Ethiopia: Are ultra-processed foods a barrier to appropriate complementary feeding?

Evidence shows that, even in rural settings with low dietary diversity, Ethiopian children are increasingly consuming ultra-processed foods (UPF). Introducing complementary foods too early and providing inappropriate foods (such as UPF) threatens infant growth and development.

This formative qualitative study explored complementary feeding practices, particularly provision of UPF to young children, in rural Oromia, Ethiopia. Sixteen focus group discussions were conducted using semi-structured questionnaires with mothers (N=45), fathers (N=21), and grandmothers (N=23) of children 6–23 months of age in beneficiary households of the Productive Safety Net Programme (PSNP). Four key informant interviews were also conducted with health workers. Inductive analysis was applied to transcripts complemented by field notes using MAXQDA software.

UPF were commonly fed to young children, often before the recommended age of initiating complementary foods at six months. In many cases, these foods were part of a liquid diet in which UPF, like juice, biscuits, and lipid-based nutrient supplements (LNS), were diluted with or dissolved in water and fed through a bottle. Caregivers perceived UPF as affordably priced and packaged, easily prepared, and nutritious. In comparison, the milk, legumes, and cereals traditionally used as complementary foods were subject to price inflation that limited their accessibility. Health workers believed that therapeutic foods and those distributed by the government and non-governmental organisations as part of food assistance programmes, like LNS and ‘Fafa’, were perceived as nutritionally balanced and prevented malnutrition in children.

“They are interested only with foods like Fafa and plumpynut foods... They think the food we are telling them to prepare and feed their children is not balanced diet food and think only as Fafa and plumpynut is balanced diet food.” – quote from a Health Worker in Milkayee kebele, Ethiopia

Provision of UPF contributed to an overall pattern of inadequate complementary feeding practices that included both early and late initiation of complementary foods – at anything between 2 and 12 months of age. Early introductions were primarily driven by a perception of breastmilk inadequacy and requirements for mothers to engage in activities taking them away from their infants at early ages, such as income generation and domestic work. In contrast, late introduction of complementary foods was linked to an overreliance on breastmilk, as well as children's dislike or rejection of the first food(s) introduced.

“I spent [much time] outside petty trading. So, grandmother started [feeding the baby] at three months of age with milk and sugar.” – quote from a mother in Hula Jeneta kebele, Ethiopia

Notable study limitations included the selection of only extremely poor households who are PSNP beneficiaries and the focus on a single region of Ethiopia relatively proximate to Somalia, where importing of UPF (particularly LNS) across the international border may have influenced the local availability of complementary foods.

Following this research, the authors called for properly designed nutrition education for caregivers, including fathers and grandmothers, to promote optimal complementary feeding practices and minimise the use of UPF. In parallel, intersectoral interventions should be considered to mitigate the impacts of price inflation on livelihoods and food security.