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A study published in the journal Pediatrics, (May 2004), titled "Breastfeeding and the Risk of Postneonatal Death in the United States," reports a 21% reduction in infant death for having EVER breastfed.

When they compare 3 months of any breastfeeding to less or no breastfeeding, the reported reduction is 36%. That's 36% fewer infant deaths! If they were to compare 3 months of exclusive breastfeeding to no breastmilk, their number would have been closer to 50% — the same number as in my prior research article BELOW:

(ADDED April 2006): This study and my below article are about industrialized nations. A more-recent large-scale study taking place in poor areas of Ghana, India, and Peru found a shocking 10.5 times the number of deaths for those not breastfed versus those exclusively breastfed. Partially breastfed infants had 2.5 times the risk of death as those exclusively breastfed. Bulletin of the World Health Organization, 2005

February 1, 2004
Infant formula was designed to be a medical nutritional tool for babies who are unable to breastfeed. Formula does not fully meet the nutritional and immunity needs of infants, leaving their tiny systems flailing. An infant's immune system has three aspects: her own immature, developing immune system; the small component of immunities that passes through the placenta during natural childbirth (and to a lesser degree with premature births and cesarean sections); and the most vast and valuable, living portion that is passed on through mother's milk on an ongoing basis. Remove any of these components and you take away a vital support structure.

This brings us face to face with the safety and effectiveness of infant formula as a breast milk substitute. Is formula actually as safe as we have been led to believe? In fact, the answer is a resounding "no." In fact, the use of infant formula doubles the risk of infant death for American babies.

While the dangers of formula feeding aren't something you're likely to hear in your doctor's office, the conclusions can be derived through an examination of the available scientific research on infant mortality in the United States and across the world. There are studies showing artificial feeding's impact on overall infant death rates in both developing and undeveloped countries. While studies offering comparative death rates are not available for industrialized regions, there are numerous studies providing comparative occurrence rates for many illnesses and disorders in the United States and other industrialized nations. Many more reports are available extolling superior survival rates and decreased illness rates among breastfed infants, but only those with solid numbers are useful here. We can assemble the statistics from these studies to build a firm picture of the ratio of infant deaths for U.S. formula-fed babies against those who are breastfed.

The Relative Risks of Formula
It is clear that feeding infants artificial formula instead of breastfeeding increases their relative risk of death. A number of studies point to this fact. Table 1 shows figures from two studies measuring infant mortality risks during certain age ranges. A risk number of 3 in the chart represents three times the risk of infant death for infants who are artificially fed.

While the numbers in the charts reflect any amount of breastfeeding during the study period (and not necessarily exclusive breastfeeding), nearly all studies mention that during the first six months, exclusive breastfeeding produces much higher survival rates than partial breastfeeding. No studies refute this assertion. Figures for each age range listed here do not include children who died prior to reaching that age group. Figures reflect infants who received no breast milk or had weaned prior to reaching the reported age group versus those who received any breastfeeding through that age.

Table 1 clearly demonstrates that the disadvantages of formula are most devastating in the earliest months. Significant disadvantages for formula continue throughout the year-long study period.

Suggested Relative Risks for Infant Deaths
No Breastfeeding or Any Breastfeeding Ending Before Designated Age Ranges vs. Breastfeeding Through Designated Age Ranges1,2

Country	Author	0 to 2 Months	3 to 5 Months		6 to 11 Months
Mexico	Palloni	13	6		3
Brazil , Pakistan and Philippines (pooled)	World Health Organization	0 to 2 Months	2-3 Months	4-5 Months	6-8 Months	9-11 Months
Brazil , Pakistan and Philippines (pooled)		6	4	2.5	2	1.5

A relative risk of 13 here means that a child who was not breastfed through the time period has thirteen times the risk of dying during his first year as a child who had received any breast milk through that period.

The studies cited in the next table compare no breastfeeding with 12 months of breastfeeding, each deriving a relative risk of death over the full first year.

