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 “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.
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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: http://bmj.co/15SjLRv Archives of Disease in Childhood,
online December 4, 2014.
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