title: Child mortality associated with reasons for non-breastfeeding and weaning: is breastfeeding best for HIV-positive mothers?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences, Baltimore, MD 21205, USA. hbrahmbh@jhsph.edu
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D001942:Breast Feeding; D002648:Child; D002755:Choice Behavior; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006306:Health Surveys; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D018570:Risk Assessment; D015983:Selection Bias; D016019:Survival Analysis; D013997:Time Factors; D014886:Weaning