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To the Editor: Dr Kramer and colleagues1 found that an intervention to promote breastfeeding in a developed country (Belarus) increased the duration and exclusivity of breastfeeding. Although breastfeeding is known to result in a large absolute reduction in mortality in developing countries,2 - 4 until now the benefit in developed countries was suspected but not certain. While the breastfeeding intervention resulted in a 4% absolute reduction in gastrointestinal tract infections and a 3% reduction in atopic eczema, it did not reduce rates of respiratory tract infections, otititis media, croup, or wheezing. Nor did it result in fewer hospitalizations. These health benefits seem to be modest and we are concerned that the conclusion of Kramer et al that "these results provide a solid scientific underpinning for future interventions to promote breastfeeding" is overstated.
Policy makers, health providers and health activists must take care in how the results of this study are used to promote breastfeeding in countries like the United States. The health benefits demonstrated (eg, the breastfeeding intervention results in a 30% relative reduction in gastrointestinal infections) should not be overstated. Similarly, the results should not be used to support a goal of a 100% rate of breastfeeding. Instead, efforts to promote breastfeeding should acknowledge that women have a real choice and provide them with accurate information to help them make this choice.
Too often, programs that support postpartum lactation in the United States are less about assistance than about advocacy. These programs assume that all women want to breastfeed and that all women should do so. Women may come away from these programs with an inflated perception of the health benefits of breastfeeding. Consequently, they may feel that not breastfeeding will seriously jeopardize their infant's health. Many would be very surprised to learn that bottle feeding confers (for example) a 13% chance of developing diarrhea during the first year of life, whereas breastfeeding reduces that chance to 9%.
Research on breastfeeding support should focus on how to best provide mothers with assistance in weighing the benefits of breastfeeding against the drawbacks.5 For women who have lactation difficulties, infections, or problems returning to work, these drawbacks can be substantial. Just as we are careful not to make a mother feel guilty about her decision to send her child to day care (which substantially increases the chance of acquiring infections6 ), we must ensure that she is not made to feel guilty or inadequate about her decision not to breastfeed.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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