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Cost Benefits of Breastfeeding

Written by Karen M. Zeretzke, MEd, IBCLC   
Thursday, 01 September 2005 00:00
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Asked at a Blue Cross/Blue Shield health care cost containment in Minot, North Dakota: “What helps reduce the incidence of ear and respiratory infections, intestinal disease, pneumonia, meningitis, Crohn’s disease, colitis, diabetes, childhood cancers, allergies, constipation, urinary tract infections, tooth decay and obesity? It also increases intelligence and reduces the incidence of breast cancer for the mother.”

No one knew the answer was breastfeeding…

Today I would add that breastfeeding reduces ovarian and cervical cancer, juvenile rheumatoid arthritis, bacterial and viral infections of all types and increases visual acuity, optimal neurological and social and oral development, as well as saves money for health care providers and families.


Cost Benefits of BreastfeedingCost Benefits of Breastfeeding

Medical costs for breastfed infants were ~$200 less per child for the first 12 months of life than those for formula-fed infants; extrapolating this to the Healthy People 2000 goal of 50% of infants breastfed could save this HMO up to $140,000 annually. This study included office visits, drug prescriptions and hospitalizations (Hoey and Ware, 1997).

Infant diarrhea in non-breastfed infants costs $291.3 million in annual health care costs. Respiratory syncytial virus (RSV) costs $225 million in annual health care costs. Insulin-dependent diabetes mellitus costs from $9.6 to $124.8 million in annual health care costs.

Otitis media costs $660 million in annual health care costs.

Total annual cost of not breastfeeding: $1.186 to $1.301 billion

Additionally, formula provided by WIC program to non-breastfeeding mothers costs $2,665,715 annually. (Riordan, 1997)

Increasing breastfeeding in Australia could add A$3.4 billion to the national food output (equal to an extra 0.7% of the GNP). (Smith, 1997)

  • Reduction in childhood cancer saves $10 million
  • Reduction in childhood diarrhea $100 million
  • Reduction in ear infections $500 million
  • Reduction in tympanosomies $500 million
  • Reduction in juvenile onset diabetes $2.6 billion
  • Reduction in hospitalization for RSV $225 million

total conservative estimate of cost savings nationally for 1 year: $4.18 billion (Lee, 1997)

  • Cost savings in disease: $3.689 billion
  • Cost savings in health expenditures: $3.96 billion
  • Cost savings in household expenses: $2.835 billion
  • Breastfeeding Support costs (1 LC/1000; additional training; direct support): $360 million

Cost Benefits of Breastfeeding

Cost/benefit ratio of 0.7—over $1 billion would be saved by providing Lactation Consultant Support (Labbok, 1995)

Annual reduction in Maternal Medicals at delivery (Philadelphia-based): $91,650. Annual reduction in premenopausal cancer: $202 million. Annual reduction in domestic violence: $42.5 million. (Lee, 1997)

Overall estimated savings of $459–$808 per family enrolled in four social service programs: Medi-Cal, WIC, AFDC, Food Stamps. (Tuttle and Dewey 1996)

Overall estimated savings of $112 for the first six months of life per infant enrolled in Medicaid; pharmacy coasts were one-half the amount of formulafed infants—infants were breastfed exclusively for a minimum of three months. (Montgomery and Splett 1997)

Overall a minimum of A$115 million could be saved/year in Australia by increasing breastfeeding rates to 80% at three months calculating savings only in otitis media, IDDM, gastrointestinal illness and eczema. (Drane 1997)


The Mother

Short-Term Benefits

Pitocin, usually administered to newly postpartum mothers to prevent hemorrhage, costs about $4.49/patient for supplies: ($0.84 18 French angiocath; $1.40 IV tubing; $0.76 saline IV fluid; $0.30 one ampule pitocin; $1.10 syringe). Babies breastfed immediately postpartum make this process unnecessary, saving $4.49/patient x ?? patients/year =


Long-Term Benefits

Breast Cancer: Treatment of breast cancer is approximately $30,000 annually/ patient. Breastfeeding reduces the incidence of breast cancer. (Lee 1997)

Diabetes: Breastfeeding reduces a diabetic mother’s need for insulin and a two-fold reduction or delay in the onset of subsequent diabetes for a gestational diabetic. Treatment of diabetes takes one of every $7 of health care dollars, and costs the US $130 billion annually. This is for direct treatment and does not factor in the high incidence of kidney disease, peripheral vascular disease and blindness which accompany diabetes.

