Every once in a while I see the bumper sticker that says, “If you think education is expensive, try ignorance.”
Maybe it’s time for a new one that says, “If you think supporting breastfeeding is expensive, try disease.”
Okay, that may not be the best slogan. But with a new study out last week, which builds on another from 2010, the price of not supporting breastfeeding mothers is looking mighty high.
Back in 2010 the press lit up with the news of a study which showed that if 90% of mothers breastfed exclusively for 6 months, each year we would save $13 billion prevent 911 deaths, nearly all of them infants. The cost per child: $3,430.
It was the first time since 2001 that a cost analysis of suboptimal breastfeeding was conducted. The 2001 analysis had looked at three health problems, and had used lower targets. The 2010 study, based on the landmark 2007 report from the Agency for Healthcare Research and Quality, looked at ten childhood health problems.
But one piece was still missing from the picture: maternal health costs. Study co-author Dr. Melissa Bartick told Time that when the 2010 study was released, “We got a million inquiries saying, That doesn’t include the women! We wanted a complete picture.”
Last week the sequel arrived to complete that picture.
This study, “A Cost Analysis of Maternal Disease Associated with Suboptimal Breastfeeding,” also used the Agency for Healthcare Research and Quality data, and tabulated the costs of breast cancer, premenopausal ovarian cancer, hypertension, type 2 diabetes mellitus, and myocardial infarction (heart attack). They considered direct costs, indirect costs, and cost of premature death (before 70 years), expressed in 2011 dollars, for a cohort of nearly 2 million women.
They found that, compared to 90% of women breastfeeding exclusively for six months, current breastfeeding rates result in:
- 4,981 cases of breast cancer
- 53,847 cases of hypertension
- 13,946 cases of myocardial infarction (heart attack)
- 4,396 additional premature deaths before age 70
In terms of cost, they found that current rates result in:
- $17.4 billion in cost to society resulting from premature death
- $733.7 million in direct costs
- $126.1 million indirect morbidity costs
The authors noted that their estimate may significantly underestimate the cost of suboptimal breastfeeding because it reviewed data for only five health problems, when there is evidence linking breastfeeding to the prevention of other diseases.
Results for premenopausal ovarian cancer and Type II diabetes were not statistically significant, likely because ovarian cancer is more rare and because Type II diabetes often occurs beyond the age range used in the study. The authors were not able to find adequate data on the “time costs” of infant feeding, so they are not included.
The premature death numbers are especially powerful, the authors point out, when compared to the number of premature deaths caused by other diseases. They found that the number of annual deaths caused by suboptimal breastfeeding is 4,396. This is more than the number of annual deaths attributable to cervical cancer (3,909), asthma (3,361) and influenza/flu (3,055).
The authors also calculated the number “needed to treat” to prevent these diseases. This means the number of people you would need to treat with a preventative measure (in this case, more breastfeeding) to prevent one case of disease. They found that one case of maternal hypertension could be prevented for every 35 mothers who breastfed more. For myocardial infarction (heart attack), it would take only 135 mothers breastfeeding more to prevent one. And to prevent a case of breast cancer, it would mean 385 mothers breastfeeding more. And of course this doesn’t include cases of childhood diseases that would simultaneously be prevented.
The primary critique of an analysis like this is that the relationship between breastfeeding and these health outcomes is not necessarily causal. In other words, are these mothers healthier because they breastfed, or is it that women who are healthier are more likely to choose to breastfeed? To tackle this perennial question, the authors consulted with a “causal-inference expert,” reports Time, who found enough evidence to suggest a causal link.
This study, combined with the 2010 paper on the cost and death rate for children, make it increasingly clear that not eliminating barriers to breastfeeding results in significant costs to our society.
Image credit: Wikimedia Commons