If more women breastfed their babies for at least four months after birth, the healthcare cost savings could be significant, not to mention the health benefits for mothers and babies, UK researchers say.
“Studies show that there is often an unsympathetic public attitude to breastfeeding outside of the home, an acceptance of formula feeding as a normal and safe way to feed babies, a lack of expertise and experience of breastfeeding among health service staff,” said Subhash Pokhrel, a health economist at Brunel University in London who led the study.
“Women’s choice to start or to continue to breastfeed is therefore constrained by the culture and community in which they live,” Pokhrel said in an email to Reuters Health.
His group calculates, for example, that if 75 percent of the babies in British neonatal units were breastfed, rather than the current 25 percent, the country would save £6.12 million ($9.6 million) on a serious intestinal problem called necrotizing enterocolitis, which affects premature infants.
Previous studies have shown that stomach, respiratory and eye problems are more common in babies who are bottle-fed. The new study’s authors argue that the costs of these childhood ailments add up for the UK National Health Service.
They also point to research suggesting that women who breastfeed may have a lower risk of breast cancer later in life – and say that breastfeeding would provide additional cost savings in that regard.
Another health economist consulted by Reuters Health, however, said some of the benefits the authors attribute to breastfeeding may not be backed by enough solid evidence.
Pokhrel and his coauthors estimated the annual costs of treating four infant diseases - gastrointestinal, respiratory and eye infections and necrotizing enterocolitis - to be £89 million (US$140 million). In addition, they estimated the lifetime costs of treating maternal breast cancer at £959 million ($1.5 billion).
The costs of breast milk substitutes also add up to roughly £13 ($20) per week in the UK, they write in Archives of Disease in Childhood.
The researchers developed different scenarios in which four-month-old babies were breastfed at varying rates.
If all preemies were exclusively breastfed when they left the neonatal care unit, instead of the 35 percent who currently are, that would save £7.4 million ($11.6 million) yearly in treating necrotizing enterocolitis, according to the analysis.
If the number of mothers who breastfed exclusively for four months increased from 7 to 21 percent, hospital costs for gastrointestinal illnesses would go down by £1.2 million ($1.9 million) yearly, they say.
Increasing the breastfeeding rates from 7 to 21 percent at four months could save £2 million ($3.14 million) per year in hospitalizations and £300,000 ($471,250) in general practitioner costs for ear infections, the study found.
By doubling the number of mothers who breastfed for 7 to 18 months, the UK would save £31 million ($49 million) in maternal breast cancer costs, the authors calculate.
The number of women who breastfeed in the UK has increased from 62 percent to 81 percent in the past 20 years, but only half the women who breastfeed keep with it at six weeks, Pokhrel noted.
“We also know that there is good quality evidence showing the negative impact of using substitutes for breastfeeding on at least five diseases in children and mothers,” Pokhrel said of his reasons for wanting to do the study.
“All those diseases must cost the National Health Services dearly each year and it seemed like low breastfeeding rates were one of the drivers of that big cost,” he said.
The American Cancer Society, however, says on its website that while “breastfeeding has often been included in the protective behaviors against breast cancer . . . the research has been inconsistent.”
And Robert Kaestner, a professor in the Institute of Government and Public Affairs at the University of Illinois at Chicago, said there were not enough randomized studies showing the benefits of breastfeeding over bottle feeding.
“The real sticking point,” Kaestner said of the analysis, “is they assume breastfeeding has all these great benefits and that’s really something that’s less well documented than they state.”
“That’s a very problematic way to proceed, given the obvious differences you think of between those who breastfeed and those who don’t,” said Kaestner, who was not involved in the study.
“We can’t make policy based on an accounting exercise that is not as well founded as we’d like,” said Kaestner, who is also a research associate at the National Bureau of Economic Research.
Pokhrel said the evidence was strong enough that policymakers should take note and make breastfeeding easier for women who choose it.
“We would like to see action and policy developments to make it easier for women to do breastfeeding as long as they want - for example, by increasing community support, putting in place appropriate education for health professionals, and removing some of the social barriers such as having little provision in the workplace and making it easier to breastfeed in public,” Pokrhel said.
SOURCE: bmj.co/15SjLRv Archives of Disease in Childhood, online December 4, 2014.
