No, breastfeeding in the first hour does NOT reduce the risk of death by 40%

Black and white shot of newborn baby right after delivery

Extraordinary claims require extraordinary evidence.

UNICEF has made the extraordinary claim that breastfeeding within the first hour after birth reduces the risk of neonatal death by 40%:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastmilk saves lives in the developed world NOT because breastmilk is magical, but because contaminated water and lack of basic medical care are deadly.[/pullquote]

Delaying breastfeeding by two to 23 hours after birth increases the risk of a baby dying in its first month by 40 percent … UNICEF said…

UNICEF, which has been campaigning to promote early breastfeeding, estimates 77 million babies around the world each year are not breastfed within the first hour of their life. It estimates about 130 million babies are born each year.

“Breast milk is a baby’s first vaccine, the first and best protection they have against illness and disease,” France Bégin, UNICEF senior nutrition adviser, said in a statement.

“Making babies wait too long for the first critical contact with their mother outside the womb decreases the newborn’s chances of survival, limits milk supply and reduces the chances of exclusive breastfeeding.”

What evidence did they provide to support that assertion?

It’s not clear what they are referring to since they failed to provide citations, but there are only a handful of studies that have looked at the issue. As far as I can determine, UNICEF seems to be relying primarily on two papers, one from Ghana and the other from Nepal, yet UNICEF does not make it clear that the data they are relying on comes from underdeveloped countries with contaminated water.

So right off the bat, the claim that initiating breastfeeding within the first hour compared to later in the first day reduces the risk of death by 40% is deeply disingenuous. Many cultures believe that babies need pre-lacteal feeds of water, tea or other liquids. These may be prepared with contaminated water raising the possibility that the cause of increased mortality is NOT delaying breastfeeding but substituting contaminated water for breastfeeding.

Second, a large proportion of babies are born in industrialized countries where the threats to babies are much smaller. UNICEF offers no evidence that the risks that babies face in the developing world extend outside it.

Third, correlation is not causation. The fact that delayed initiation of breastfeeding is associated with an increased risk of neonatal mortality does not mean that delayed initiation of breastfeeding caused the increased risk of neonatal mortality. Contaminated water and lack of basic medical care are only two among many possible confounding variables. The authors of both papers tried to correct for the confounding variables that they recognized, but there may have been others that they did not recognize.

But there’s even a bigger problem here. The papers that UNICEF appears to rely upon reach conclusions that are not supported by their data.

The first paper is Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality that appeared in the March 2006 issue of Pediatrics.

The study took place in Ghana where breastfeeding rate are very high. Indeed breastfeeding was initiated in the first 24 hours in 71% if infants and 98.7% of infants were breastfeeding by day 3.

The following chart presents the authors’ findings:


As you can see, the neonatal death rate for babies breastfed in the first hour is taken as the reference point. Compared to babies breastfed within the first hour, the odds ratio of neonatal deaths for babies first breastfed between hours 1-24 is 1.45, meaning that there is a 45% increased risk of death. But take a look at the 95% confidence interval. It ranges from 0.9-2.35.

What are confidence intervals? They tell us the likelihood that the difference we observed experimentally represents a real difference.

If a 95% CI for the relative risk includes the null value of 1, then there is insufficient evidence to conclude that the groups are statistically significantly different.

And that’s just what we see here. The confidence interval includes the number 1 and therefore, there is insufficient evidence that the groups are statistically significantly different.

How about the second paper Breast-Feeding Patterns, Time to Initiation, and Mortality Risk among Newborns in Southern Nepal?

Here’s the relevant chart from that paper:


Once again we see that delaying initiation of breastfeeding from the first hour to the any time later in the day has a relative or 1.43 or a 43% increased risk of neonatal death. But once again we also see that the confidence interval (0.5-3.89) includes the value 1. Therefore we cannot conclude that the groups are statistically significantly different.

In other words, we cannot rely on the conclusions of either of these papers.

The idea that breastfeeding initiation within the first hour saves lives compared to the second hour or later is an extraordinary claim. Yet UNICEF does not merely fail to provide extraordinary evidence to support it; it fails to provide ANY evidence to support it.

No doubt the folks at UNICEF mean well, but they don’t seem to understand that scaremongering based on bad data is unethical.  They seem to be unable to avoid grossly exaggerating the benefits of breastfeeding. Moreover, it is deeply disingenuous to imply that what is lifesaving for infants in developing countries has any bearing on the health of babies in the rest of the world.

Breastfeeding is good; in certain parts of the world it may even be lifesaving. But that’s NOT because breastmilk is magical, but because contaminated water and lack of basic medical care are deadly. Perhaps if they spent less time making unsupported claims about breastfeeding and more time providing clean water and basic medical care, they could save far more lives than promoting breastfeeding ever would.