Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them

Abstract

Background: In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding.

Methods: This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities.

Results: In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to suboptimal breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Suboptimal breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles.

Conclusions: Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.

Figure 1

Global trend in breastfeeding behaviors in children under six months, 1990 to 2010.

Figure 2

Map of absolute change in exclusive breastfeeding prevalence in developing countries among children younger than six months of age, 1990 to 2010.

Figure 3

Exclusive breastfeeding prevalence trends in selected countries, 1990 to 2010.

Figure 4

Breastfeeding prevalence by income quintile in selected countries.

Figure 5

Map of disease burden due to suboptimal breastfeeding in 2010, as measured by percent of a country's total child DALYs attributable to suboptimal breastfeeding. DALYs, disability adjusted life years.

Figure 6

Percent change in DALYS attributable to suboptimal breastfeeding, 1990 to 2010.

Figure 7

Countries where suboptimal breastfeeding is the leading child risk factor in 1990 or 2010. Countries in green are those where suboptimal breastfeeding was the top child risk factor in 1990 only; countries in purple are those where suboptimal breastfeeding was the top child risk factor in 2010 only; countries in red are those where suboptimal breastfeeding was the top child risk factor in 1990 and 2010.