Individual-level retrospective data from the Malaysian Family Life Survey are used to examine why the infant mortality rate (IMR) has declined rapidly in Malaysia since World War II. Substantial increases in mothers’ education and improvements in water and sanitation have contributed. However, breastfeeding reductions have kept the IMR from declining as rapidly as it would have otherwise. The detrimental effects of reduced breastfeeding more than offset the beneficial effects of water and sanitation improvements. The majority of the IMR decline, however, is not explained by changes in the variables considered here, or in their relationships with infant mortality.

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