Health is one of the priority areas of sustainable human development. It is part of the Millennium Development Goals (MDGs). Indeed, MDG 1 and MDG 4 focus on reducing malnutrition and infant mortality. Thus, most of the development stakeholders are aware of this real fact and attempt to address health issues worldwide. In developed countries, health indicators display quite a satisfactory rate that resulting from concrete actions that have been carried out for the population regarding children and mothers. In these countries, the mortality of children under 5 years old has declined by half. In other words, the number of child deaths decreased from 90 to 46 per 1000 live births in 2013 according to the estimates . However, in developing countries, particularly in Sub-Saharan Africa, the mortality rate of children under five is high . In Sub-Saharan Africa, the probability of children to die before they turn 5 is 14 times higher than in developed countries . Sub-Saharan Africa has the highest child mortality rate in the world with 1 child out of 12 who dies before his fifth birthday . In Côte d’Ivoire, the rate of mortality under 5 years old varies respectively from 106 to 103, 99, 96, and to 93 per thousand live births in 2011, 2012, 2013, 2014, and in 2015 . Regarding infant mortality, the rates vary from 104.9 to 99.5, 84.1, 81.3, 79.0, 76.9, 75.0, 72.8, 70.6, 68.5 and to 66.6 (per 1000 live births), respectively, in 1990, 2000, 2007, 2008, 2009, 2010, 2012, 2014, and in 2015 . The downward trend in mortality is the positive result of the measures taken by the government on public health. During the same period, progress has been made in the health sector in Côte d’Ivoire, particularly in Mother and Child Protection Services, where access to the health care system is free. Health care is supported by public hospitalsFootnote 1. Cesarean delivery is free in public health centers and the cost of normal birth is reduced .
Furthermore, to promote children’s growth, development, and survival, WHO and UNICEF recommend exclusive breastfeeding during the first 6 months after birth. In the implementation of this recommendation, since 1991, the Ivorian public health authorities have reinforced the breastfeeding program with the initiative “Hospitals Babies’ Friends” . This is a global strategy, developed jointly by WHO and UNICEF whose goal is to protect, encourage, and promote breastfeeding. In Côte d’Ivoire, many hospitals have supported breastfeeding through this initiative, thereby increasing the number of breastfeeding mothers . In the same context, since 1995, the World Breastfeeding Week is celebrated every year among women of childbearing age, especially mothers on practicing exclusive breastfeeding up to the first 6 months of child’s life . The Ivorian government continues to intensify through campaigns, lectures, debates, workshops and seminars, and promotion of exclusive breastfeeding across the country . Exclusive breastfeeding is a decline factor in infant mortality . In fact, breast milk is the first safe food for children aged between 0 and 2 years old . It covers all the nutritional requirements of infants while protecting them against infectious diseases . Breastfeeding promotes children’s sensory and cognitive development .
Several studies show that breastfeeding is a child mortality reduction factor. Filmer and Pritchett  who say that drinking water and quality infrastructure are factors to improve children’s health under 5 years old. Economic development implies access to basic social services such as schools, health facilities, access to drinking water, and road infrastructure. Thus, Christopher Grigoriou  shows the positive impact of economic development on child mortality. Despite the growth in the 1990s in Burkina Faso, Lachaud  argues that poverty still persisted. He conducted a study to explain the link between changes in child survival and the persistence of poverty. In this study, he emphasizes the determinants of infant and child survival. They are the standard of living of households in terms of assets, education of the mother, the geographical location of households, childbirth assisted by qualified medical staff, mothers’ age during birth, intergenesic interval, multiple births, and birth rank. Among these factors, the mother’s education draws the attention of most authors who worked on these issues. They focus on the role of educated mothers on increasing child survival chances. In his study in Bobo Dioulasso (Burkina Faso), Banza Baya  shows that parental education significantly increases the chances of child survival. The mother’s education acts through several channels. Economically and socially, formal instruction enables households to obtain gainful employment, secured source of the welfare of the family, children in particular. Culturally, formal instruction promotes access to information by the media concerning practical measures to improve the nutritional status and health of children.
Furthermore, in addition to socio-economic determinants of child survival, some authors emphasize the feeding modes that can significantly contribute to maintaining the child’s good health. In this perspective, regarding children with ages between 0 and 1 year old, health officials consider breastfeeding as the first and best infant food . In this conception, after a sociological analysis, Bayard  emphasizes that breast milk provides benefits for mother and child on the physical, psychological, emotional, and cognitive aspects. Breast milk completely covers the nutritional needs of infants and is one of the best investments regarding child survival, since its cost lies primarily in the mother’s diet . Breast milk is known for its nutritional value (vitamins, minerals, proteins, fats, carbohydrates) and immune . Breastfeeding and birth spacing have significant effects on child survival in China . The act of birth planning allows the mother to increase the duration of breastfeeding at the first child level under the age of 2 years old and over according to the recommendation of the World Health Organization . The practice of breastfeeding fight against intestinal and respiratory infectious diseases . Breastfeeding is associated with a reduced risk of gastrointestinal infections . The protective effect is higher against gastrointestinal and intestinal infections than against respiratory infections and increases with exclusive breastfeeding . Breast milk is a complete food necessary for the child’s growth, development, and survival . Breastfeeding is the most effective way to save the life of infants . It is also a means of preventing early malnutrition compared to artificial milk . It is therefore the best mortality reduction factor. Breastfeeding in the early hours preceding the birth and exclusive breastfeeding for the first 6 months are key interventions to achieve MDG 1 and MDG 4. These authors continue their analysis and show that breastfeeding produces long-term effects. According to them, this mode of feeding plays a preventive role regarding certain diseases that may occur during adulthood, such as hypertension, cardiovascular disease, and obesity.
Most authors emphasize the importance of breastfeeding during the first 6 months of infant life. However, in the economic literature, few empirical studies highlight the positive impact of healthy environment on child survival. Our contribution is to show that a healthy environment is also one of the key factors in child survival after the crucial role that exclusive breastfeeding plays in the child’s growth process.
Despite the government's efforts in urban sanitation, the mentality and the behavior of the Ivorian people do not change. In the neighborhoods as well as inside the city, several people throw rubbish at the roadside. Waste management is poorly designed in Côte d’Ivoire. Much work remains to be done. An unhealthy environment is the source of several diseases such as typhoid fever, cholera, dysentery, and measles. These are diseases created by microbes (bacteria, viruses). Children aged 0 to 5 years old are very vulnerable compared to poor living environment. So, our study places particular emphasis on showing the impact of a healthy environment on the survival of children specifically.
In general terms, using an econometric approach our study evaluates the impact of breastfeeding on infant survival and highlights some major socio-economic determinants of child survival from 0 to 5 years old.
The interest of this analysis lies in the choice of the variables of the estimation model. This will allow us to answer our questions. Hence, we are in need of a methodology for analysis.