Emotional Stability: Oxytocin, a hormone released each time a mother breastfeeds, decreases blood pressure, stress hormone level and calms the mother. A 38-fold difference in the frequency of domestic violence and sexual abuse was found between the group that breastfed and the group which did not. (Acheston 1995)

Infertility: Breastfed women were 25% less likely to have hyperprolactinemia, galactorrhea and menstrual disturbances according to Dr. Shafig Rahimova. He also feels that males not breastfed are at greater risk of developing genito-urinary difficulties.

Ovarian and Endometrial Cancer: A WHO Collaborative Study found the relative risk of endometrial cancer decreased significantly with increased duration of breastfeeding; women whose lifetime lactation was 72 months or greater had the greatest protection. Those breastfeeding for less than one year did not accrue this benefit. (Rosenblatt, 1995)

Lactation has a preventative effect on ovarian cancer; the ACS estimates 26,888 new cases of ovarian cancer will be diagnosed this year. For every 1.6 women who did not lactate, only one woman who did developed ovarian cancer. (Gwinn, 1990)

Osteoporosis: Lactating protects women against osteoporosis; not breastfeeding is a risk factor in its development. Bone mineral density decreases during lactation but after weaning showed higher bone mineral density than those who did not breastfeed. A mother’s bone mineral density increases with each child breastfed; lumbar spine density increased 1.5% per child breastfed. Thus a decrease in the risk of a fracture of the hip, vertebrae, humerus or pelvis. (Kalwart and Specker 1995; Hreschyshyn 1988)

In 1983 osteoporosis and osteoporotic fractures cost an estimated $6.1 billion; an adult white woman who lives to the age of 80 has a 15% lifetime risk of a hip fracture. (Cummings 1985)

Rheumatoid Arthritis: In Norway, 63,090 women with rheumatoid arthritis were followed for 28 years. The total time of lactation was associated with reduced mortality; the protective effects of breastfeeding appear dose related. (Brun 1995)

Weight Loss: During the first year postpartum, lactating women lose an average of 2 kg more than nonbreastfeeding women, with no return of weight once weaning occurs. The impact of overweight impacts health by increasing chances of cardiovascular disease and diabetes. (Dewey 1993)


The Baby

Short-Term (Up to One Year)

Allergies: Allergy protection is one of the most frequently cited reasons mothers choose to breastfeed. Premature infants are also protected from allergies; breastfed preemies had less than one-third of the allergies, particularly atopic disease, in the first 18 months of life. (Lucas 1990)

There has not been a documented case of anaphylaxis to human milk. (Baylor, 1991; Ellis 1991)

Estimated treatment cost of allergy diagnosis and treatment is $400; acute reaction treatment costs about $80-100 per episode. (Hoey at 1996 ILCA Conference)

Estimated treatment cost of allergy diagnosis and treatment is $400; acute reaction treatment costs about $80-100 per episode. (Hoey at 1996 ILCA Conference)

Anemia: Piscante 1995 reports that “none of the infants who were exclusively breastfed for 7 months or more…were anemic.”


