Exclusive Breastfeeding Rate (EBR)

Definition
Exclusive breastfeeding is defined as those infants who receive only breastmilk, and no other solids or liquids including water. Infants are, however, allowed to have drops of vitamins/minerals/medicines. This is the WHO definition of exclusive breastfeeding (1991) adopted thereafter by international agencies, including USAID.

The EBR can be calculated using the following equation:

Data Requirements
A 24-hour recall question of food consumption of infants less than 6 months of age.

Data Source(s)
Population-based surveys employing representative samples. Preferable are complete evaluation surveys establishing baseline and end-of-project results conducted prior to project implementation and at the end of the project carried out in intervention and control areas.

Program records may be used to track trend, not impact, EBR data.

The DHS country reports and Nutrition Reports both present the EBR for infants 0-<4 months of age. However, EBR for infants 0-<6 months can be calculated using DHS data with the attached calculator.

Purpose and Issues
Although the benefits of breastfeeding in terms of child survival are well known, changes in child mortality are difficult to measure. Indicators of current breastfeeding practices, however, can be relatively easily measured and are sensitive to changes resulting from program activities.

Using a 24-hour recall period measures current status and may cause the proportion of exclusively breastfed infants to be slightly overestimated, since some infants who are given other liquids irregularly may not have received them in the 24 hours before the survey. WHO's Indicators for Assessing Breast-feeding Practices, Wellstart International's Tool Kit for Monitoring and Evaluating Breastfeeding Practices and Programs, and the DHS reports all calculate EBR using the 24-hour recall method.

The best estimates of exclusive breastfeeding are obtained from current status data in cross-section surveys. The advantage of this approach is that it is not subject to recall error. The measure should be interpreted as the percent of infants who "are currently being exclusively breastfed" rather than the percent who have been exclusively breastfed since birth.

It is important to note that even in hot, dry climates, breastmilk contains sufficient water for an infant's needs. Additional water or sugary drinks are not needed to quench the infant's thirst, and they can also be harmful. If the infant is also given water, or drinks made with water, then the risk of getting diarrhea and other illnesses increases.