On April 5, 2005, Pediatrics, the official magazine of the American Academy of Pediatrics, published a new study, entitled “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.” The study essentially finds that significant cost savings can be achieved in health care (not to mention a reduction in infant mortality) if more women breastfed exclusively for the first 6 months of the baby’s life.

Specifically, the results from the abstract of the study (linked below) state the following:

“If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).”

This study is based essentially upon calculating costs and deaths associated with health conditions that have been shown to occur in statistically lower rates among breastfed babies.

Thankfully, this story is receiving significant mainstream press coverage. Much of it seems to focus on the related victory of strong protections on breastfeeding in the workplace that passed in the highly-controversial 2010 federal health care legislation. When this new law takes effect, it certainly could have an impact on rates of breastfeeding success among working mothers, especially as it no longer gives a blanket exemption to small employers.

Other stories have pointed, appropriately, at the mismatch between good breastfeeding establishment practices and common hospital policies surrounding postpartum care as well as common hospital birth practices that may negatively impact breastfeeding.

These are certainly two accurate and important causes of suboptimal breastfeeding rates that should be explored. However, most articles also strain to sidestep any implication that the actions of any individual mother should be called into question. Many women choose not to breastfeed or are unable to breastfeed. Some of this is due directly or indirectly to the two causes already mentioned above. But I believe there are two important factors that influence these individual decisions outside of these larger societal/medical issues.

Improved prenatal breastfeeding education could, in my opinion, significantly improve breastfeeding rates and terms. Most prenatal education, even at pro-breastfeeding and baby-friendly hospitals, focus on “selling” the benefits of breastfeeding. Shorts amounts of time may be included on basic positioning and latch (the silver bullets of successful breastfeeding, to be sure, when taught correctly and comprehensively, which they often aren’t).

Discussing the benefits of breastfeeding is certainly important and may sway some mothers or couples on the fence, but without more comprehensive instruction, as well as support on the lifestyle and cultural components of breastfeeding, there simply isn’t a full enough toolbox to predict breastfeeding success. I believe a second level of education needs to be available to those who KNOW they want to breastfeed, not just those who want to learn about it or are thinking about it.

Further, more needs to be done to dispel the notion that artificial baby milk (ABM, or formula) is an equal substitute for mother’s milk. Is is quite possibly adequate (although this study suggests even less than we thought) – but equal, not even close. Until breastfeeding is viewed as the “standard” and ABM then correctly understood as “substandard” it will be hard to change this notion, regardless of how many “breastfeeding is best” slogans are in the fine print on formula cans or baby bottle packaging.

YES – women need more support in the workplace, in the maternity ward and in the prenatal classroom and new mom clinic. But the personal commitment and choice aspect of the breastfeeding decision must be part of the discussion as well. It is not enough to tell mothers that breastfeeding has in fact been proven to be better for their babies, but it must then logically follow that society expects them to make that choice unless truly impossible along with providing the societal and clinical support to succeed. Only then can we achieve or even approach the optimal rates set as a goal for public health in this study.

**Share your comments about this topic in the Breastfeeding and Health Care Costs discussion in the Breastfeeding Forum.**


Interested in learning more about the intersection of breastfeeding with politics and economics? You might find these two books useful: