Series L, Number 14
Issues in World Health

CONTENTS

Home (Key Points)

Breastfeeding Gains and Goals
Table 1. Breastfeeding Practices Improving
Web Table 1. Early Initiation of Breastfeeding Over Time
Web Table 2. Exclusive Breastfeeding Over Time
Web Table 3. Breastfeeding at Two Years
Table 2. Breastfeeding Common but Not Usually Optimal
Web Figure 1. Most Infants Breastfed Initially
Web Figure 2. Levels of Breastfeeding Vary Widely

Comprehensive Strategies Needed

Spotlight: Madagascar’s Comprehensive Approach Improves Breastfeeding

Breastfeeding Increases Women’s Contraceptive Options
Table 3. When Breastfeeding Mothers Can Begin a Family Planning Method After Childbirth Compared with Mothers Not Breastfeeding

Centerspread: Breastfeeding Is Best
Figure 1. Better Breastfeeding Reduces Diarrhea

Women with HIV Face Crucial Breastfeeding Decisions
Figure 2. Estimated Risk of HIV Infection in Infants and Young Children

Bibliography

Credits

• Counseling Aid: When Can a Woman Use LAM?
• Counseling Aid: HIV and Infant Feeding Counseling Flow Chart

• Box: Taking Ten Steps to Successful Breastfeeding
• Table: When Breastfeeding Mothers Can Begin a Family Planning Method

Order this report
Download PDF or PowerPoint
E-mail this page
See Companion INFO Report
on Breastfeeding "A Guide for Providers"
See more Population Reports

Centerspread: Breastfeeding Is Best

Breastfeeding is the healthiest and safest way to feed most babies. Breastmilk is complete in its nutritional composition. Breastmilk contains a combination of fats, proteins, carbohydrates, other nutrients, and growth factors essential to fully satisfying the nutritional needs of infants and children (159, 162).

Breastfeeding Saves Infants Lives

Babies who are breastfed have a lower risk of death both in infancy (under age one) and in early childhood (ages one to five) (15, 43, 152, 216, 255). For instance:

• An analysis of survey data from 17 countries in Africa, Southeast Asia, and Latin America found that infants who stopped breastfeeding before two months of age were four times more likely to die before reaching four months of age than infants who continued to breastfeed through two to three months of age, after accounting for other factors that affect infant mortality (195).
• A study in Bangladesh found that infants who received partial or no breastfeeding were more than twice as likely to die before age one than infants who were exclusively breastfed for the first four months of life (11).

Breastfeeding and Breastmilk Promote Healthy Growth and Development

The nutrients in breastmilk promote a child's growth and development better than any substitute. The composition of breastmilk enables babies easily to digest the nutrients they need. Exclusive breastfeeding for up to six months as well as longer durations of any breastfeeding appear to promote greater gains in weight during infancy and greater gains in height as the child develops thereafter (12, 73, 121, 169, 179, 215, 246).

Breastfeeding also may have a small protective effect against childhood obesity and other cardiac risk factors (9, 13, 85, 130, 171, 211, 212). This protective effect may be due to a lower protein intake and energy metabolism among breastfed babies than among formula-fed babies (9, 117).

Several recent studies have found better cognitive development among breastfed children (7, 92, 155, 163). The more months of breastfeeding, the greater the gains in cognitive development (7, 8, 79, 163, 184).

Breastfeeding can help strengthen the emotional bond between mothers and their children, through closeness and connectedness (64, 144). This mother-child bonding may help to encourage women to breastfeed for more months, extending the health benefits (31, 243).

Breastfeeding Protects Against Certain Infectious Diseases

Both direct and indirect immunological benefits of breastfeeding help protect against the two most common types of childhood diseases-diarrhea and acute respiratory infection-as well as against middle-ear infections. An HIV-positive woman, however, can pass HIV to her baby through breastfeeding (see p. 17).

Diarrheal diseases. Breastfeeding, especially exclusive or full breastfeeding, significantly reduces the likelihood of diarrheal disease (4, 120, 138, 139, 197, 247) (see Figure 1). Breastfeeding protects against diarrheal diseases in two ways:

1. By reducing a baby's exposure to potentially contaminated drinking water (exclusive breastfeeding eliminates exposure altogether). Contaminated water is the leading source of diarrheal disease in many countries (89, 180, 242).
2. By helping the infant's own immune system to develop and protect against pathogens. Growth factors in breastmilk promote the growth of essential bacteria that prevent the growth of gastrointestinal pathogens. Anti-infective agents in breastmilk, such as antibodies and macrophages, actively inhibit or destroy pathogens (88, 127, 162).

