The objective of this paper was to assess the contribution of the timing of initiation of breastfeeding to any impact. Based on data from Ghana, the results show that the risk of neonatal death was four times higher in children who were not exclusively breastfed (given milk-based fluids or solids in addition to breast milk). Delay in initiation of breastfeeding, from one hour to seven days had and increasing risk of neonatal mortality. The authors state that 16 per cent of neonatal deaths could be saved if all infants were breastfed from day one and 22 per cent saved if breastfeeding started within the first hour. Promotion of early initiation of breastfeeding has the potential to make a major contribution to child survival and achieving the MDGs and breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding.