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Research Article | Volume 4 Issue 2 (April-June, 2024) | Pages 1 - 6
Nurturing Futures: Evaluating IYCF Awareness and Practices among Women of Reproductive Age in Shimla, Himachal Pradesh
Medical Officer (Specialist Pediatrics), Civil Hospital, Sunni, District Shimla, Himachal Pradesh, 171301, India
Junior Resident, Department of Anesthesia, PGIMER, Chandigarh, 160012, India
Under a Creative Commons license
Open Access
Feb. 5, 2024
Feb. 20, 2024
March 30, 2024
April 30, 2024

Background: The initial years of a child's life are crucial for their overall development and health. Practices such as exclusive breastfeeding and timely introduction of complementary foods are essential for reducing child mortality and improving health outcomes. This study investigates the awareness and implementation of IYCF practices among women of reproductive age in the culturally unique setting of Shimla, Himachal Pradesh, aiming to fill a notable gap in current research and contribute towards the Sustainable Development Goals (SDGs) related to health and nutrition. Materials and Methods: A descriptive, cross-sectional survey was conducted from October to December 2023, involving 400 women of reproductive age residing in Shimla for at least 12 months. Data collection was facilitated through a pre-tested Google Form questionnaire, covering socio-demographic details and a wide range of questions on IYCF practices. Analysis was performed using Epi Info V7, focusing on frequencies and percentages to evaluate awareness and practices. Results: The study revealed high awareness levels, with 91.75% of respondents correctly identifying the WHO-recommended duration for exclusive breastfeeding. Overall, 34% exhibited very good knowledge of IYCF practices, while knowledge on specific areas such as signs of adequate breast milk intake and the importance of iron-rich foods showed room for improvement. A significant rural-urban divide in responses indicated differential access to information and resources. Conclusion: The awareness of IYCF practices among the study population is generally high, yet targeted interventions are needed to address specific knowledge gaps. These findings underscore the importance of tailored public health strategies to enhance maternal and child health in Shimla, contributing valuable insights to the national discourse on nutrition and health policy.

Infant and Young Child Feeding (IYCF)
Complementary Feeding
Himachal Pradesh
Public Health

In the landscape of global health, the foundational years of a child's growth are critical for ensuring a pathway towards achieving lower child mortality rates and improving maternal health outcomes. Practices related to feeding infants and young children — specifically, exclusive breastfeeding during the first half-year of life and introducing appropriate solid foods thereafter while continuing breastfeeding for two years or more — are recognized as crucial strategies for bolstering child health. However, the application and understanding of these Infant and Young Child Feeding (IYCF) guidelines vary widely, especially across areas with distinct cultural practices and levels of health education. [1-4]


Nestled in the northern part of India, Shimla district in Himachal Pradesh offers a unique vantage point for investigating how well women of childbearing age understand and apply IYCF norms. This group's knowledge and practices are vital for the health trajectory of their offspring, influencing not only immediate nutritional outcomes but also long-term well-being. Despite the critical nature of this issue, detailed investigations into IYCF awareness within Shimla's unique socio-economic and cultural context are scarce, presenting a notable research gap that this study intends to bridge.


Our research aims to meticulously assess the awareness levels and the implementation of IYCF practices among reproductive-age women in Shimla. By identifying the degree of familiarity with and adherence to IYCF recommendations, the study seeks to highlight factors that either support or hinder the proper nutritional practices. Such an investigation is essential for crafting precise public health interventions that can elevate both maternal and child health in the district. Moreover, it is expected that the insights gained will enrich the national conversation on nutrition and health policy, offering evidence-based recommendations for enhancing child development and well-being across India.


This study is poised not just to fill an existing knowledge gap but to also contribute towards the global efforts encapsulated in the Sustainable Development Goals (SDGs), particularly those focused on health and sustainable communities. By closely examining the status of IYCF awareness and practices in Shimla, the research aims to forge a pathway towards improved nutritional strategies and health outcomes for children, ensuring a healthier future where every child has the chance to reach their full potential.


Objectives of the Study

  • To evaluate the awareness about IYCF Practices among women of reproductive age group in District Shimla, Himachal Pradesh.

Research Methodology
  • Research Approach -Descriptive

  • Research Design-  Cross-sectional survey design

  • Study area:  District Shimla,  Himachal Pradesh

  • Study duration- between  October 2023 to December 2023

  • Study population: All women of reproductive age group who were staying in the District Shimla , Himachal Pradesh for 12 months or more. 

