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To the Editor: Dr Kramer and colleagues¹ found that an intervention to promote breastfeeding in a developed country (Belarus) increased the duration and exclusivity of breastfeeding. Although breastfeeding is known to result in a large absolute reduction in mortality in developing countries,^2-4 until now the benefit in developed countries was suspected but not certain. While the breastfeeding intervention resulted in a 4% absolute reduction in gastrointestinal tract infections and a 3% reduction in atopic eczema, it did not reduce rates of respiratory tract infections, otititis media, croup, or wheezing. Nor did it result in fewer hospitalizations. These health benefits seem to be modest and we are concerned that the conclusion of Kramer et al that "these results provide a solid scientific underpinning for future interventions to promote breastfeeding" is overstated.

Policy makers, health providers and health activists must take care in how the results of this study are used to . . . [Full Text of this Article]

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Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus
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JAMA. 2001;285(4):413-420.
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