My turn to address all of you Wise Ones:
Help me understand, please. I'm reading the segment Infant Feeding and Infant Mortality in B&HL, 4th Ed., page.62.
The two key sentences in these two paragraphs are:

"Infant mortality has tended to be highest among populations in which breastfeeding was most common: the poor."
"The advent of primary health care for a large portion of a population may explain decreased in infant mortality in the face of declines in breastfeeding."

The authors, Riordan and Wambach, cite five key studies that establish these facts and explain them in much greater detail in the balance of these two paragraphs. If you have this essential text book, please read these two paragraphs yourself.

My take-away message is, if you are really, REALLY impoverished poor, it doesn't matter HOW you feed your baby.
It takes a primary (organized) population-wide health care program to reduce infant mortality.
ONLY after good health care does breastfeeding matter and formula feeding becomes a problem.

The accompanying study guide has a test question on this section to affirm that fact about poverty in the student's learning program.

Then I read this famous quote:
"Breastfeeding is a natural "safety net" against the worst effects of poverty. If the child survives the first month of life (the most dangerous period of childhood) then for the next four months or so, exclusive breastfeeding goes a long way toward canceling out the health difference between being born into poverty and being born into affluence .... It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born."
--James P. Grant, former Executive Director, UNICEF
(He gave no citations to studies.)

And I look at the photo of the Pakistani woman and her twins.
The girl was formula fed and died.
The boy was breastfed and lived.
Maybe she was poor but not impoverished?
And I haven't yet found a date for that photograph.

This is NOT criticism of the authors. It is my personal confusion or misunderstanding. 
I always thought breastfeeding was normal / natural / best / a life-saver, no matter what.
Where am I going wrong with these concepts? 
And how did humans survive before anyone ever thunk up formal health care?

Background: I am preparing a basic breastfeeding educational program using several key reference texts and this was a major stopper for me. If I am confused after so many years of practice, how do I explain this to my students?

Phyllis
Maybe too many grey hairs affect brain function?

--
Phyllis Adamson, BA, IBCLC, RLC
Glendale, AZ.
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