Obeng, Cecilia S.
Foster, Darian L.
School of Public Health - IUB
5/20/2017
Introduction
Infant Mortality, death before the age of one, is becoming increasingly more common in
both developed and developing countries. There are multiple causes for infant mortality
including: low birth weight, infections, birth defects, lack of prenatal care and other factors.
Perhaps one of the most prominent factors can be attributed to the decreased exposure infants
have to human milk and the increase in commercial formula usage. A study done by Palloni in
Mexico, found that an infants morbidity risk was increased 10 times when exclusively formula
fed for an entire year, compared to infants who were breastfed exclusively for one year
(Gonzalez de Cosio, Escobar, Gonzalez, Gatell, & Hernandez, 2013). Infants are dying at an
alarming rate from preventable factors which emphasizes the importance of promoting
Historically, breastfeeding has been the traditional first food for infants until the
introduction of commercialized infant formula in 1867. Breastmilk has been noted as the most
complete, non-replicable nutrition for infants. However, breastfeeding has suffered incredible
losses due to miseducation, conflicting information, false advertising from formula companies
and numerous other factors. The aforementioned issues have lead women to supplementing with
artificial milk. In lieu of this, many infants around the globe have not consumed their mothers
milk, therefore have not been exposed to the important antibodies, vitamins, minerals and other
protective factors that breastmilk naturally contains. Science has already proven and researched
in-depth why human milk is vital for human babies. Biologically plausible mechanisms through
which breastfeeding may impact neonatal mortality have been proposed, such as composition of
breast milk changing according to the newborn's need for passive immunological protection
Early breast milk has an abundance of cytokines at a time when neonatal organ systems are
immature, suggesting that these bioactive components of breast milk may be important in
Since breastfeeding rates have decreased, we have seen a significant rise in infant
mortality rates globally. The United States, in particular, has shocking rates. Although the U.S. is
counterparts, Americas infant mortality rates are some of the worst among developed countries.
While countries such as Sweden and Finland have infant mortality rates as low as 2 or 3 deaths
per 1,000 births; the United States had an infant mortality rate of 6 deaths per 1,000 births in
2014 (Texas A&M University, 2016). These statistics are a huge cause for concern and are an
Certain populations are more at-risk for infant mortality than others. For instance, those
infants who are exclusively formula-fed are the most at-risk, because there is no exposure to their
mothers milk. Why is this exposure so important? An infant is born with an extremely immature
immune system and the mothers body protects the infant by detecting bacteria in the childs
saliva and synthesizing antibodies to attack germs that the infant has been exposed to; therefore,
the infant receives personalized protection from specific bacteria that can cause harmful
illnesses, such as: necrotizing enterocolitis, diarrhea, and other infections. Minority populations
are also more at-risk than others. African Americans and American Indian populations have a
higher risk compared to other ethnic groups [Caucasian, Hispanic, and Asian American]; one of
the most substantial factors influencing this increased risk is the higher proportion of low birth
weight and preterm births in these populations (Matthews, MacDorman, & Thoma, 2015, pp.6-
7). This is similar even in developed countries (Texas A&M University, 2016). In addition,
those with lower income and less education are also at a higher risk for infant mortality.
What We Know
The substantial effect that breastfeeding has on reducing infant mortality despite income,
race, or education level has been well documented through current literature on breastfeeding
and infant mortality. The biggest barrier to exclusive breastfeeding is commercial infant
infants only in cases where breastmilk is not available; however, in most cases formula is forced
upon families and falsely advertised as just as good or even better than breastmilk, leaving
todays infants immune systems sorely lacking in strength. One research article reads, Infant
formula was designed to be a medical nutritional tool for babies who are unable to breastfeed.
Formula does not fully meet the nutritional and immunity needs of infants, leaving their immune
systems flailing. An infant's immune system has three aspects: her own immature, developing
immune system; the small component of immunities that passes through the placenta during
natural childbirth (and to a lesser degree with premature births and cesarean sections); and the
most valuable, living portion that is passed on through mother's milk on an ongoing basis.
Remove any of these components and you take away a vital support structure (Palmer, 2003).
The longer the duration of breastfeeding, the less likely infants will perish before the age
of one (Chen & Rogan, 2004). The American Academy of Pediatrics recommends that, babies
be exclusively breastfed for about the first 6 months of life. This means your baby needs no
additional foods (except Vitamin D) or fluids unless medically indicated. Babies should continue
to breastfeed for a year and for as long as is mutually desired by the mother and baby (American
Academy of Pediatrics). Additionally, the World Health Organization, recommends
Current research also suggests that exclusive breastfeeding reduces not only risk of all-
cause infant mortality but also infection-related infant mortality. In fact, a literature review
conducted in 2015 compared predominately, partially, and non-breastfed infants with exclusively
breastfed infants and found the following: Infants 05 months of age who were predominantly,
partially or not breastfed had significantly higher risk of all-cause and infection-related mortality
compared to exclusively breastfed infants. Children aged 623 months who were not breastfed
had higher risk of all-cause and infection-related mortality than children who were continued on
Breastfeeding is also the most preventative and protective measure against infant
mortality (Golding, Emmett, & Rogers, 1997). Some may question what exactly makes
breastmilk so protective. The answer lies in breastmilks composition changing according to the
the first hour after birth, surveyed 67 countries and how breastfeeding in this time frame reduced
infant mortality rates. The article explains the unique protection human milk offers. Several
components in breast milk reduce the inflammatory response to stimuli in the newborn intestine.