  • Sample size- 400 women of reproductive age group assuming 50% have adequate knowledge regarding Infant and Young Child Feeding (IYCF) Practices, 5% absolute error, 95% confidence level, and 5% non-response rate.

  • Study tool: A google form questionnaire consisting of questions regarding socio-demography and Infant and Young Child Feeding (IYCF) Practices was created. The questionnaire was initially pre-tested on a small number of women of reproductive age group to identify any difficulty in understanding by the respondents. 

  • Description of Tool- 

  1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

  2. Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about Infant and Young Child Feeding (IYCF) Practices. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero in each category. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

  • Validity of tool - by the experts in this field

  • Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like email and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin  among women of reproductive age group in both rural and urban areas of District Shimla ,Himachal Pradesh till the 400 responses were collected. 

  • Data analysis- Data was collected and entered in Microsoft excel spreadsheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

  • Ethical Considerations- Participants confidentiality and anonymity was maintained. 


The goal of the current study was to assess the awareness about Infant and Young Child Feeding (IYCF) Practices among women of reproductive age group in District Shimla, Himachal Pradesh through a non-experimental descriptive survey.

A total of 400 respondents including 163 (40.75%) were from urban areas and 237 (59.25%) from rural areas participated in the study. (Table 1)


Table-1: Knowledge regarding Infant and Young Child Feeding (IYCF) Practices among study participants



Frequency of Correct Responses



What is the recommended duration for exclusive breastfeeding according to WHO guidelines?




Can you name some benefits of exclusive breastfeeding for infants?




What are the signs that indicate a baby is getting enough breast milk?




When should complementary feeding be introduced to an infant's diet?




What are some appropriate first foods for introducing complementary feeding to a baby?




How often should a baby be breastfed or given complementary foods at 6-8 months of age?




What are some common challenges mothers may face while breastfeeding, and how can they be addressed?




Can you explain the importance of iron-rich foods in a child's diet?




What are some suitable sources of iron for infants and young children?




How can mothers ensure their child receives adequate vitamin D?




What are the risks associated with early introduction of solid foods before 6 months of age?




Can you explain the concept of responsive feeding?




How can mothers safely store and prepare breast milk and formula?




What are the potential consequences of not following proper hygiene practices during feeding?




What should be done if a child refuses certain types of foods?




How can mothers support a smooth transition from breastfeeding to complementary feeding?




Can you name some indicators that a child may be ready for weaning?




What are some signs of a food allergy or intolerance in infants?




How can mothers ensure their child receives enough fluids as they transition to solid foods?




Can you discuss the importance of continued breastfeeding alongside complementary feeding?




In the present study 34% (136) females had very good knowledge (16-20 marks) towards Infant and Young Child Feeding (IYCF) Practices, 39.75% (159) having good knowledge (12-15 marks), 21.25% (85) having fair knowledge  (8-11 marks) and 6% (24) having poor knowledge (<8 marks). ( Figure 1)


Maximum =20 Minimum=6


Figure-1: Knowledge score regarding Infant and Young Child Feeding (IYCF) Practices among study participants


This study aimed to evaluate the awareness and implementation of IYCF practices among women of reproductive age in Shimla, revealing critical insights into maternal and child nutrition within the region. With 34% of the participants demonstrating very good knowledge, and a significant portion showing good to fair understanding, the results underscore a promising level of awareness about IYCF practices among the study population. These findings align with global research underscoring the importance of breastfeeding and appropriate complementary feeding in reducing child mortality and supporting healthy development. [5-9]


A notable 91.75% of respondents correctly identified the recommended duration for exclusive breastfeeding according to WHO guidelines, reflecting widespread recognition of breastfeeding's foundational role in child health. This is consistent with findings from other regions, indicating a strong global message on the benefits of exclusive breastfeeding. However, the study also highlighted areas needing improvement, such as knowledge on signs of adequate breastfeeding, management of common breastfeeding challenges, and the importance of iron-rich foods, where responses fell below 60%. [10-12]

Comparatively, these findings suggest a more nuanced understanding of IYCF practices in Shimla than in certain other contexts, where knowledge gaps remain more pronounced. The rural-urban divide, with a larger portion of rural respondents, hints at differential access to information and resources, a factor that has been identified in previous literature as a determinant of IYCF knowledge and practices. [13-15]

