A Powerful Tool in the Campaign for Breastfeeding

by Katie Black

"On a global scale there's a hefty price tag attached to forgoing breastfeeding—both figuratively and literally."

Both the World Health Organization and the United Nations Children's Fund recommend breastfeeding exclusively for 6 months if possible, and in conjunction with other food until your child is at least 2 years old. Breastfeeding has shown to provide physical, cognitive and emotional benefits to both moms and babies.

However, despite everything we know about the importance of breastfeeding, current statistics show 43% of children worldwide are breastfed exclusively, and 46% are breastfed until the age of 2. While the World Health Assembly's Global Nutrition Target aims for at least 50% of infants being breastfed exclusively by 2025, the current rate of increase is not fast enough to reach this goal.

But what is really at risk when these guidelines are vastly unobserved?

On a global scale there's a hefty price tag attached to forgoing breastfeeding—both figuratively and literally.

"Every year, not breastfeeding is responsible for a staggering 595,000 childhood deaths..."

Calculating the true costs of not breastfeeding is vital for the work of advocates and policy-makers, so in order to close gaps previously present in determining global losses, the Cost of Not Breastfeeding Tool was born. Evidence based, and user friendly, this revolutionary online tool summarizes national estimates of the human and economic consequences of not breastfeeding, especially for Low and Middle Income Countries (LMIC). There is a downloadable workbook available for advanced technical workers as well with analysis for over 130 countries.

The tool takes into account women and childhood morbidity and mortality, health system and formula costs, and future economic loss due to mortality and cognitive reduction all attributed to not breastfeeding. Because the estimations are conservative and not every factor and preventable disease is accounted for, the costs are likely even greater than reported.

Every year, not breastfeeding is responsible for a staggering 595,000 childhood deaths (6 to 59 months) from diarrhea and pneumonia. Breast milk contains extremely vital components including white blood cells needed for an immune system to fight off infections, and in some cases formula or a diet which does not contain breast milk can increase the chances of contracting fatal illnesses.

For women, breastfeeding has the potential to prevent over 98,000 deaths from breast and ovarian cancers as well as type II diabetes each year. When breastfeeding, you shed breast tissue which potentially contains damaged DNA thus reducing the chance of breast cancer, and it prevents ovarian cancer by hindering ovulation which can expose you to cancer causing cells. Breastfeeding may prevent type II diabetes as well because it elevates the metabolic burden on mothers. The increased energy requirement reduces blood glucose levels and thus decreases the risk of obtaining the disease.

"The largest component of economic losses are cognitive, at $285.4 billion annually."

This level of avoidable morbidity and mortality costs the global health system $1.1 billion annually and the economic losses of premature child and women’s mortality are estimated to equal $53.7 billion in yearly future earnings.

For formula, the global mean price per cheapest 900-g container is $18.74. At this cost, it's estimated that feeding a child with an economy brand of formula for the first 2 years of their life will cost over 6.1% of the household’s income and will be even higher for low-income families and LMIC.

However, the largest component of economic losses are cognitive, at $285.4 billion annually.

After adjusting for the mother's IQ for the best accuracy, the analysis calculated a difference of 2.62 IQ on average between children who are exclusively breastfed, and those who are not. Just one point in variation can equal hundreds of dollars lost or gained for the GNI per capita (the value of a country's income divided by its population). The total future income lost in a country is based on the work of an individual from 18 years of age until expected retirement at age 65 or the country’s age of life expectancy, (whichever comes first). From this analysis the results of the cognitive disadvantages due to not breastfeeding are severe.

Altogether, the global economy loses an astonishing $341.3 billion per year.

The fact that the tool counts loss of life and resources due to not breastfeeding, rather than listing the benefits or savings of breastfeeding is key. This small but critical distinction can completely change the way people understand its significance. When breastfeeding is said to be "more beneficial" it often implies that is not the standard way to feed your child, instead it is just a better diet as opposed to formula or a combination of both.

Studies found when the benefits of breastfeeding were explained to one group versus the risks of not breastfeeding to a different group, the latter reported they were more likely to breastfeed. US surveys have also reported while 74% of the participants disagreed with the statement that formula was as good as breastfeeding, only 24% agreed that feeding a child with formula instead of breastmilk would increase the chance of illness.

The Cost of Not Breastfeeding Tool is a powerful resource created for policy-makers and advocates striving to change the current status of breastfeeding around the globe. It helps compel donors to invest in breastfeeding campaigns to further the goals in greatly improving the global economy and save lives as a result of increased breastfeeding. It is not only in the best interest of our children, but also for our mothers and the rest of the world.