Suggested Relative Risks for Infant Deaths
No Breastfeeding vs. Any Breastfeeding for 12 Months3-7

Country	Author	Current Infant Mortality Rate (IMR)	IMR During Period Study was Performed	Relative Risk To Formula-Fed Infants
United States		7		Number we wish to find
Malaysia	Habicht	19	30	> 2 *
Mexico (from Table 1)	Palloni	24	38	10 *
Philippines	Guilkey	28	31	> 5.5
China	Tu	27	36	> 3.0
Peru	Palloni	38	100	2.5
Brazil , Pakistan , and Philippines , pooled (from Table 1)	WHO	48 average		4.5 *
India	Srivastava	61	106	> 1.5

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.
A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying as an infant who is partially or completely breastfed.
* These values are calculated from numbers provided in the studies, with averages weighted by percentages of total deaths occurring in each age range. More than two-thirds of deaths occur during the first month.

While the United States has a current infant mortality rate of 6.75 per thousand, many countries have rates approaching 100, with 16 of 225 reporting nations suffering well over 100 infant deaths for every 1,000 children born.8 The nations in the above table with lower infant mortality rates can thus be seen as somewhat comparable to the U.S.

Factors influencing high infant death rates include malnourished mothers, high numbers of births per mother with short spacing between births, poor weaning foods, the early use of cow's milk, inadequate medical attention and supplies, poor sanitation leading to high infection rates and a rapid spread of infectious disease, and limited education about methods of limiting infection and the spread of disease.

Why do U.S. Babies Die?
Below are the percentages and total numbers of U.S. infants who die from various leading causes, according to the 1999 National Vital Statistics Reports.9,10

Total U.S. births in 1999:	4,000,000
Total U.S. infant deaths in 1999:	28,000

20%	Congenital abnormalities (birth defects)	5,500
16%	Low birth weight and premature birth	4,500
10%	Sudden Infant Death Syndrome (SIDS)	2,700
8.5%	Complications during pregnancy and birth	2,400
6%	Respiratory distress: lung collapse, influenza, pneumonia	1,750
3%	Accidents (unintentional injuries)	850
2.5%	Bacterial sepsis (infections)	700
2.4%	Circulatory system diseases	650
1.4%	Necrotizing enterocolitis	400
1%	Intestinal inflammations (diarrhea)	300
0.3%	Meningitis	100
0.3%	Cancer	100

Numbers account for 70% of total infant deaths

So how does formula play into these deaths? Let's look at some of the common causes of infant death and see what current research has to say on the involvement of infant formula.

Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) accounts for a full 10% of U.S. infant deaths. Several studies performed in the United States and other industrialized nations reveal increased risks of SIDS among babies who receive formula instead of breast milk. In the table below, the 2002 Scandinavian study takes into account variables thought to have affected the 2000 U.S. study, finding even stronger risks associated with formula.

The most recent U.S. study (2003) takes advantage of the lessons from these earlier studies to raise confidence in its final results. Its finding of five times the risk of infant death from SIDS for formula-fed infants seems to be the most powerful statistic yet.

Studies Demonstrating Relative Risks of Infant Death from SIDS
Formula-Fed vs. Breastfed11-17

Country	Author	Year of study publication	Relative risk for SIDS, formula-fed infants
United States	Hauck	2003	5
Scandinavia	Alm	2002	1.6 to 5.1
United States	McVea	2000	2
Germany	Schellscheidt	1997	7.7
England	Gilbert	1995	3.1
United States	Klonoff-Cohen	1995	2.7
New Zealand	Ford	1993	2

A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying from SIDS as an infant who is breastfed.

Heart, Circulatory and Respiratory Failure
Premature infants and those with circulatory abnormalities often display one or more warning signs of potential death, including inadequate oxygenation of the blood, apnea (episodes where breathing stops) and high blood pressure. Studies illustrate the dangers of formula for these infants. One study observed better body temperature and superior oxygenation in pre-term infants receiving breast milk. Formula-fed infants demonstrated many episodes of inadequate oxygenation and some apnea, both of which were not seen among the breastfed infants. A Scottish study found significantly better blood pressure among naturally fed infants.

Three U.S. studies are available examining feeding methods for infants with early circulatory problems. One study reported that more than half of infants with congenital heart disease lost oxygenation during bottle feedings, while none did so while breastfeeding. Another study also dealing with heart disease found infants' growth to be significantly inferior and their hospitalizations to be longer when they were fed formula. A third study of very low birth-weight infants found twice as many episodes of inadequate oxygenation among formula-fed infants as in those who received breast milk.

