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Regional Perspective: Latin America and the Caribbean (LAC)

Yvette Fautsch Macías is a Nutrition Specialist at the UNICEF Regional Office for the LAC Regional Office (LACRO)

Paula Veliz is a Regional Nutrition Specialist at UNICEF LACRO

Maaike Arts is a Regional Adviser at Survive and Thrive (Health and Nutrition), UNICEF LACRO

UNICEF LACRO would like to acknowledge the co-authors of the peer-reviewed article1 which, along with other resources, informed this Field Exchange article: Franziska Gassmann, Richard de Groot, Stephan Dietrich, Eszter Timar, Florencia Jaccoud, Lorena Giuberti and Giulio Bordon (UNU-MERIT, Maastricht University, Maastricht, Netherlands). The team contributed to the conceptualisation, data curation and formal analysis, as well as the writing, reviewing and editing of the original draft. Aashima Garg (UNICEF Headquarters, Programme Group – Nutrition) contributed to the conceptualisation, supervision, writing, reviewing and editing of the manuscript. UNICEF LACRO would also like to thank UNICEF country offices in Guatemala, Peru, Paraguay and Uruguay for their contributions.

In the LAC region, the prevalence of wasting in children under the age of five is low (1.3%), and that of stunting reduced from 18% to 11.3% between 2000 to 2020. Despite this, 5.8 million children in the region are still affected by stunting (UNICEF, WHO, & World Bank, 2021). Regional prevalences hide national and sub-national discrepancies. The prevalence of childhood stunting is 47% in Guatemala – one of the highest levels globally – and is above 20% in Ecuador, Haiti and Honduras (UNICEF LACRO, 2020). At the same time, the prevalence of overweight in children under the age of five increased from 6.8% to 7.5% 2000–2020, resulting in 3.9 million children affected, ranging from 3.7% in Haiti to 12.9% in Argentina. Of all countries analysed in the LAC region, only Guyana, Haiti and Uruguay still have a higher prevalence of childhood wasting than overweight. One of the key determinants of this simultaneous burden of undernutrition and overnutrition are the gaps in early IYCF practices throughout the region.

To explore child feeding practices in the region, UNICEF LACRO conducted a landscape analysis according to the following three thematic areas of UNICEF’s Action Framework for improving diets of young children: (1) the ‘what’, ‘when’ and ‘how’ of feeding; (2) drivers of children’s diets, especially nutrition services and practices; and (3) strategic actions in place across WASH, health and social protection systems. A total of 59 documents and two datasets from countries across the region were included in the analysis, although there was substantial variation in the availability and timeliness of data between different countries.

Findings from the landscape analysis

On average, 84% of infants in the LAC region were introduced to complementary foods at an appropriate time. This is favourable when compared to other regions, but there were substantial variations within the region. Only 38% of infants under six months were exclusively breastfed, ranging from alarmingly low rates in some countries (3% in Suriname, 4% in Saint Lucia and 5% in Dominica) to rates that were at or above the global average in others (66% in Peru, 58% in Bolivia and 53% in Guatemala). Peru, El Salvador and Cuba had the highest percentage of boys and girls aged 6–23 months who consumed a minimum of five of the eight food groups (83%, 73% and 70% respectively), while the Dominican Republic, Guyana and Haiti had the lowest percentage (51%, 40% and 19% respectively). These findings reinforce the unequal progress towards healthy diets for children between sub-regions and countries.

Most infants and young children in the region were fed at an appropriate frequency, but their diets lacked diversity, with children aged 6–11 months receiving less diverse diets than those aged 12–23 months. Poor dietary diversity has been attributed to the availability of ultra-processed foods and the comparatively prohibitive cost of nutrient-dense foods.2 Indigenous communities were particularly vulnerable, typically having poorer dietary quality and more limited household food access.

Awareness surrounding effective IYCF practices and caregiver knowledge was generally poor in the region, except for Paraguay and Panama, which have developed and implemented food-based dietary guidelines for children under the age of two.