Communicable Childhood Diseases

Antibody response to oral and parenteral vaccines is higher in the breastfed infant. Formula feeding, particularly soy formula, may interfere with the immunization process. (Zoppie 1989; Hahn-Soric 1990)

Death: Breastfeeding protects against sudden death from botulism. In one study, all of the infants who died were not breastfed. (Arnon 1982)

Globally, breastfeeding has been identified as one element of protection against SIDS. (Mitchell, 1991) One study identified the risk of SIDS increasing by 1.19 for every month the infant is not breastfed. (McKenna 1995) Breastfed infants are one-fifth to onethird less likely to die of SIDS. SIDS is a leading cause of US infant death, impacting nearly 7,000 families per year. (Goyco 1990)

Diarrhea: Breastfeeding for 13 weeks has been shown to reduce the rate of vomiting and diarrhea by one-third and reduce the rate of hospital admissions from GI diseases. (Howie 1990)

Breastfed infants are protected against salmonellosis; breastfed infants are one-fifth less likely to develop this. (Stigman-Grant 1995) Breastfed babies are also protected from giardiasis. (Nayak 1987)

Gastrointestinal Disease: Children with acute appendicitis are less likely to have been breastfed for a prolonged time. (Piscante 1995)

Breastfeeding may reduce the risk of pyloric stenosis. (Habbick, 1989)

Hospitalization: Breastfed infants are less likely to be hospitalized if they become ill and were hospitalized for respiratory infections less than half as much as formula-fed infants. (Chen 1988) Cunningham 1986 reports that formula-fed infants are 10-15 times more likely to become hospitalized when ill.

Breastfed babies are half as likely to be hospitalized for RSV infections; in 1993 about 90,000 babies with RSV were admitted to hospitals at a cost of about $450 million. (Riordan, 1997)

Breastfeeding reduced re-hospitalizations in very low birth weight babies. (Malloy 1993)

In a Honolulu hospital, readmission rates were reduced 90% following the initiation of a lactation program. The drop was seen in dehydration, hyperbilirubinemia and infection. (Lee, 1997)

Necrotizing Enterocolitis: Premature infants fed their own mother’s milk or banked human milk were one-sixth to one-tenth as likely to develop NEC, which is potentially fatal. The incidence of NEC in breastfed infants is 0.012; in formula-fed infants it is .072. In Australia, one study has calculated that 83% of NEC cases may be attributed to lack of breastfeeding. (Drane 1997)

NEC adds between one and four weeks to the NICU hospital stay of a preemie. At a cost of $2000/day, this translates to $14,000 to $120,000 per infant. (Lee 1997)

Even when infants survive NEC, the disease can leave life-long costs via the development of short-gut syndrome and chronic malabsorption syndromes. A Pennsylvania physician has estimated the cost of one year’s at-home IV nutritional support treatment for a child with chronic malabsorption to be $50–100,000. (Lee 1997)

Otitis Media: Conservative estimates of savings for this disease alone range from one-half to two-thirds of a billion dollars if women were to breastfeed for 4 months. The savings estimate for Ohio if half of the mothers on WIC were to breastfeed was $1 million. (Riordan, 1997) Based on these figures, health care provider agencies could, conservatively, save two-thirds of what it spends to treat otitis media.

More than one million tympanosomies are performed yearly in the US at a cost of $2 million. By reducing the ear infections which cause the need for tubes for ear drainage, $2/3 to $1 billion could be saved.

Respiratory Infections: Breastfeeding protects against respiratory infections, including those caused by rotaviruses and respiratory syncytial viruses. (Grover 1997) Breastfed babies were less than half as likely to be hospitalized with pneumonia or bronchiolitis. (Pisacane 1994)

Breastfed infants had one-fifth the lower respiratory tract infections when compared to formula-fed infants. (Cunningham 1988)

Sepsis: Infants receiving human milk while patients in the intensive care nursery were half as likely to develop sepsis, a reason for increased length of hospital stays and provider expenditure. (El-Mohandes 1997)

Urinary Tract Infections: Breastfeeding protects babies against UTIs and subsequent hospitalization. (Pisacane 1992)


Long-Term Effects of Breastfeeding

Breastfeeding prevents or lessens the severity of the following conditions.

