More breast-feeding, lower costs

If most new mothers could follow medical experts' recommendation to exclusively breast-feed for six months, countries might save billions in healthcare and other costs each year, a study suggests.

Researchers say the findings, published in the journal Pediatrics, underscore a need to make prolonged breast-feeding easier for women to manage.
How the study was done

For the study, the investigators calculated the current costs of 10 paediatric diseases for which there is evidence of a protective effect of breast-feeding -- including eczema, middle-ear infections, lower respiratory tract infections like pneumonia, asthma, type 1 diabetes and sudden infant death syndrome (SIDS).

They then estimated what the cost savings would be if 90% of new mothers in the US breast fed exclusively for six months, as is generally recommended.

The researchers calculated the direct costs of medical care, as well as indirect expenses, such as parents' time away from work to care for a sick child.

Based on their calculations, the US could save $13 billion per year, as well as prevent 911 annual deaths -- mainly from SIDS ("cot death"), necrotizing enterocolitis (an intestinal disorder seen mainly in preterm infants) and respiratory infections.

Government survey data suggest that while most US women start breast-feeding their newborns, only 32% are still exclusively breast-feeding at three months, and 12% are doing so at six months.

'Don't blame women'

However, the current findings should not be seen as placing blame on non-breastfeeding mothers for healthcare and other costs, the researchers say.

"We shouldn't be blaming women, because not only are they often not actively supported in attempting to breast feed, but they are also undermined" in a number of ways, lead researcher Dr Melissa Bartick, of the Cambridge Health Alliance and Harvard Medical School in Boston, said in an interview.

Hindrances often begin immediately, according to Bartick. She said there is research showing that keeping mother and newborn in skin-to- skin contact for at least the first hour of life is important in "imprinting" the baby's breast-feeding behaviour. But in most US hospitals, Bartick noted, newborns spend that time away from their mothers, being bathed and having routine tests, and then returned to mom tightly swaddled.

But while experts agree that breast milk is the best nutrition for infants, estimating the actual financial costs of suboptimal breast-feeding rates is not straightforward.

Bartick and colleague Arnold Reinhold based their estimates on data from a 2007 report from the US Agency for Healthcare Research and Quality (AHRQ), which reviewed evidence from more than 100 studies on breast-feeding and mother and infant health.

Breast-feeding lowers risks

The AHRQ report concluded that breast-feeding is associated with lower risks of certain infant health problems: For instance, on the basis of five studies, the report found that infants who were exclusively breast-fed for three to six months were half as likely to develop middle-ear infections as babies who were exclusively formula-fed.

However, the studies the agency reviewed were almost all observational -- meaning the researchers looked at rates of a given health problem among infants whose mothers chose to breast-feed and those whose mothers did not.

These types of studies cannot prove that breast feeding itself prevents certain illnesses, because there may be other important differences between babies whose mothers breast-feed and those whose mothers do not -- though researchers try to account for those factors to the extent possible.

Still, Bartick said, there are strong associations between breast-feeding and lower risks of a number of infant health problems, and "more than enough" evidence supporting the biological mechanisms by which breast-feeding could help prevent those diseases.

She also pointed out that her team's estimate did not consider mothers' health. Some studies have linked breast-feeding to lower long- term risks of certain diseases in mothers -- including type 2 diabetes and breast cancer -- so the $13 billion estimate may be too conservative, according to Bartick.

"My main message is that moms need more support for breast-feeding," she said.

Among her suggestions: better access to lactation counseling, which is often not covered by insurance; a scaling back in the "aggressive marketing" of infant formula, including the free samples given to new parents at the hospital, and paid break time for women to pump their breast milk or, where possible, offer flexible work schedules or on-site daycare.

Paid maternity leave could also help more mothers successfully breast-feed, according to Bartick. Right now, the US requires employers with 50 or more workers to offer 12 weeks of non-paid maternity leave."We're the only developed country in the world without paid maternity leave," Bartick said.

The SA situation

There has long been controversy about the promotion of formula to mothers on or below the bread line in South Africa, and while it's important to acknowledge that breast-feeding really is best for the baby, the reality is that most mothers are not in a position to stay home (or take their babies) to fulfil the six-month recommendation. Promotion of breast-feeding is also complicated by the country's high HIV-infection rate, and HIV-positive mothers can transmit the virus to their babies via breast milk. 

- (Reuters Health, April 2010)

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