Heart and Circulatory Disease in Formula-Fed vs. Breastfed18-22

Country	Author	Year	Findings for formula-fed infants
Scotland	Wilson	1998	Higher blood pressure
Taiwan	Chen	2000	Apnea and many episodes of oxygen desaturation (none among breastfed infants) Inferior body temperature regulation
USA	Bier	1993	Double the episodes of oxygen desaturation
USA	Combs	1993	Less growth; longer hospital stays
USA	Marino	1995	Oxygen desaturation during more than half of bottle feedings (none during breastfeeding)

Necrotizing Enterocolitis
Necrotizing enterocolitis is a severe intestinal inflammatory disorder that affects around 4% of low birth-weight babies and 1% of full-term infants. About one-third of low birth-weight infants and 20% of full-term infants who contract this disorder die. While necrotizing enterocolitis is reported to be responsible for 1.4% of infant deaths, many more unconfirmed cases are likely to be responsible for some portion of infant deaths reported as caused by prematurity.

In the United Kingdom , it was discovered that confirmed cases of necrotizing enterocolitis occurred in three times as many infants who received no breast milk as in those who received both breast milk and formula. For infants who exclusively received breast milk, necrotizing enterocolitis occurred six to 10 times less often than among wholly formula-fed infants.

Necrotizing Enterocolitis23

Country	Author	Year	Relative risk of necrotizing enterocolitis, formula-fed infants
United Kingdom	Lucas	1990	6-10 times more often

Diarrhea
A World Health Organization (WHO) study revealed a risk of diarrhea for formula-fed babies in developing nations averaging more than six times that of breastfed babies. A summary article for industrialized nations demonstrated an average of triple the risk of diarrhea for formula-fed babies. The risk in China and Israel is reported as slightly less than triple (2.8); in Scotland , the risk is five-fold; and a doubled risk is measured in Canada .

While one study noted nearly twice the risk of developing diarrhea for artificially fed infants in Brazil , other studies have demonstrated that the risk of actually dying from diarrhea was an astounding 14 to 15 times greater. The latter studies demonstrated not only that the artificially fed infants suffer higher rates of illness, but also that the severity and duration of their illnesses are even greater when they do occur and result in proportionately more deaths. This same assertion is demonstrated in a study from India , where formula-fed infants suffer six times the death rate, once diarrhea occurs, as breastfed infants with diarrhea.

Four separate studies in the United States all deduce a doubled risk of diarrhea for formula-fed babies. The U.S. studies also reiterate the well-established factor of greater severity and extent of illness once diarrhea does occur among formula-fed babies. Death rates for formula-fed U.S. infants who get diarrhea may be three times higher or more than their breastfed contemporaries.

The table below collates the reported risks of diarrhea for formula-fed infants from many studies.

Diarrhea Risks for Formula-Fed vs. Breastfed24-40

Country	Author	Year	Relative risk of diarrheal illness (or death), formula-fed infants
Israel	Palti	1984	2.7 (during the first 5 months)
Brazil	Victora	1989	14 times the death rate
Scotland	Howie	1990	5 (compared with infants with 3 months of breastfeeding)
India	Sachdev	1991	6 times the death rate with diarrhea during the first 6 months
Canada	Beaudry	1995	1.9
Philippines	Yoon	1996	9 times the death rate
Mexico	Lopez-Alarcon	1997	4 to 6.3
Industrialized nations, pooled	Golding	1997	3 (gastroenteritis and diarrhea)
China	Fu	2000	2.8 (during the first 4 months)
6 developing nations	WHO	2000	6 (during the first 6 months)
Italy	Gianino	2002	3 (rotavirus, including increased severity)
Brazil	Escuder	2003	15 times the death rate (during the first 6 months) 2.2 times the death rate (from 4 to 11 months)
Brazil	Vieira	2003	1.8
USA	Dewey	1995	2
USA	Scariati	1997	1.8
USA	Wright	1998	2
USA	Raisler	1999	2 (during the first 6 months)

Respiratory Illnesses
Numerous studies document higher numbers of respiratory infections among formula-fed infants than among those who are breastfed. It is clear that respiratory infections are at least triple in the United States for formula-fed infants. The death rate is likely to be even higher, since some of these studies note that both the severity and extent of respiratory illnesses are considerably higher once they occur.

