Sometimes, doing the simplest things can save not only money, but lives. A recent study published in Pediatrics found that poor compliance with breastfeeding recommendations is costing the U.S. at least $13 billion each year, with nearly all of the cost related to infant illnesses and deaths.
The study's authors, Dr. Melissa Bartick of Harvard Medical School and Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics, found that if 90% of U.S. families followed the Department of Health and Human Services' guidelines, the U.S. would save $13 billion per year and prevent about 911 deaths, mostly of infants. Those guidelines call for six months of exclusive breastfeeding -- meaning, no other food or drink. An 80% compliance level would save $10.5 billion and prevent 741 deaths each year.
Experts agree that breast milk often provides the best nutrition for babies up to six months of age and lowers the risk of several diseases. The U.S. Surgeon General recommends that babies be fed with breast milk only for that first half-year of life.
But the Centers for Disease Control's National Immunization Survey found actual rates for exclusive breastfeeding at six months were only 12.3% in 2005. The survey also found that while 74.1% of mothers breastfed during the early postpartum period, only 42.9% reported any breastfeeding at six months, with just 21.5% still doing any breastfeeding at 12 months.
Direct and Indirect Costs
Similarly, in 2006, only 13 states met the quite low target set by Health and Human Services' Healthy People project: 17% of mothers exclusively breastfeeding their infants through six months of age.
The study authors listed direct and indirect costs associated with illness and premature death due to the current poor levels of breastfeeding compared with the predicted numbers of 90% of mothers doing so, adding they may be conservative estimates. In 2007 dollars, the costs were:
$4.7 billion and 447 deaths due to sudden infant death syndrome.
$2.6 billion due to 249 deaths from necrotizing enterocolitis, a common gastrointestinal syndrome in premature infants.
$1.8 billion due to 172 excess deaths from lower respiratory tract infections, such as pneumonia.
$908 million due to otitis media (ear infection).
$601 million due to atopic dermatitis (eczema).
$592 million due to childhood obesity.
To improve the situation, the authors recommend investing in strategies that would promote longer breastfeeding duration and exclusivity, saying the measures would likely be cost-effective.
Too Many Hurdles
But herein lies the crux of the problem. "Women in the U.S. want to breastfeed," says Bartick, who adds that three-quarters of them begin doing so. But a whole host of hurdles are put in their way, and very little social, cultural and government support exists to help women who want to breastfeed. It begins already in prenatal classes, says Bartick, where women are often asked to pay for a separate breastfeeding class.
Then, many hospitals are doing a poor job of educating and supporting mothers about breastfeeding, and often even offer formula to breastfeeding mothers. And, of course, there's work and conflicts with breastfeeding. "The U.S. is also the only Western nation without a paid maternity leave," Bartick notes. The lack of support continues as insurance companies won't pay far lactation-consultant services, often because states don't license them.
"We also cannot underestimate the effect of the aggressive marketing of formula makers," Bartick says, adding that the U.S. now accounts for half of the world's formula market. That marketing influenced the mothers and grandmothers of today's new moms. They have never breastfed, and knowledge was lost, says Bartick. While breastfeeding is natural, it's also a learned behavior.
Moms Are Not at Fault
But some progress is being made. The health care reform package will bring federal help to bear on the problems with a section regarding support for employed breastfeeding moms. And the Bartick-Reinhold study's release comes on the heels of a letter sent to Congress on March 16, signed by 90 organizations, asking for an appropriation of $15 million per year to help build the support necessary to improve breastfeeding rates. Also, as of April 1, promoting breastfeeding is an added measure of hospital quality.
The Centers for Disease Control's Breastfeeding Report Card for 2009 lists the improvements in some areas, including better hospital support, increased professional support from lactation consultants, mother-to-mother support, infrastructure support and legislative support, including laws protecting breastfeeding in public.
Bartick emphasizes that until these support systems improve, mothers cannot and should not be blamed for low breastfeeding rates. "There is markedly inadequate support in the U.S. They're undermined at every corner. That's why the rates are not as high as they should be."