While the study that showed infant mortality at 4/1000 may have been valid
at the time the study was published (Rogan, 1989, Cancer from PCB's in
Breast Milk? A risk benefit analysis.  Pediatric Research 25:105A ), infant
mortality rates have dropped significantly since then and it is almost
certainly not still true. In the US, rates have dropped from 15/1000 in
1989 to 7/1000 in 1999.  Furthermore, Rogan's estimate was based on a
mathematical model, not an epidemiological study and has never been
substantiated by data.  At least 1/2 of the current infant mortality in the
US is from causes which breastfeeding cannot contribute to- congenital
anomalies, RDS, maternal complications, placenta/cord, accidents, birth
asphyxia. That would account for 3.5/1000. If you look at the other half
SIDS, low birth weight (bottle feeding would only be secondary from reduced
interbirth interval), neonatal infections, pneumonia and other I would be
surprised if you could make a case for even 1/2 being attributable to
bottle-feeding. Some will be iatrogenic nursery infections that feeding
method may influence, but it certainly couldn't be considered causal. You
could probably make a good case for pneumonia and SIDS. Studies show a 2-5
fold increase in risk for pneumonia from bottle-feeding, if we attribute
80% of pneumonia deaths pneumonia it would represent 0.12/1000 infant
deaths per year. SIDS deaths have gone from 1.39/1000 in 1989 to 0.64 in
1998, if 80%(highest estimate I have seen) of those cases are attributable
to bottle feeding it would translate to 0.51/1000 infant deaths per year in
US. Because feeding method is highly correlated with socio-economic status
and poverty in this country and so are infant death rates, and because
breastfeeding is not well defined, it is very difficult to demonstrate that
any of these deaths are directly attributable to feeding method. If we
assume that 1/2 of the 3.5/1000 deaths may be influenced by feeding method
(and that is quite a stretch), the maximum impact might be about 1.75/1000
deaths attributable to bottle feeding. You can probably defend 0.5-1/1000
deaths attributable to feeding method as a contributing cause. Of the
approximately 25,000 infant deaths per year in the US that would be between
1800 and 6500 which is still a lot of inexcusably dead babies. I think the
real problem is that deaths attributable to bottle-feeding are insidious
and less recognized. If a baby dies in a car accident it is easy to assign
cause, but it is more difficult to recognize problems associated with
formula feeding. Cathy Liles

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