Respiratory Illness Risks for Formula-Fed vs. Breastfed41-50

Country	Author	Year	Relative risk of respiratory illness (or death), formula-fed infants
Israel	Palti	1984	3.7 (during the first 5 months)
Brazil	Victora	1987	3.6 times death
Italy	Pisacane	1994	4.5
Mexico	Lopez	1997	2 to 8.5 (during the first 4 months) 1.5 to 3 times as many days for each occurrence
Scotland	Wilson	1998	1.9 (during the first 4 months)
Brazil	Cesar	1999	17 times hospitalization for pneumonia
USA	Wright	1998	2 (bronchitis) 4 (pneumonia)
USA	Levine	1999	3.7 (pneumococcal disease, 2 to 11 months)
USA	Blaymore- Bier	2002	6 times as many days of upper respiratory infection (during the first month)
USA	Bachrach	2003	3.5 (severe respiratory tract illnesses)

Cancer
A joint study between the United States and Canada on neuroblastoma, a common childhood cancer, revealed a doubled risk for children who did not receive breast milk for more than one year. This study is consistent with several other childhood cancer studies in other nations, with results ranging from 1.45 to 4 times the risk for developing various common childhood cancers for formula-fed babies.

Childhood Cancer Risks for Formula-fed vs. Breastfed51-56

Country	Author	Year	Findings for formula feeding and cancer risks
China	Shu	1995	1.5 (leukemia and lymphoma)
UAE	Bener	2001	2.8 (leukemia and lymphomas for no or less than 6 months breastfed versus longer breastfeeding)
France	Perrillat	2002	2 (leukemia for breastfeeding over 6 months)
U.S. & Canada	Daniels	2002	2 (neuroblastoma)

Low Birth-Weight and Pre-term Birth
Representing 16% of U.S. infant mortality totals, premature birth and low birth-weight are the second leading diagnoses on death certificates of U.S. infants. While prematurity may lay the foundation for difficulties in tiny infants, the factors that actually take their lives include infection, respiratory distress, unconfirmed necrotizing enterocolitis, circulatory deficiency and diarrhea. These diagnoses are often detectable only with a biopsy, so the listed cause in these cases is often simply prematurity. One study that performed autopsies on a group of extremely low birth-weight infants who had not survived found that infection was the actual primary cause of death for half of the infants. Prematurity was the cause of death predominantly for infants who weighed less than one pound.

Preemies in India who received only preemie formula were found to develop more than twice as many infections as those who received some human milk. Another Indian study on high-risk newborns found that those receiving human milk plus formula suffered twice the infection rate of those receiving only pasteurized human milk and triple the rate of those receiving only raw human milk. A Columbian study found a nearly doubled death rate for low birth-weight infants who were partially or completely formula fed. And a Malaysian study found a huge difference in total infant survival among extremely low birth-weight babies who received expressed breast milk as opposed to those who did not.

A U.S. study performed at George Washington University Hospital found 2.5 times the number of infections among formula-fed infants in the intensive care unit than among those receiving human milk. Another study at Georgetown University Medical Center also found more than double the number of infections in very low birth-weight infants not receiving human milk. A San Diego study found twice as many infections in pre-term, formula-fed infants compared with infants who received human milk.

As shown in many other studies, the extent and severity of infection among pre-term and low birth-weight infants are generally greater in formula-fed infants as well. One study gives a solid example for preemies, finding respiratory infections among U.S. formula-fed preemies to run six times as many days as those in their breastfed counterparts.

