Are the WHO / UNICEF guidelines on breastfeeding appropriate for India?

Using data from India's first National Family Health Survey (NFHS-1), this study examines breast-feeding practices and their effect on infant mortality in India. Conducted in 1992-93, NFHS-1 collected complete birth histories from a probability sample of 89,777 ever-married women aged 13-49 years. In the study, the breast-feeding status of infants at ages 2,7, and 11 months and the effects of exclusive and nonexclusive breast-feeding on mortality at ages 1-14 months were estimated using logistic regression models to NFHS-1 data. Separate analyses focus on three groups of states, distinguished according to levels of infant mortality, namely, high-mortality states, medium mortality states, and low-mortality states. Results show that breast-feeding reduces mortality in the first few months of life. The beneficial effects extend to older infants when combined with supplemental foods. At the same time, the results indicate that the effect of breast-feeding in lowering infant mortality is smaller the higher the level of mortality. The beneficial effects of both exclusive and nonexclusive breast-feeding are weakest in states where infant mortality is high and strongest in the medium-mortality states. Findings suggest that educational programs that promote breast-feeding with supplementation could help lower infant mortality in India.