What price breastfeeding?

Article written by Dr Susan Tawia, Senior Scientific Information Officer, Breastfeeding Information and Research team, for the September 2013 health professional member eNewsletter.

What is the value of breastfeeding? Several papers have been published which look at the ‘cost’ of not breastfeeding infants or conversely the value of breastmilk and breastfeeding from a public health and economic perspective in Australia.

Over the last decade, Dr Julie Smith, a Research Fellow at the Australian Centre for Research on Health has written a series of papers on the topic of breastfeeding, population health and economics in Australia.

A study by Smith, Thompson and Ellwood (2002) found that premature weaning, that is exclusive breastfeeding for less than 6 months, added around $1 to $2 million annually to ACT hospitalisation costs of treatment of infants and children (aged 0–4 years) for gastrointestinal illness, respiratory illness, otitis media, eczema and NEC.

When these figures were extrapolated nationally, it was estimated that between $60 and $120 million could be saved annually across the Australian hospital system, just for these childhood illnesses.

In 2010, Smith and Harvey calculated the difference in the risk of developing a chronic disease depending on whether people had been breastfed or artificially fed as infants.

By using the data on disease development and data about breastfeeding rates in Australia from 1945 to 2005, they were able to calculate the proportion of chronic disease in the adult population that can be attributed to not being breastfed exclusively to 6 months (Table 1).

 

% of chronic disease in the population that is attributable to not being breastfed exclusively for 6 months

% of population not being breastfed exclusively for 6 months

Obesity

Type 2 diabetes

Cardio-vascular disease

90

20

37

15

30

8

16

6

10

3

6

2

Table 1. Attributable proportion of chronic disease risk for different percentages of population not being breastfed exclusively to 6 months. It must be remembered that these figures calculate the proportion of chronic disease in a population, not the risk to individuals.

So, for example, if 90% of the population are not exclusively breastfed to 6 months, then 20% of obesity in that population can be attributed to artificial infant feeding. If 10% of the population are not exclusively breastfed to six months, then only 3% of that population’s obesity can be attributed to artificial infant feeding.

As a result of this research, Smith and Harvey concluded that ‘encouraging greater duration and exclusivity of breast-feeding is a potential avenue for reducing future chronic disease burden and health system costs.’

Julie Smith has just had two further papers on the economics of breastfeeding published in the Journal of Human Lactation. The first paper determined the value of the economic contribution of breastmilk if it was included in calculations of the Gross Domestic Product (GDP) of Australia and the second looked at the time it takes mothers to exclusively breastfeed an infant at 6 months compared with non-exclusive breastfeeding.

The first paper demonstrated how the economic value of breastmilk production can be included in, and valued as part of the national food system or GDP estimate in Australia.

Smith acknowledges that breastfeeding cannot be reduced to its economic aspects, but states that estimating the economic importance of breastfeeding would:

  • emphasise the extent of breastfeeding and its value
  • acknowledge the unique contribution breastfeeding women make to society
  • highlight its importance to economic welfare and
  • contribute to more accurate and soundly-based economic and health policies.

Since breastmilk is now traded as a good in a market, it can be included in calculations to estimate the economic value of breastmilk production.

Using the price of breastmilk sold by milk banks in the US, it was estimated that breastmilk production levels in Australia exceed $3 billion annually and prematurely weaning infants before 6 months results in ‘substantial loss of economic benefit.’

In the second paper, Smith and Forrester (2013) addressed the question of ‘who pays for the health benefits of exclusive breastfeeding?’

By tracking the time usage of Australian mothers, they found that mothers exclusively breastfeeding 6-month-old infants spent on average 18 hours per week or 2.6 hours a day breastfeeding their infants. They also spent 7 hours extra breastfeeding, but 2 hours less per week feeding solids compared with mothers who had introduced artificial baby milk or others foods.

Exclusive breastfeeding was found to be time intensive and economically costly to women, which may lead to premature weaning before 6 months. In order to gain the public health benefits of exclusive breastfeeding, policies giving mothers the time to exclusively breastfeed to 6 months are required, such as 6 months paid maternity leave.

The most recent statistics for breastfeeding in Australia found that, although 60.1% of Australian infants receive some breastmilk at 6 months, only 15% of infants were exclusively breastfed in their 6th month of life (AIHW 2011).

More and more, the research clearly shows that exclusive breastfeeding to 6 months has both public health and economic benefits which need to be acknowledged and used to develop more accurate and soundly-based economic and health policies.

Mothers who exclusively breastfeed their infants to 6 months contribute both to the physical and economic health and welfare of their own infants and society at large.

Women who exclusively breastfeed to 6 months should not be economically penalised for doing so. Policies such as 6 months paid maternity leave would acknowledge the importance of their contribution and may discourage premature weaning.

 

References

Australian Institute of Health and Welfare (AIHW) 2011, 2010 Australian National Infant Feeding Survey: indicator results. Canberra.

Smith JP, Thompson JF, Ellwood DA 2002, Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory. Aust New Zeal J Public Health 26: 543–551.

Smith JP 2013, “Lost Milk?” Counting the economic value of breast milk in Gross Domestic Product. J Hum Lact doi: 0.77/08903344 3494827

Smith JP, Forrester R 2013, Who pays for the health benefits of exclusive breastfeeding? An analysis of maternal time costs. J Hum Lact doi: 0.77/08903344 3495450

Smith JP, Harvey PJ 2010, Chronic disease and infant nutrition: is it significant to public health? Public Health Nutr 14: 279–289.