Pre-term Infant Illness and Death Rates57-64

Country	Author	Year	Relative risk for illness or death, formula-fed pre-term and low birth-weight infants
India	Narayanan	1980	2.25 times the infections for no breast milk as opposed to some
India	Narayanan	1984	2 times the infections for formula plus pasteurized breast milk as pasteurized breast milk alone3 times the infections as raw breast milk alone
Malaysia	Boo	2000	Many times the death rate for no breast milk
Columbia	Charpak	2001	2 times the death rate for any amount of formula as for exclusive breastfeeding
USA	el-Mohandes	1997	2.5 times the infections
USA	Hylander	1998	2 times the infections
USA	Schanler	2001	2 times the infections
USA	Blaymore-Bier	2002	6 times the duration of upper respiratory infections

Exclusive feeding of raw breast milk is not always an option for premature infants, although it is common in some hospitals with excellent support. Sometimes, less-effective pasteurized breast milk is used and often fortifiers are added. Several studies show decreased survival for infants fed milk with added fortifiers as opposed to those fed unfortified milk,65-68 but the picture is complex and the choices of fortifiers vary greatly.

And finally, it is worth noting that the eye damage that can occur in very low birth-weight infants, retinopathy of prematurity, occurs only half as often in infants who receive some breast milk.69 Even a disorder as apparently unrelated to feeding methods as inguinal hernia has been discovered to occur twice as often in artificially fed infants and even more frequently when compared with infants who are exclusively breastfed.70

Congenital Abnormalities
Twenty percent of U.S. infant deaths are attributed to birth defects. The most common potentially lethal birth defects include heart disorders, various chromosomal or genetic defects and underdeveloped lungs. In terms of infant formula's impact, we have the least amount of statistical information in this category. However, many factors suggest that formula-fed infants with congenital abnormalities have smaller chances of survival than their breastfed counterparts.

While death certificates often list the initial abnormality as the cause of death, infection is actually the final factor in many of these deaths. We have already seen how drastically infection rates and deaths are reduced by breastfeeding. It is clear that the youngest and weakest infants are the ones who are most strongly endangered by infant formula's inadequacies.

Studies suggest that formula-fed infants suffer inferior blood oxygenation and higher blood pressure as well as more episodes of apnea (cessation of breathing for a short time) than their breastfed counterparts. While no studies compare the actual survival of such infants in the United States , it is obvious that some proportion of babies with congenital heart abnormalities is being seriously disadvantaged by formula feedings. Artificially fed infants with heart defects requiring surgery are less likely to live until their surgery and less likely to recover from surgery's challenges.

A wide variety of common birth defects has been shown to have better survival rates among breastfed infants, although the actual figures are not available. Most birth defects have not been specifically studied in this regard. The background information, nonetheless, is striking.

For example, infants born with phenylketonuria (PKU), a defect in handling a certain protein in the diet, need specialized supplementation to breast milk in order to prevent mental retardation and other difficulties. Yet a study demonstrated that infants who had been breastfed before being diagnosed with PKU fared far better than those who had been fed on formula.71 The greatest complications for infants with cystic fibrosis are lung infection, decreased oxygenation and malnutrition — all of which are recognized to be complicated by formula feeding.72 The negative impact of formula on neurological development has been demonstrated in healthy infants.73-76 One study that quantified the effect reported double the amount of neurological "non-normality" in formula-fed infants.77 It is reasonable to assume that neurological damage or problems stemming from birth disorders can be exacerbated by artificial feeding.

Clearly, feeding choice may have a significant impact on the survival of infants born with various defects, although there is not enough information available to render an actual ratio of survival.

Complications of Pregnancy and Birth
Complications of pregnancy and birth produce a wide range of injuries and problems for babies. Some certainly pose no hope of survival. Infection, insufficient neurological recovery and inadequate oxygenation lead to many infant deaths. Artificial feeding certainly has some degree of impact on mortality in these cases. Based on a lack of further detailed evidence, we will apply a very modest number to figures for increased risk of death for formula-fed infants in this category.

Accidents
It seems logical that accidents happen equally among artificially and naturally fed infants. Figures bear this out. One paper actually measured accidental injuries between breast- and formula-fed infants, finding an equal number in both.78

Examining the Numbers
So now we are left to examine artificial feeding's actual impact on all American babies. First, we note that there should be a relationship dictating that if rates for a certain disease are doubled by formula feeding, for instance, then death rates for that disease may also be somewhere in the neighborhood of doubled when compared with rates for breastfed infants. In fact, the evidence suggests that the death rates would be even higher. While formula feeding may result in twice as many episodes of a certain illness, a great number of studies demonstrate that each of these episodes are also longer and more severe. This would suggest that the rate of death among artificially fed infants from various causes would actually be higher than the rates that the various illnesses occur.