Acute respiratory infection and pneumonia. Acute respiratory infection is a leading cause of death in children under age five in developing countries. Pneumonia is the most serious respiratory infection. It causes 9 deaths in every 10 from acute respiratory infection among children under age five (267).

Breastfed children, especially those exclusively breastfed, have a lower risk of pneumonia than other children (14, 34, 66, 70, 175, 245, 247, 274). For example, in Brazil infants who were partially breastfed and those who were not breastfed had a risk of developing pneumonia that was, respectively, 3.8 and 16.7 times higher than that for infants who were exclusively breastfed (39).

Middle-ear infections. Breastfeeding reduces the occurrence of middle-ear infections in children (62, 72, 197, 232). For example, a study in Mozambique found that children who had been breastfed for more than 18 months had one-fifth the risk of middle-ear infection that children breastfed for 6 months or less had (52). Middle-ear infections can lead to hearing impairment and thus to delayed speech development (21, 222).

Breastfeeding May Protect Against Chronic Diseases

Breastfeeding may help lower susceptibility to later chronic diseases such as diabetes and asthma. Some studies have found that breastfeeding is associated with a reduced risk of childhood onset of diabetes mellitus (84, 109, 145, 161, 196). The early introduction of breastmilk substitutes, such as cow's milk, into an infant's diet may increase the risk of childhood onset diabetes mellitus (78, 161, 177).

There is some evidence that breastfeeding helps protect against asthma (192), although not all studies find such a relationship (200). One study found that children who had ever breastfeed had reduced their risk of having asthma by almost 60% compared with children who had never breastfed (86). In particular, exclusive breastfeeding during the first months after birth has been associated with lower asthma rates during childhood (77, 164).

Breastfeeding appears to reduce the occurrence of some childhood cancers (97, 141, 208, 233). Longer durations of breastfeeding may provide more protection against childhood leukemia and lymphomas than shorter durations (53, 178, 208, 214). For example, one study found that the risk of leukemia and lymphomas was more than 2.5 times greater among children who had breastfed for six months or less compared with children who had breastfed longer than six months (20).

Health Benefits for Breastfeeding Women

Breastfeeding has direct health benefits for mothers-as soon as they begin to breastfeed, throughout breastfeeding, and for the rest of their lives.

Postpartum benefits. Breastfeeding early, ideally as soon as possible after childbirth, can help to expel the placenta, reduce blood loss, and speed uterine involution-the process by which the uterus returns to its normal size. These benefits occur because oxytocin, a hormone released in the body when a woman breastfeeds, stimulates uterine contractions (10, 205). The contractions help to expel the placenta and decrease postpartum blood loss (198). Breastfeeding also may help a woman's body weight to return to normal postpartum (58-60, 102, 111), although study findings on weight loss are mixed.

Reducing cancer risks. Breastfeeding reduces the risk of both epithelial ovarian cancer (158, 189, 190, 229, 275) and breast cancer (19, 126, 228, 279). One large study found a reduced risk of breast cancer averaging 14% among women who ever breastfed compared with women who never breastfed (22). Among premenopausal women, the longer the total duration of breastfeeding over a lifetime, the more protection that breastfeeding appears to provide (22, 131, 158, 229, 279).

Bone health. Breastfeeding may be associated with better bone health later in life. Some studies report greater bone density among women who have ever breastfed compared with women who have not breastfed (41, 148, 174). Two studies have reported lower risk of hip fracture later in life in women who have breastfed for longer durations (51, 123). While studies consistently find a temporary bone loss during breastfeeding, this loss is fully recovered after weaning or once menses resume (40, 91, 181, 278).

Breastfeeding Saves Money

es in the developing world (2, 149). Women who breastfeed save the cost of buying formula as well as supplies such as bottles and teats and equipment for sterilization and refrigeration (69, 182). As noted, breastfed children experience fewer and less severe illnesses than children who are formula-fed (153, 231). Thus breastfed children require less health care-another savings both for families and for the health care system (15, 16, 28, 134, 182).