The study's cross-sectional design allowed for a broad snapshot of current practices and attitudes, echoing the work of previous studies who found varying levels of IYCF awareness across different Indian states. However, like all studies of this nature, it is not without limitations. The reliance on self-reported data may introduce bias, and the digital distribution of surveys could have excluded those without internet access, potentially skewing results towards more educated, urban participants. This suggests a need for diverse methodological approaches to fully capture the spectrum of IYCF practices across different communities. [16-17]


Future research should focus on longitudinal studies to understand changes in IYCF practices over time, especially in response to public health interventions. Additionally, qualitative studies could offer deeper insights into the cultural, socio-economic, and environmental factors influencing feeding practices. Implementing community-based participatory research (CBPR) approaches may also enhance engagement and effectiveness of IYCF programs. [15-18]


In conclusion, while the awareness of IYCF practices among women of reproductive age in Shimla is generally high, there remain specific areas where knowledge could be improved. These findings provide a valuable foundation for developing targeted interventions aimed at enhancing IYCF practices, ultimately contributing to better health outcomes for children in Shimla and beyond. By addressing the identified gaps, stakeholders can work towards fulfilling the SDGs related to health, nutrition, and sustainable communities.

  1. Engelhart, Alexis, et al. "Sustainability of breastfeeding interventions to reduce child mortality rates in low, middle-income countries: a systematic review of randomized controlled trials." Frontiers in Health Services 2 (2022): 889390. 

  2. Beluska-Turkan, Katrina, et al. "Nutritional gaps and supplementation in the first 1000 days." Nutrients 11.12 (2019): 2891. 

  3. Infant and Young Child Feeding. Available at: (Accessed on 12 March 2024)

  4. Infant and Young Child Feeding. Available at: media/145641/file/Nutrition%20Global%20Annual%20Results%20Report%202022.pdf(Accessed on 12 March 2024)

  5. Saxena, Vartika, et al. "Assessment of Infant and Young Child Feeding (IYCF) practices in rural areas of Dehradun, Uttarakhand." Journal of Family Medicine and Primary Care 11.7 (2022): 3740-3745. 

  6. Mekonnen, Mathewos, et al. "Infant and young child feeding practice among mothers of children age 6 to 23 months in Debrelibanos district, North Showa zone, Oromia region, Ethiopia." PloS one 16.9 (2021): e0257758. .

  7. Parashar, Anupam, et al. "Infant and young child feeding practices-insights from a cross-sectional study in a hilly state of North India." International Journal of Nutrition, Pharmacology, Neurological Diseases 5.3 (2015): 103-107. 

  8. Legesse, Seid, et al. "Infant and Young Child Feeding Practices and Associated Factors Among Mothers of Children Aged 0-23 Months in Kalu District, North-East Ethiopia: Community Based Cross-Sectional Study." J Nutr Food Sci 11 (2021): 794. 

  9. Deshpande, Mugdha, and Devaki Gokhale. "Knowledge, attitude and practices regarding infant and young child feeding among lactating mothers from rural areas of Nanded, Maharashtra." Biomedical and Pharmacology Journal 13.2 (2020): 833-841. 

  10. Exclusive breastfeeding. Available at: Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD003517. 


  12. Dukuzumuremyi, Jean Prince Claude, et al. "Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review." International breastfeeding journal 15 (2020): 1-17. 

  13. Khandelwal, Shweta, et al. "Infant young child feeding practices in an Indian maternal–child birth cohort in Belagavi, Karnataka." International Journal of Environmental Research and Public Health 19.9 (2022): 5088. 

  14. Lokesh, N., Kulkarni, P. R., Basheer, S., et al. "Comparative Study of Feeding Practices Among Children Less Than Two Years Attending Rural and Urban Primary Health Centers, Mysuru, Karnataka." International Journal of Community Medicine and Public Health, vol. 10, no. 9, 2023, pp. 3219–3225.

  15. Tariqujjaman, Md, et al. "Between and within-country variations in infant and young child feeding practices in South Asia." International Journal of Environmental Research and Public Health 19.7 (2022): 4350. 

  16. Dhami, Mansi Vijaybhai, et al. "Infant and young child feeding practices among adolescent mothers and associated factors in India." Nutrients 13.7 (2021): 2376. 

  17. Radjasegarane, Arulprasad, et al. "A cross sectional study on optimal infant and young child feeding practices with reference to WHO indicators in a rural area of Puducherry." Int J Community Med Public Health 6.4 (2019): 1684. 

  18. Ahishakiye, Jeanine, et al. "Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda." BMC public health 21 (2021): 1-13.

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