The reported percentages of U.S. infants dying from each cause include a certain number of infants who were breastfed and a portion who were formula-fed. Because formula feeding's impact is much more or less influential in some disorders than others, we need to weigh each category accordingly. (This exercise will account for the assumption that a lower proportion of infants who died from congenital abnormalities, for instance, were formula-fed infants than the proportion who died from SIDS.) Because two-thirds of all infants die in the first month, and because exclusive breastfeeding runs about 50% during the first month, this number can be used in the calculations to help weigh the greater or lesser impact of breastfeeding for each cause.

2001 U.S. Breastfeeding Rates79,80

Study	Hospital Initiation		4 Months		6 Months		12 Months
	Any BF	Exclusive	Any BF	Exclusive	Any BF	Exclusive	Any
Ross/Abbott Labs	69.5%	46.2%			32.5%	17.2%
National Immunization Survey	65.1%	59%	35%	24%	27%	7.9%	12.3%

An overall risk rate of infant death for formula-fed infants has been selected conservatively based on the available information presented in this paper for each cause of death in the table below. Assuming that 50% of the total infants born were breastfed, we can calculate formula-fed and breastfed infant death rates and totals for each cause.

Because one-third of the deaths actually occurred as the percentage of infants breastfeeding was dropping to a much smaller number, the use of 50% throughout the calculations keeps the resultant finding very conservative. Although the literature reiterates time and again how the extent, severity and frequency of disease is greater in formula-fed infants, I have only taken this factor into account in an extremely conservative manner in instances where the literature provides solid numerical examples. In other instances where this aspect is not clearly demonstrated, I have not used this factor at all. Again, this effort keeps the final quotient conservative. Finally, the ratios from many studies used are for full formula feeding versus any amount of breastfeeding. Some of these ratios would be much higher if formula feeding were compared to exclusive breastfeeding. This factor again keeps our final conclusion conservative.

Here's the Math
There are 4,000,000 births annual births in the United States . Using 50% as the number of infants who have actually been breastfed, the number of infants breastfed (B) equals 2,000,000. The number of formula-fed (F) infants also equals 2,000,000.

B = F = 2,000,000
R = Infant Mortality Rate (IMR) for each cause
RB = IMR for breastfed
RF = IMR for formula fed
Rel = Estimated Relative Risk for formula feeding versus breastfeeding, for each cause

RFF + RBB = Total Number of Deaths for that cause = TND

RF = Rel x RB

RF x 2,000,000 + RB x 2,000,000 = TND

Rel x RB x 2,000,000 + RB x 2,000,000 = TND

RB = __________TND___________
	Rel x 2,000,000 + 2,000,000

RB x 4,000,000 = Number Deaths if all B

Let's apply this formula to congenital abnormalities. Clearly, feeding's impact in this category could be significant, but there is not enough solid statistical evidence to say for sure. If we modestly assume a 50% higher death rate for the 50% of formula-fed infants, the number of breastfed infants who died would be 2,200. The number of formula-fed who died would be 3,300. If all of the infants had actually been breastfed, then the total number of deaths would be 4,400 — a savings of 1,100 lives.

The relative risk for formula feeding in other categories was much more clearly defined by the studies. Conservative but appropriate rates were selected, as seen in the table below.

Calculating Formula's Final Impact

Cause of death	Actual U.S. infant deaths (1999)	Relative risk for formula-fed infants	Estimated IMR for breastfed babies	Deaths if all were breastfed	Deaths if all were formula-fed	Lives saved if all were breastfed
Congenital abnormality	5500	1.5	1.1	4400	6600	1100
Prematurity	4500	2.5	.643	2570	6430	1930
SIDS	2700	4	.27	1080	4320	1620
Complications of pregnancy & birth	2400	1.25	.533	2135	2670	270
Respiratory distress & infections	1750	4	.175	700	2800	1050
Accidents	850	1	.213	850	850	0
Bacterial infection	700	3	.087	350	1050	350
Circulatory problems	650	1.5	.13	520	780	130
Necrotizing enterocolitis	400	8	.022	90	710	310
Diarrhea	300	2.5	.043	170	430	130
Meningitis	100	3	.014	55	170	45
Cancer	100	2	.02	80	160	20

SUBTOTALS	19950	2.075	3.25	13000	26970	6955
All other	8050	2	1.6	6440	12880	1610
TOTALS	28000	2	4.7	18665	37335 IMR 9.4	9335

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.

