

South Asia, and West and