The WHO recommends exclusive breastfeeding up to 6 months of age and with other complementary foods up to 2 years of age or older (1) due to the multiple benefits for mother and baby. Today we talk about the indirect costs to the healthcare system of suboptimal breastfeeding rates.

The American Academy of Pediatrics defines suboptimal breastfeeding as breastfeeding that does not comply with exclusive breastfeeding for the first 6 months and continues breastfeeding until 1 year or as long as the mother or infant desires (2). In the US, among infants born in 2019, most (83.2%) started out receiving some breastmilk, and 78.6% received any breast milk at 1 month. But at 6 months, 55.8% of them received any breast milk and only 24.9% received exclusively breastmilk (3). Given these results, we can affirm that breastfeeding rates and duration in the US are lower than those recommended by the WHO. And this trend is similar at a global level, with an average of 2 out of every 5 infants being exclusively breastfed (4).

Breastfed infants are less susceptible to suffering from middle ear infections, gastrointestinal infections, and respiratory infections, including pneumonia, necrotising enterocolitis (NEC) and sudden infant death syndrome (SIDS) (4,5,6). Breastfeeding could also reduce the incidence of overweight, obesity, chronic diseases such as diabetes (5,6) and cancer such as leukaemia (7). It has also been observed that breastfeeding mothers have a lower risk of developing breast and ovarian cancer (8).

But what is the cost of suboptimal breastfeeding to the healthcare system?

Bartick et al. studied the incidence of premature deaths and infant and maternal illnesses attributable to suboptimal breastfeeding (6). They estimated that in 2014 in the United States, there were about 3,340 premature maternal and infant deaths due to the country’s low breastfeeding rates and a medical cost of $3 billion and $14.2 billion in costs due to premature deaths.

A study in Mexico estimated that the annual paediatric cost derived from suboptimal breastfeeding ranged from $745 million to $2,416 million associated with respiratory infections, ear infections, gastroenteritis, necrotising enterocolitis (NEC), and sudden infant death syndrome (SIDS) (9). The same authors published in 2018 the associated costs attributable to maternal diseases, such as type 2 diabetes, ovarian and breast cancer, myocardial infarction, and hypertension (10). They estimated that in 2012 in Mexico, there were 1,681 premature maternal deaths and a cost of $561 million due to suboptimal breastfeeding.

Along the same lines, in seven Southeast Asian countries, it was estimated that 12,400 preventable maternal and infant deaths and a cost of 0.3 billion dollars per year were associated with diarrhoea and pneumonia due to poor breastfeeding rates (11).

Finally, a study in Spain estimated savings of 51 million euros per year if 50% of infants were exclusively breastfed until 6 months of age (12).

These studies suggest that investing in strategies that provide effective support so that more women have the tools they need to breastfeed optimally would result in significant health improvements and cost savings.

References: 

1. World Health Organization. Breastfeeding [Internet] https://www.who.int/health-topics/breastfeeding#tab=tab_2
2. Eidelman AI, Schanler RJ. Breastfeeding and the use of human milk [Internet]. Vol. 129, Pediatrics. American Academy of Pediatrics; 2012. p. e827–41.
3. CDC, Breastfeeding Record Card https://www.cdc.gov/breastfeeding/data/reportcard.htm
4. UNICEF United Nations Children’s Fund. From the First Hour of Life. 2016.
5. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475–90.
6. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2017 Jan 19;13(1):12366.
7. Amitay EL, Keinan-Boker L. Breastfeeding and childhood leukemia incidence: A meta-analysis and systematic review. Vol. 169, JAMA Pediatrics. American Medical Association; 2015.
8. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Vol. 104, Acta Paediatrica, International Journal of Paediatrics. Blackwell Publishing Ltd; 2015. p. 96–113.
9. Colchero MA, Contreras-Loya D, Lopez-Gatell H, De Cosío TG. The costs of inadequate breastfeeding of infants in Mexico. Am J Clin Nutr. 2015;101(3):579–86.
10. Unar-Munguía M, Stern D, Colchero MA, González de Cosío T. The burden of suboptimal breastfeeding in Mexico: Maternal health outcomes and costs. Matern Child Nutr [Internet]. 2019;15(1):1–10.
11. Walters D, Horton S, Siregar AYM, Pitriyan P, Hajeebhoy N, Mathisen R, et al. The cost of not breastfeeding in Southeast Asia. Health Policy Plan [Internet]. 2016;31(8):1107–16.
12. Santacruz Salas E. Relación entre el tipo de lactancia suministrada y el gasto sanitario generado [Internet]. Universidad Complutense de Madrid; 2017.