Inequalities in Infant Feeding Practices among the Growing Up in New Zealand Cohort

Abstract

Background: Nutrition in the first year of life has a profound and enduring effect on health. This study is the first in New Zealand (NZ) to provide generalizable national information about a range of infant feeding practices beyond breastfeeding. Methods: Data were collected from 2009–2012 on 6435 infants enrolled in the Growing Up in NZ longitudinal study, using face-to-face and telephone interviews when the infant was in-utero, 6-weeks, 9-months and 31-months old. Thirteen indicators measured adherence at 9-months of age to the Ministry of Health’s Guidelines for Healthy Infants (2008), covering breastfeeding, introduction to solids, variety of diet, and inappropriate foods (e.g., sweets, hot chips, potato crisps) and drinks (e.g., fruit juice, soft drinks). Descriptive statistics and multivariate regression were used to investigate associations between indicators and maternal/household characteristics (p < 0.05). Results: Guidelines with overall high adherence (>80%) at age 9-months were: appropriate milks, no salt/sugar added to meals, and serving an iron-rich food daily. Indicators with both low adherence (<50%) and statistically independent differences between ethnic groups were: exclusive breastfeeding to around 6-months (lower in Māori, Pacific, Asians); two serves of vegetables and fruit daily at 9-months (lower in Māori, Pacific, Asians); inappropriate foods and drinks at 9-months (higher in Māori and Pacific). Infants of younger mothers, with low maternal education, and with no partner antenatally had higher risk of not meeting these guidelines. Infants living in neighbourhoods of high deprivation had additional risk of not meeting the fruit and vegetable guideline. Conclusions: This study highlights the urgency to better support breastfeeding and appropriate timing of introduction to solids. Additionally, vegetable and fruit intake, and avoiding discretionary foods, remain key population nutrition messages. Substantial inequalities exist in the early diets of NZ infants. Culturally- and socially-appropriate nutrition education is needed to improve infant nutrition in New Zealand.