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The two best ways to reduce infant mortality

Preventing early childhood death is one of the main objectives of the global-health community. But while huge investments in health-care infrastructure will no doubt be needed to achieve this goal, the highest returns will most likely come from encouraging maternal immunization and breastfeeding.


One of the more ambitious targets of the United Nations Sustainable Development Goals (SDGs) is the commitment to end preventable deaths of newborns and children over the next decade. If this target is met, by 2030 no country will have a neonatal mortality rate above 12 deaths per 1,000 births – a quarter of the current rate in parts of Sub-Saharan Africa.
Given the magnitude of the challenge, huge investments will be needed in health-care infrastructure and planning. Perhaps the most effective way to reduce infant mortality would be to encourage uptake of two readily available resources: maternal vaccinations and breast milk.
Protecting children from early deaths begins before they are born. When a woman is vaccinated against common illnesses like influenza, her body creates antibodies that recognize viruses and boost natural defenses against pathogens. When she becomes pregnant, these protective proteins are transferred to her baby across the placenta.
Remarkably, the benefits continue after birth. For example, while the flu shot is not approved for infants younger than six months old, clinical trials have shown that children born to mothers who have been vaccinated are better protected against the illness. In one study of mothers and their babies in Bangladesh, researchers recorded a staggering 63% reduction in influenza cases among infants born to vaccinated mothers, a 36% reduction in the number of serious respiratory illnesses for mothers, and a 29% reduction in such illnesses among infants.
Maternal immunization against the flu also helps protect infants from pneumonia, a common cause of childhood mortality. A 2018 analysis of flu-vaccine trials conducted in Nepal, Mali, and South Africa found that infants were 20% less likely to develop pneumonia if their mothers had been inoculated. Children too young to be completely vaccinated against Streptococcus pneumoniae and influenza were the biggest beneficiaries. Armed with data from these and other studies, governments in low-income countries should be able to plan smarter immunization campaigns and substantially lower rates of infant morbidity and mortality.
The second way to reduce childhood mortality, breastfeeding, arguably has a greater impact. Breast milk is the perfect nutrition for a baby, providing all the proteins, fats, vitamins, minerals, and enzymes that a young body needs to stay healthy. Best of all, mothers create new antibodies in real time, which help strengthen young immune systems.
Unfortunately, rates of breastfeeding and breast-milk consumption are well below desired levels. Only 40% of infants worldwide are breastfed exclusively until they are at least six months old, as the World Health Organization (WHO) recommends. The reasons are complex, but in many countries, lack of education, together with aggressive marketing by makers of baby formula, has contributed to a decline in breastfeeding. Recently, the United States has been accused of siding with the formula industry by opposing a WHO resolution in support of breastfeeding.
Convincing mothers to breastfeed should be easier. For starters, breastfed babies are less likely to contract ear infections and meningitis, or to suffer gastrointestinal illnesses and diarrhea. These advantages continue for as long as a baby is breastfed.
Mothers also benefit from breastfeeding. Research shows that women who have breastfed during their lives are less likely to develop non-communicable diseases like cardiovascular illness, breast cancer, and type 2 diabetes. Many of these gains derive from the fact that breastfeeding helps break down the extra fat that accumulates in a woman’s body during pregnancy. In fact, producing milk for a single infant burns as much as 500 calories a day.
Even though the majority of new mothers are able to breastfeed, not all women can produce enough milk, owing to exhaustion, depression, or physical weakness following postpartum surgery. Some mothers are simply unable to meet their child’s needs, while others lack the medical or social support to navigate the logistics of breastfeeding. Nonetheless, for those who can supply their babies with at least six months of breast milk, the benefits are significant.
If the international community is serious about meeting the health targets set by the SDGs, it must redouble its efforts to encourage more mothers to be vaccinated against preventable illnesses and to feed their newborns breast milk. These two practices alone could do more to reduce infant mortality than just about any other global health initiative.

Melvin Sanicas, a public health physician and vaccinologist, is regional medical expert at Sanofi Pasteur – Asia, Japan, and the Pacific. He is a consultant for the World Health Organization, a partner at the Brighton Collaboration, and an independent expert reviewer for the Coalition for Epidemic Preparedness Innovations and the National Vaccine Program Office.

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