  • Allergies
  • Asthma
  • Childhood Cancer
  • Diabetes
  • Gastrointestinal Disease
  • Heart Disease
  • Inguinal Hernia
  • Multiple Sclerosis
  • Juvenile Rheumatoid Arthritis


Karen M. Zeretzke, MEd, IBCLC lives in
Baton Rouge, Louisiana and can be
reached at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it


Bibliography

Publications:

  • Baumslag, Naomi, MD and Dia Michels. Milk, Money and Madness, 1995.
  • Cunningham, Allan S MD. Breastfeeding, Bottle-feeding and Illness: An Annotated Bibliography 1986. Lactation Resource Center: Nursing Mother' Association of Australia.
  • Dettwyler, Katherine, PhD and Patricia Stuart-Macadam. Breastfeeding: Biocultural Perspectives, 1995.
  • Lee, Nikki, RN, MSN, IBCLC, ICCE. Benefits of Breastfeeding and Their Economic Impact: A Report. August, 1977.
  • Palmer, Gabrielle. The Politics of Breastfeeding, 1993.

Articles:

  • Acheston, L "Family violence and breast-feeding" Arch Fam Med 1995; 4:650-652
  • Arnon, SS et al. "Protective role of human milk against sudden infant death syndrome" J Pediatr 1982; 100:568-573
  • Baylor, JG and Bahna SL. "Anaphylaxis to casein hydrolysate formula" J Pediatr 1991; 118:71-73
  • Brun, JG et al "Breast feeding, other reproductive factors and rheumatoid arthritis: A prospective study" Br J Rheum 1995; 24:542-546
  • Chen, Y et al. "Artificial feeding and hospitalization in the first 18 months of life" Pediatr 1988; 81:58-62
  • Cummings, SR et al "Epidemiology of osteoporosis and osteoporotic fractures" Epidemiol Rev 1985; 7:178-208
  • Davies, HA et al. "Insulin requirements of women who breast feed" BMJ 1989; 298:1357-1358
  • Dewey, KG et al "Maternal weight-loss patterns during prolonged lactation" Am J Clin Nutr 1993; 58:162-166
  • Drane, D "Breastfeeding and formula feeding: a preliminary economic analysis" Breastfeed Rev 1997; 5:7-15
  • Ellis, MH et al. "Anaphylaxis after ingestion of a recently introduced whey protein formula" J Pediatr 1991; 118:74
  • El-Mohandes, A et al. "Use of human milk in the intensive care nursery decreases the incidence of nosocomial sepsis" J Perin 1997; 2:130-134
  • Goyco PG and RC Beckerman. "Sudden Infant Death Syndrome" Curr Prob Pediatr 1990;20:299-346 cited in the National SIDS Resource Center Information Sheet #1
  • Grimsely, Kirstin Downey. "Companies find a cost-saving formula for working moms".Washington Post Biz: The Workplace July 1, 1997.
  • Grover, M et al. "Effect of human milk prostaglandins and lactoferrin on respiratory syncytial virus and rotavirus" Acta Paediatr 1997; 86:315-316
  • Gwinn, ML "Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer" J Clin Epidemiol 1990;43:559-568
  • Habbick, BJ et al. "Infantile pyloric stenosis: A study of feeding practices and other possible causes" CMAJ 1989; 140:401-404
  • Hahn-Soric, M et al. "Antibody responses to parenteral and oral vaccines are impaired by conventional low-protein formulas as compared to breast-feeding" Acta Paediatr Scand 1990; 79:1137-1142
  • Hoey, Christine, RN, IBCLC and Julie Ware MD, IBCLC. "Economic advantages of breast-feeding(sic) in an HMO setting: A pilot study". Am J Man Care 1997; 3:861-65
  • Howie, PW et al. "Protective effect of breast feeding against infection" BMJ 1990; 300:11-16
  • Hreschyshyn, MM et al. "Associations of parity, breast-feeding and birth control pills with lumber spine and femoral neck bone densities: Am J Obstet Gynecol 1988; 159:318-322
