Associations Between Breastfeeding and Post-perinatal Infant Deaths in the U.S

Area of Science:

• Public Health
• Epidemiology
• Maternal and Child Health

Background:

• Breastfeeding initiation is linked to lower infant mortality rates.
• Existing state initiatives promote breastfeeding, but regional and state-level data on its impact on infant mortality are lacking.

Purpose of the Study:

• To analyze the association between breastfeeding initiation and post-perinatal infant mortality at state and regional levels in the U.S.
• To identify geographic variations in the impact of breastfeeding on infant mortality.

Main Methods:

• Prospective cohort analysis of nearly 10 million U.S. infants born between 2016-2018.
• Linked national birth and post-perinatal infant death data, followed for one year.
• Analysis conducted in 2021-2022, examining data from 48 states and D.C.

Main Results:

• Overall, breastfeeding initiation was associated with a 33% reduction in post-perinatal infant mortality (AOR 0.67).
• All seven U.S. geographic regions showed significant reductions, with the Mid-Atlantic and Northeast regions demonstrating the largest effect.
• Thirty-five individual states reported statistically significant reductions in post-perinatal infant deaths associated with breastfeeding initiation.

Conclusions:

• Consistent evidence shows breastfeeding initiation reduces post-perinatal infant mortality across U.S. regions and states.
• Despite variations in effect magnitude, breastfeeding promotion and support are recommended strategies to decrease infant mortality nationwide.