Data gaps also remained a significant challenge. For example, most countries do not have the capacity to measure the prevalence of MDD, making it difficult to monitor progress.

Large-scale policies and programmes on food fortification are popular in the region and contribute to tackling micronutrient deficiencies. However, access to safe water and sanitation is not universal and there are substantial rural-urban divides, similar to other regions.

Priority actions for improving the diets of infants and young children

Based on the findings from the landscape analysis, UNICEF LACRO identified the following key priority actions.

Availability of data: Improvements in data capture and administration, as well as multi-sector coordination, are recommended across the region. To address gaps in information and data relating to the diets of young children and to allow for monitoring of progress, UNICEF LACRO will prioritise supporting the integration of regular data collection and monitoring of complementary feeding indicators in national surveys and health information systems.

Ultra-processed foods and their marketing: A stronger policy response to unhealthy eating habits should be promoted and supported, focusing on supporting countries to adopt regulatory strategies to reduce the accessibility, availability and desirability of sugar-sweetened beverages and unhealthy or ultra-processed foods. These include ‘sugar taxes’, advertising restrictions and requirements for transparency in food labelling to facilitate healthy purchasing choices by caregivers (front-of-pack labelling).3

Research should be strengthened and experiences should be documented regarding tackling the availability and marketing of ultra-processed foods and commercial milk-based formulas, as well as strategies and programmes to improve diet diversity among children aged 6–23 months across the region. This can serve as a model for developing effective interventions and strategies that simultaneously target child overweight and undernutrition.

Counselling and support: To promote caregiver knowledge and awareness of healthy infant feeding practices, UNICEF LACRO will prioritise expanding the coverage and intensity of counselling and support to caregivers on feeding practices while considering local preferences, beliefs and socio-cultural contexts. Support of programmes will also promote positive interactions between service providers and caregivers during service delivery. Expanding the coverage of social protection services and using such services as an entry point for counselling and support have also been identified as a priority area.

Next steps

UNICEF LACRO will provide technical assistance to country offices in adapting the complementary feeding Action Framework to their context. In addition, UNICEF LACRO is committed to supporting the improvement of young children’s diets in emergency situations, thus building resilience in a region regularly affected by economic shocks, migration and disasters caused by natural phenomena. UNICEF LACRO has already conducted a regional webinar with the Global Nutrition Cluster Technical Alliance on supporting complementary feeding in emergencies, and will provide support to countries that are interested in, and require support to, expand their emergency preparedness and response efforts.

For more information, please contact Yvette Fautsch Macías: yfautsch@unicef.org

References

UNICEF LACRO (2020) Trends, Drivers and Determinants of Young Children’s Diets. Regional and Country Briefs of Findings and Trends of Children's Diets Between 6 Months to 2 Years in Latin America and the Caribbean. United Nations Children’s Fund https://www.unicef.org/lac/en/reports/trends-drivers-and-determinants-young-childrens-diets

UNICEF, WHO, & World Bank (2021) Joint Malnutrition Estimates. UNICEF, WHO, & World Bank https://www.who.int/news/item/06-05-2021-the-unicef-who-wb-joint-child-malnutrition-estimates-group-released-new-data-for-2021

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1 https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000260.

2 UNICEF LACRO was not able to monitor the unhealthy foods in the diets since the tools for this were launched after the completion of this study.

3 Across Latin American countries, 39 such regulatory strategies aimed at reducing the consumption of unhealthy foods and beverages were previously identified, with the efforts of Chile, Ecuador and Mexico being most comprehensive: see https://www.unicef.org/lac/media/30436/file/The-role-of-schools-in-preventing-overweight.pdf.

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Yvette Fautsch Macías, Paula Veliz, Maaike Arts (). Regional Perspective: Latin America and the Caribbean (LAC). Field Exchange 68 , November 2022. www.ennonline.net/fex/68/uniceflatinamericaandthecaribbean

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