Whenever I write about “breastfeeding saves lives,” I always get some reader comments like this: “Only babies in underdeveloped countries would die from diseases that could be prevented by breastfeeding. Babies in developed countries would thrive with whatever milk they get.”

Sounds about right. Indeed, when a country’s economy takes off and people’s income increases, the benefits of breastfeeding seem to be less significant—in developed countries people have access to clean drinking-water, and everyone can afford infant formula. Formula feeding seems to be very safe in these countries, where babies have little chance to die from polluted drinking-water or diluted formula milk. Also, an increased number of mothers may work outside of the home, which makes formula feeding a more convenient option.

Brazil is an example. As the country experienced economic growth, it also saw a dramatic decline in breastfeeding rates. Only 5% of 6-month-old infants were being exclusively breastfed in 1986. While these rates have increased, to this day there are fewer than half of infants being exclusively breastfed for 6 months in Brazil.

However, the latest research published in this month’s Pediatrics shows that the benefit of breastfeeding is much more than making sure that the baby “won’t die.” This analysis controlled for many confounders that are not usually considered, including child care attendance, presence of the father at home, household food insecurity, inter-parental conflict, and maternal depression. Even when adjusting for these and additional confounders, the association of breastfeeding with positive physical and developmental outcomes remain—breastfeeding was still associated with increased height of age, decreased physical stunting, and increases in overall child development. 

It is unarguable that it’s still important to promote and protect breastfeeding in developed countries. In undeveloped countries, breastfeeding makes the difference between life and death. In advanced countries, breastfeeding makes the difference between thriving and surviving.

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