Study Overview
Infant formula use has been implicated in tens of millions of infant deaths in low and middle-income countries over the past several decades, but causal evidence of its link with mortality remains elusive. We combine birth record data from over 2.6 million infants across 38 countries in the Demographic and Health Surveys (DHS) with reconstructed historical data from annual investor reports on the timing of Nestlé entrance into infant formula country markets.
Study Results
Consistent with the hypothesis that formula mixed with unclean water could act as a disease vector, we find that infant mortality increased in households with unclean water sources by 19.4 per thousand births following Nestlé market entrance, but had no effect among other households. This rate is equivalent to a 27% increase in mortality in the population using unclean water and amounts to about 212,000 excess deaths per year at the peak of the Nestlé controversy in 1981.
Intervention: Infant formula
News & media
The deadly toll of marketing infant formula in low- and middle-income countries
10/31/23
One message that emerges from our analysis is the critical importance of making sure that parents who use formula, use it safely. Clear instructions comprehensible to mothers of all education levels need to be included in marketing and packaging materials. In regions where many households do not have access to clean water, infant formula companies may consider pre-mixing formula with clean water, or perhaps including chlorine tablets with formula packaging.
This Economist Reveals the Deadly Truth About the Trump Administration’s Assault on Breastfeeding
7/10/18
For a recent paper, University of California-Berkeley economist and public health expert Paul J. Gertler and a team of colleagues looked at infant mortality rates in low- and middle-income countries, comparing regions that had access to infant formula with regions that didn’t. They found no impact, except under one condition: In communities that lack clean water, access to formula raised infant mortality by 9.4 per 1000 births—essentially, the availability of formula “led to more bad water getting to infants,” he said. “The formula [served] as a vector for bad water.”