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News from Cambridge Health Alliance
April 5, 2010
Poor Breastfeeding Rates Cost U.S. $13 Billion
Annually
Landmark study finds nearly one thousand excess
preventable deaths associated with lack of compliance
Cambridge, MA…Failure to comply with medical recommendations
around breastfeeding is costing the United States $13 billion per
year, with 911 excess preventable deaths, according to a study published
today by Pediatrics.
The authors compared the costs of 10 pediatric diseases at current
U.S. breastfeeding rates to projected costs for 90 percent compliance
with the medical recommendation to breastfeed exclusively for six
months with continued breastfeeding for at least the first year
of life. For each disease, costs were calculated for direct cost
of health care, indirect expenses such as time missed from work,
and the cost of premature death.
Of the 911 excess deaths, 95% are in infants and result from Sudden
Infant Death Syndrome (SIDS), necrotizing enterocolitis (NEC, a
disease seen primarily in preterm infants), and lower respiratory
tract infections such as pneumonia, said the study's lead author
Melissa Bartick, MD, a hospitalist at Cambridge Health Alliance
and an instructor in medicine at Harvard Medical School.
While nearly 75 percent of all U.S. mothers initiate breastfeeding,
only 32 percent are breastfeeding exclusively at three months. Just
12 percent of U.S. infants meet the medical recommendation to breastfeed
exclusively for six months. Only 22 percent are breastfeeding at
all at one year. In comparison, other countries, such as Sweden
and Kenya, fare much better.
"People shouldn't blame mothers because they are often not
supported well, even from the moment their babies are born,"
said Dr. Bartick. According to data from the Centers for Disease
Control and Prevention, the average U.S. maternity hospital performs
quite poorly in providing evidence-based care around infant feeding.
Research shows that keeping mother and baby together, skin-to-skin
and uninterrupted in the first hour of life is something vitally
important to ultimate breastfeeding success, but this does not consistently
occur in most U.S. hospitals. Only 86 U.S. hospitals are certified
as Baby-Friendly, a WHO/UNICEF quality initiative on breastfeeding,
which includes avoiding separation of mother and baby and avoiding
formula without a medical reason.
Limited worksite support and lack of social and cultural support
also contribute to poor breastfeeding rates as well as aggressive
marketing of infant formula, added Dr. Bartick.
The study's release comes on the heels of a letter sent to Congress
on March 16 asking for the appropriation of $15 million per year
to help build the support necessary to improve breastfeeding rates.
The letter was signed by 90 organizations, including the American
Academy of Pediatrics, the American Congress of Obstetricians and
Gynecologists, and the American Academy of Family Physicians.
The authors based the excess disease burden associated with lack
of breastfeeding on a comprehensive 2007 report from the U.S. Agency
of Healthcare Research and Quality (AHRQ). The largest costs came
from premature death due to SIDS, NEC, and lower respiratory tract
infection, followed by the overall costs of otitis media (middle
ear infections) and atopic dermatitis. The other diseases studied
were childhood asthma, childhood obesity, type 1 diabetes in childhood,
gastroenteritis, and childhood leukemia.
Although breastfeeding also has been linked to lower rates of maternal
cardiovascular disease, type 2 diabetes, breast cancer, and ovarian
cancer, these costs were not included in this study. As a result,
the authors estimate the true cost of poor U.S. breastfeeding rates
is significantly higher than $13 billion.
Melissa Bartick, MD, and Arnold Reinhold, MBA. "The Burden
of Suboptimal Breastfeeding in the United States: A Pediatric Cost
Analysis." Pediatrics published online: April 2010 (doi:
10.1542/peds.2009-1616).
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