Based on the current U.S. infant death rate of 6.75 and an average breastfeeding rate of 50%, the American infant mortality rate would climb to 9.4 if all infants were formula-fed and would drop to 4.7 if all were breastfed. Twenty-two nations with high rates of breastfeeding have infant mortality rates below 5, while the U.S. ranks higher in infant death than 41 other nations.81 Clearly, lower rates for the United States are a possibility.

The Ugly Truth About Formula
From the above statistics, we see that formula feeding costs American babies more than four additional lives per thousand. The final relative risk for formula feeding comes out to 2 — that's double the risk of death for American infants who are fed with formula, compared with babies who are fed naturally.

A multitude of studies demonstrate that when breastfeeding is accompanied by formula supplementation, illness and death rates are much closer to those of babies who are fully formula-fed. Studies also reveal conclusively that the longer breastfeeding lasts, the greater the measurable difference in illness and death rates.

Answering the Detractors
Criticisms are often spread about studies that find increased illness and death rates associated with formula feeding. For just this reason, each later study aggressively attempts to take into account any factors that have been purported as distorting previous study outcomes. These research papers address as many aspects as possible, from maternal education, to smoking, to income level, to day care usage and many more possibilities. The results continue to reveal the risks of formula feeding.

It's commonly said that formula feeding does not risk lives in industrialized nations where education and medical advances prevent increased deaths. The evidence is quite to the contrary. Some insist that the blame for the United States ' relatively high infant death rate lies with underprivileged communities. Again, it has been shown that elevated death rates among U.S. blacks cannot be attributed to poverty. Hispanic Americans rank similarly to African-American populations for socio-economic factors, but they match non-Hispanic whites in their lower infant mortality rates. The difference is not socio-economic; rather, it's in rates of formula use versus breastfeeding.82-84

A New York study sought to establish the connection between education, income and infant survival. It concluded strongly that the number of illnesses is increased by two to three times in formula-fed babies regardless of socioeconomic status or level of parental education.85 A later study in Israel confirmed the effects of formula feeding across all classes and education levels.86 The most recent analysis of this issue, again performed in the United States, reiterated that higher illness rates among formula-fed or formula-supplemented infants "did not differ among income groups."87

And Beyond the First Year
While the extent of breast milk's health protection declines with age, a great number of studies demonstrate the continued survival advantage of breastfeeding through the second year and beyond. A World Health Organization study of less-developed countries found a doubled risk of death in the second year of life for those weaned prematurely or never receiving breast milk.88 A study in The Netherlands found a strong correlation between the extent of breastfeeding and the number of illnesses in children. Significant protection from breastfeeding was noted during the first three years of life.89 Other studies show a sizeable increase in illnesses throughout all of childhood for those who were never breastfed or prematurely weaned.90-92 In fact, an increased risk of death throughout life has been well documented for people who were formula-fed. Higher blood pressure, more heart disease, obesity, diabetes and artery disease, a nearly doubled rate of Crohn's disease and tripled rates of celiac disease have all been associated with early formula feeding.93-105

What Your Doctor Doesn't Tell You
Pediatricians spend much time frightening parents with 1 in 100,000 risks from vaccine-preventable diseases when parents question the utility and safety of vaccines. "Would you want to risk the life of your child?" they demand. Yet these very same professionals offer formula samples with the other hand — when the magnitude of health risks associated with the use of formula is 500 times greater.

Parenting is all about making choices and weighing risks and benefits. Many parents need to make the riskier choice of formula feeding in order to balance other factors that benefit the family. Yet some parents who have lost their children, possibly based on pediatric advice condoning or encouraging formula-feeding, would surely wish that they had been informed of the very real risks related to using formula.