We recently had a series of articles about our infant mortality and how we are worse than any state in the union. In the article they stressed the large number of teen moms and showed a picture of one bottle feeding. I am posting the answer that one of the pediatricians I work with wrote as I thought it was very good - and succinct. I am posting with her permission. Breastfeeding and essential weapon against infant mortality I commend the STAR for recent articles on the island's high infant mortality rate. I also commend the secretary of health for launching the educational campaign to decrease infant mortality. Clearly, emphasis on adequate prentatl care and avoidance of drugs, alcohol and cigarettes during pregnancy are important. However, there is a glaring omission in the article: the extremely low rates and durations of breasteeding in Puerto Rico substantially contribute to infant mortality. It is widely accepted that formula feeding is associated with increased infant mortality as well as morbidity (disease), even in developed countries. Estimates are that, even in the United States, breastfeeding has the potential to decrease infant mortality by 4 in every 1,000 live births. If Puerto Rico could achieve high rates of exclusive breastfeeding for 4 to 6 months as is currecntly recommended, there would be a huge impact on infant mortality incidence, bringing the 12.7 in 1,000 much closer to average stateside levesl of 8 in 1,000. The picture on the May 4 article on teenage pregancy tells the story. The baby has a bottle in it's mouth. This was a missed opportunity to point out the all to obvious correlation between the problem (dying children) and one of the most efficient and readily available solutions (mother's milk). Both the Puerto Rico and the San Juan Health Departments have proclaimed public policies to promote breastfeeding. We cannot afford to miss such golden opportunities as your article to educate people about the benefits of breastfeeding - and the risks of formula feeding. More importantly, Feliciano [Sec. of Health of Puerto Rico] and Varela [ Head of Dept. of Health of San Juan] MUST include breastfeeding support and promotion in both the "Action Committee for the Prevention of Infant Mortality" as well as the home visitation probram for at-risk mothers. Caroline J. Chantry, MD, FAAP Centro Pediatrico de Lactancia y Crianza, Inc. Ashford Hospital, Condado [Puerto Rico]