Inequalities in Complementary Feeding Programs in Randomized Intervention and Nonintervention Areas after Program Implementation in Bangladesh, Ethiopia, and Vietnam.

Background: Children in the 6-23-mo age group need to consume adequate energy and nutrients for healthy growth, brain development, cognition, and future productivity. Yet, large deficits remain. Complementary feeding practices can be improved on a large scale, but whether interventions reach and benefit disadvantaged mothers is not known. Objectives: To assess inequalities in complementary feeding practices and coverage following large-scale program implementation in 3 low- and middle-income countries. Methods: We re-analyzed evaluation data from randomized controlled studies conducted in Bangladesh, Ethiopia, and Vietnam and calculated socioeconomic inequality using Erreygers index for intervention and nonintervention areas. Intervention coverage indicators were developed in each country for interpersonal communication, community mobilization, agricultural extension, and media. We compared the direction and magnitude of inequalities in intervention and nonintervention areas. Results: At the endline, coverage, and practices related to complementary feeding were better in intervention areas, but coverage and practices favored the better-off and more educated mothers. In Bangladesh, only 5, and in Vietnam, only 1 out of 16 coverage variables measured favored disadvantaged mothers or were neutral; in Ethiopia, out of 18 coverage variables measured, 11 favored disadvantaged mothers or were neutral, and in all 3 countries, only 5-6 variables out of 16 that were measured favored disadvantaged mothers or were neutral. Conclusions: Inequalities exist both in how children in the 6-23-mo age group are fed and in programs aimed at improving complementary feeding practices. Programs favor the better-off and more educated mothers. We need to better understand context-specific program barriers and tailor targeted interventions to reach disadvantaged mothers.