These components include transforming growth factor beta, interleukin-10, erythropoietin, and
milk including bioactive enzymes, hormones, growth factors, cytokines, and immunological
agents that increase and stimulate host defense (Oddy, 2013). A 2015 literature review, also
stated, The better the breastfeeding practice, the higher the protection. Even partial
2015).
infant mortality in different populations. An infant mortality research study was conducted in
Ethiopia, which had a high infant mortality rate of 88 deaths per 1,000 births (November 2009 to
August 2011), with a cohort of 1,752 infants. The study found that exclusive breastfeeding was
not only protective in rural areas but was the strongest indicator of survival for those infants
(Biks, Berhane, Worku, & Gete, 2015). UNICEF also indicated that optimal breastfeeding
practices would prevent numerous deaths in developing countries, including 10% of neonatal
deaths in India alone (Chan, 2011). The text reads, It has been estimated that optimal
breastfeeding of children under two years of age has the potential to prevent 1.4 million deaths in
children under five in the developing world annually, based on a report in The Lancet 2008
Nutrition Series (Chan, 2011). This research reveals that whether in developed or developing
countries, rural or urban areas, in every ethnic group and income bracket, exclusive breastfeeding
With information from current literature, there is a further understanding that exclusive
breastfeeding can prolong many lives; with this knowledge, we must ask, what can we do to
ensure that breastfeeding happens in our society as a whole? For instance, more research can be
done on how breastfeeding decreases infant mortality in developed countries, since most
neonatal morbidity in this population is caused by low birth weight and Sudden Infant Death
Syndrome; this includes studying how breastfeeding decreases the risk of SIDS. In addition to
this research, providing evidence-based breastfeeding information is crucial for not only
expectant mothers but family members as well. This information discredits breastfeeding myths
and allows families to get questions answered to help support the mother during her
breastfeeding journey.
Another vital component of increasing breastfeeding rates is extended paid family leave
for mothers and fathers to help with the adjustment period after birth. This will give mothers
more time to get breastfeeding established. Parental leave policies have tremendous influence
on health outcomes for both mom and baby, as well as long-term economic impact, McKyer
said. Studies show that in countries where there is a generous parental leave policy, there are
tremendous effects on morbidity and mortality rates of infants and young children. Theyre
considerably less likely to get sick enough to require hospitalization or to die. Again, its
investing on the front end so that were not paying on the back end (Texas A&M University,
2016).
Another research article stated, Unfortunately, many parents in rural areas have been
forced to leave their children in the care of their grandparents while they work in the cities, and
replace breastmilk with low-quality commercial milk powder and formula substitutes (Chan,
2011). This leads into the next step to improve breastfeeding rates; decreasing and creating strict
standards against the aggressive and false advertising of formula companies. UNICEF also
stated, Besides societal pressures to stop breastfeeding, aggressive marketing and promotion by
formula producers and inaccurate medical advice from health workers have also led mothers to
stop exclusive breastfeeding early (Chan, 2011). In addition to monitoring formula company
advertising, medical personnel need quality training on, at minimum, the basics of breastfeeding
that come from an evidence-based source so they can accurately promote human milk for human
babies. Nationally, preventative methods against infant mortality, such as breastfeeding, need to
be promoted before pregnancy and further built upon during the prenatal period. The CDC
suggested additional tactics for decreasing infant mortality, Strategies include 1) improving
women's health before pregnancy, 2) promoting quality and safety in prenatal care, 3) investing
Families should be well-educated on how human milk helps infants health, not just the
mother. Free visits from registered nurses were also found to benefit new parents and could help
increase breastfeeding rates. These visits could effectively answer questions and disqualify false
information, as long as the nurses are educated thoroughly with evidence-based breastfeeding
Two articles touched on the importance of breastfeeding during the first hour after birth.
The faster breastfeeding is initiated, the more likely it is that breastfeeding will be successful for
the mother and child. The text reads, In countries with neonatal mortality rates higher than 29
per 1,000 live births, the correlation with maternal milk in the first hour of life was stronger in
relation to the percentage of deliveries in health facilities and people with secondary education or
higher. In countries with the highest mortality rates, those included in the lowest tertile of
breastfeeding in the first hour of life had the highest rate of neonatal deaths per 1,000 live births,
and those included in the highest tertile had the lowest rate of deaths (Oddy, 2013).
To ensure that babies are getting to the breast as soon as possible, more breastfeeding-
friendly practices need to be established in hospitals and clinics. Policies such as, skin-to-skin
after birth, delayed cord clamping, delaying postpartum procedures to give time for bonding,
gentle cesarean sections that allow skin-to-skin after a Cesarean birth and the mother to have
more control during the surgery, and open availability of Lactation professionals will promote
breastfeeding during the first hour. Of the nutritional factors, early initiation of breast-feeding
associated with reduced risk of infant mortality was consistent with the previous studies reported
showing a strong relationship between infant mortality and early initiation of breast milk. The
risk of infant death increases when breast milk is not initiated immediately after birth [13,14].
About 20% of all neonatal deaths could be prevented if all newborns were initiated breastfeeding
within one hour of birth [16,21,22]. Early breastfeeding initiation reduces the risk of infectious
diseases, which is one of the most common causes of death during the neonatal period (Biks,
The literature surrounding breastfeeding and infant mortality is extensive and one major
theme is clear from each resource; many infant deaths can be prevented with exposure to human
milk. One may assume that promoting breastfeeding is complicated but on the contrary, it is as
simple as changing our priorities. If we shift our priorities from societal profits to well-being for
all, these changes will be easy to apply and maintain. Medical professionals knowing basic
knowledge about breastfeeding and promoting accordingly. Formula companies advertising their
product as being available only if medically necessary. Families, including grandparents, aunts,
uncles, siblings, fathers and mothers being well-educated about breastfeeding and equipped to
have a positive, successful breastfeeding journey together. It is all possible, if we shift our focus