Saturday, April 25, 2009

Breastfeeding: Benefits to Mothers, Children, Wallets, & Environment

Breastfeeding provides benefits to: mothers and children, as well as family and nationwide cost savings and environmental benefits.  However, only 29% of women are breastfeeding at 6 months after delivery (Healthy People 2010 goal is 50%).  
The benefits for children are: increased immunity and reduced risks of: sudden infant death syndrome (SIDS), obesity, acute otitis media, gastroenteritis, lower respiratory tract infections, asthma, atopic dermatitis, and childhood leukemia. In mothers, there is a decreased risk of type 2 diabetes, cardiovascular disease,  high cholesterol, and breast and ovarian cancer.  There is also a benefit of increased bonding with the mother and baby, which is linked to better brain development and relationship formation in children.  A strong dose-response relationship appears between breastfeeding and infant health in the first year of life. 
Economically speaking, there are no formal studies on cost savings, taking into account time, money on formula, and the cost of medical care.  It has been estimated that bottle-fed infants had US$200 higher medical costs in the first year of life [4].  It is healthier, all-natural, and inexpensive to mothers and families.  At a national level, if we reached the Healthy People 2010 goals of getting 50% of women to  be feeding at 6 months, WIC would save US$6.5million per month!  
There are also benefits to the environment by saving water and eliminating the energy used to create formulas--contributing to waste and air pollution.  Formula tin cans can seep toxic BPA into formula, although there are opinions regarding the levels of potential BPA  on both sides of the argument.   Also, being as formula is dairy or soy-based primarily, the dairy business' pollution needs to be considered, with cows (and their methane), land, resources, and fertilizers providing large emissions.

 Healthy People 2010 goals include getting 75% of women to initiate breastfeeding, 50% to remain feeding for 6 months, and 25% for a full year after delivery.  Breastfeeding is the preferred choice of feeding for all infants, as endorsed by the American Academy of Pediatrics (AAP).   However,  according to a 2002 survey, only 71% of all children had ever been breastfed (16% for a full year).  Late last year the US Preventive Services Task Force came out with their recommendation that primary care providers should encourage and support interventions aimed to increase the prevalence and duration of breastfeeding.  It has also been noted that lay support is extremely effective in getting mothers to initiate and maintain breastfeeding, so programs should be tailored to mothers in this capacity.  The AAP has some great resources for families on their website (below) .  So, the science is there and we're working on the full translation to individual family practice.

Public policy should be more appropriately following the science and should be made to fill in the gaps.  This requires funding support programs and implementing cost-effective breastfeeding intervention programs to encourage more mothers to initiate and maintain breastfeeding activities.  Health insurers also have a role (and I would argue a responsibility) to insure lactation services to produce healthier mothers and children.  Environmental advocacy organizations should bring salience to the environmental costs and benefits for both the public and government.  Researchers have a role in performing some cost-benefit and cost-effectiveness analyses on breastfeeding.

I wanted to make some noise on the breastfeeding horn today.   How many of you were breastfed?  If you are a female, did you, or do you plan to, breastfeed your children?

1) Kuehn BM.  Preventive Services Task Force Endorses Breastfeeding Support in Primary Care.  JAMA 2008;300(22):2598.
2) Chung M, Raman G, Trikalinos T, Lau J, & Ip S.  Interventions in Primary Care to Promote Breastfeeding:  An Evidence Review for the US       Preventive Services Task Force.  Arch Int Med 2008;149(8):565-582.
3) US Preventive Services Task Force (USPSTF).  US Department of Health and Human Services; Agency for Healthcare Research & Quality.
4) Breastfeeding Initiatives:  Family Resource Guide.  American Academy of Pediatrics.
5) Bonuck K, Arno PS, Memmott MM, Freeman K, Gold M, & McKee D.  Breast-feeding promotion interventions:  good public health and economic sense.  J Perinatol 2002;22(1):78-81.

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