3.1 Evidence Linking Breastfeeding to Improved Outcomes
Breastfeeding contributes to infant nutrition and health through a number of important mechanisms. It provides a complete source, of nutrition for the first six months of life, half of all requirements in the second six months of life, and one-third of requirements in the second year of life.12 It provides immunity as well as other factors that protect against specific illnesses. When infants and children become ill, breastfeeding provides an important source of nutrients because intake of breastmilk is not reduced in contrast to the intake of complementary foods, which declines considerably.13-15 Furthermore, exclusive breastfeedinga eliminates the risk of illness through the use of contaminated foodstuffs and utensils. It also lengthens the period of postpartum amenorrhoea and hence, in the absence of contraceptive use, lengthens the birth interval, which is strongly related to infant and child survival.
a Breastfeeding with no other food or fluid given to the child, not even water.
Because infant feeding mode cannot be randomly assigned, all data on the protective effect of breastfeeding on morbidity and mortality are observational. However, the dose-response effect observed with exclusive breastfeeding, any breastfeeding, and no breastfeeding provides evidence of causality.16-19 The risk of death decreases dramatically as the infant ages; therefore the protective effect of breastfeeding on mortality is greatest in the first month of life and declines by month until 6 months.20 Many - though not all - studies continue to show protective effects until 12 months of life, and some studies show protective effects into the second year as well. A dose response has also been observed between the amount of breastmilk consumed through a naso gastric tube in preterm infants and cognitive development1 and between a longer duration of exclusive breastfeeding and reduced risk of obesity among school-age children.5 A similar pattern is observed with the protective effect of breastfeeding on morbidity, with the protective effects being greatest in the first 6 months of life and reduced thereafter.17, 18
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