IFC Comments on the April 2010 Pediatrics Article “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis”

 

An April 2010 article published in the journal Pediatrics suggests if 90% of U.S. mothers were to exclusively breastfeed for six months, the U.S. would save $13 billion per year.¹ The International Formula Council* (IFC) believes breastfeeding is ideal and offers specific child and maternal benefits.  However, we believe this study’s economic analysis misrepresents the data and fails to take into account certain factors, such as costs associated with breastfeeding at work.  

There is widespread acknowledgement that breast milk is the best form of nutrition for babies and there is a growing body of high quality research intended to quantify the benefits of breast milk.  The primary reference for the study, a 2007 report by the Agency for Healthcare Research and Quality (AHRQ) on breastfeeding and health outcomes, concluded that, “There were insufficient good quality data to address the relationship between breastfeeding…and infant mortality.”²  Yet Bartick and Reinhold’s estimate of $13 billion dollar savings is heavily dependent on estimates of costs associated with excess deaths, based on infant mortality. Defining the value of life and lost wages associated with infant illness as health care costs is inaccurate and misleading.  

 

The literature on infant feeding and health outcomes is primarily based on epidemiological models, and there are inconsistencies and lack of adequate control among many of the studies.  Women who breastfeed are typically older, more educated, and have a higher socioeconomic status.  Potential poor health outcomes may have a much stronger association with lower socioeconomic status and poverty than “lack of exclusive breastfeeding.”

 

Further, many of the studies analyzed in the AHRQ report, upon which this analysis was based, have inconsistently-defined key variables (e.g. “breastfeeding” is defined as “any” in some studies and “some” in others). Additionally, some studies are over 10 years old and, in some cases, subsequent literature has been published showing little if any relationship between breastfeeding and a certain disease state (e.g. SIDS, obesity). Bartick and Reinhold chose to examine selected new literature since the AHRQ report (e.g. Vennemann et al.) in their analysis, but did not do a systematic review to examine and include all post-AHRQ literature. Therefore, a potential bias exists in the data examined.

The authors make no attempt to calculate the cost of breastfeeding and do not acknowledge that there are associated costs to breastfeeding. Examples include the cost of healthcare professionals’ time to assist breastfeeding mothers, costs associated with breast pumps, pads and other accessories, costs of treating breastfeeding-related mastitis, and the indirect costs associated with mothers’ time spent breastfeeding.

 

Efforts to increase breastfeeding rates would be best served by addressing the major barrier to breastfeeding in the U.S. -- the lack of workplace support programs.  Research indicates that returning to work is one of the most common reasons women stop breastfeeding.  Current data from the Centers for Disease Control and Prevention show that breastfeeding initiation rates are at an all time record high of 77% -- which exceeds the 2010 Healthy People goal.   However, the greatest drop in breastfeeding rates happens at three months -- the time when mothers typically return to work. Additionally, the US is one of the only developed nations without paid maternity leave for working mothers. For any breastfeeding promotion program to be successful, workplace barriers to breastfeeding must be addressed.

 

A recent Shriver report (2009) found that for the first time in U.S. history, women represent half of all U.S. workers and mothers represent the primary breadwinners or co-breadwinners in almost two-thirds of American families.³  Thus, unless there are significant workplace support program for working mothers, it is unrealistic to expect 90% of new U.S. moms to exclusively breastfeed for six months when many of them are challenged by the economic necessity of returning to the workplace before their baby is six months old.

References Cited:

 

1. Bartick, M. and Reinhold, A. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics 2010.

2. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007(153):1-186.

3. Shriver, M. The Shriver Report: A Woman’s Nation Changes Everything. October 2009 (available at: http://www.americanprogress.org/issues/2009/10/womans_nation.html)