Breastfeeding behavior and infant survival with emphasis on reverse causation bias: Some evidence from Nigeria

Tbe possibility of selection bias in the estimation of the effects of breas tfeeding on subsequent survival is implied by the clinical evidence that ch ildren who are healthier at birth are more likely to be breastfed than thei r less healthy counterparts who may be prone to difficulties in sustaining breastfeeding. This paper addresses an important problem in understanding t he association of breastfeeding and child survival with regard to reverse c ausation. It utilizes data on the reported reason for weaning to assess the degree to which reverse causality may be responsible for observed associat ions. The analysis indicates that children who are weaned in the neonatal p eriod because of illness or weakness to suckle, experience a much higher ri sk of dying than others. This is not mainly because of the cessation of bre astfeeding, but because of the original factor, being their illness. Any bi ases imparted by an initial selection mechanism appear, therefore, to have influence on the effectiveness of breastfeeding behavior.