Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?

Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV.