Exclusive Breastfeeding and Under-Five Mortality, 2006-2014: A Cross-National Analysis of 57 Low- and-Middle Income Countries

BACKGROUND: Few studies have examined the long-term, cross-national, and population-level impacts of exclusive breastfeeding on major global child health indicators. We investigated the overall and independent associations between exclusive breastfeeding and under-five mortality in 57 low- and-middle-income countries. METHODS: Data were obtained from the latest World Health Organization, United Nations, and United Nations Children’s Fund databases for 57 low- and middle-income countries covering the periods 2006-2014. Multivariate linear regression was used to estimate the effects of exclusive breastfeeding on under-five mortality after adjusting for differences in socioeconomic, demographic, and health-related factors. RESULTS: In multivariate models, exclusive breastfeeding was independently associated with under-five mortality after adjusting for sociodemographic and health systems-related factors. A 10 percentage-points increase in exclusive breastfeeding was associated with a reduction of 5 child deaths per 1,000 live births. A one-unit increase in Human Development Index was associated with a decrease of 231 under-five child deaths per 1,000 live births. A $100 increase in per capita health care expenditure was associated with a decrease of 2 child deaths per 1,000 live births. One unit increase in physician density was associated with 2.8 units decrease in the under-five mortality rate. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Population-level health system and socioeconomic factors exert considerable effect on the association between exclusive breastfeeding and under-five mortality. Given that the health policy and socioeconomic indicators shown to influence exclusive breastfeeding and under-five mortality are modifiable, policy makers could potentially target specific policies and programs to address national-level deficiencies in these sectors to reduce under-five mortality in their countries.