  • Kalwart, HJ and Specker BL. "Bone Mineral loss during lactation and recovery after weaning" Obstet Gynecol 1995; 86:26-32 Kjos, SL et al. "The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes" Obstet Gynecol 1003; 82:451-455
  • Lucas et al. "Early diet of preterm infants and development of allergic or atopic disease: Randomized prospective study" BJM 1990; 300:387-840
  • Malloy MH et al. "Predictors of rehospitalization among very low birth weight infants" Clin Res 1993; 41:791(a)
  • Mitchell, EA et al. "Results from the first year of the New Zealand cot death study" Breastfeeding Rev 1991; 11:106-114
  • Mothering Magazine "Health News" Fall 1997, pp. 44-45
  • McKenna, JJ and N Bernshaw. "Breastfeeding and infant-parent co-sleeping as adaptive strategies: Are they protective against SIDS?" Breastfeeding: Biocultural Perspectives, chapter 10, pp 265-303.
  • Montgomery, DL and PL Splett. "Economic benefit of breast-feeding infants enrolled in WIC" Am J Diet Assoc 1997; 97:379-385
  • Nayak, N et al. "Specific secretory IgA in the milk of giardia lamblia infected and uninfected women" J Infect Dis 1987 155:724-730
  • Pisacane, A et al. "Breastfeeding and acute appendicitis" BMJ 1995; 310:836-837
  • Pisacane A et al.. "Breastfeeding and acute lower respiratory infection" Acta Paediatr 1994; 83:714-718
  • Pisacane, A et al. "Iron status in breastfed infants" J Pediatr 1995; 127:429-431
  • Rosenblatt, KA et al. "Prolonged lactation and endometrial cancer" Int J Epidemiol 1995; 24:499-503
  • Riordan, Jan, EdD, RN, FAAN. "The cost of not breastfeeding: A commentary". J Hum Lact 1997; 13(2)93-97
  • Sigman-Grant, M. "Confirmation of Breastfeeding as a protective factor from salmonellosis in Pennsylvania infants" FASEB J Abstr: Part 1 Vol 9(7) 1995:A183
  • Smith, Julie. "The economics of breastfeeding" Australian Financial Review 7/24/97.
  • Tuttle, CR and KG Dewey. "Potential cost savings for Medi-Cal, AFDC, Food Stamps and WIC programs associated with increasing breastfeeding among low-income women in California" Am J Diet Assoc 1996; 96:885-890)
  • Ware, Julie MD, IBCLC and Christine Hoey, RN, IBCLC. "Revised abstract: economic advantages of breastfeeding is an HMO situation". ABM News and Views 1997; 3(1)3.
  • Zoppie, G et al. "Response to RIT 4237 oral rotavirus vaccine in human milk, adapted -and soy formula fed infants" Acta Paeditr Scand 1989; 78:759-762.

Presentations

  • Hoey, Christine, RN, IBCLC. "Cost Analysis of Breastfeeding and the Lactation Consultant within the HMO Setting" Presented at the International Lactation Consultants Association 1996 Conference in Kansas City, MO.
  • Labbok, Miriam, MD, MPH. "The Real Cost of Not Breastfeeding" Presented at the La Leche League International conference in Washington DC, July 4, 1997. Draft article submitted for journal publication Cost Effectiveness of Breastfeeding in the U.S.: The Forgotten Woman's and Children's Preventive Health Issue published in the conference syllabus, pp 23-32.
  • Labbok, Miriam, MD, MPH. "Models for Cost Savings Associated with Breastfeeding" presented July 14, 1995, at the International Lactation Consultant Association Conference in Scottsdale, AR. Conference syllabus, pp 23-24.
  • Webster, Bernie, SRN SCM HVDip. "Medical and Financial Costs Associated with Artificial Infant Feeding" presented August 11, 1997, at the International Lactation Consultant Association Conference in New Orleans, Louisiana. Conference syllabus p. 57 and Handouts.


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