Breastfeeding: A return on investment
Breastfeeding is the natural way to feed newborns and infants, and an important contributor to their health. It provides nutrition, boosts immunity, and fosters maternal–child bonding.1 Babies who are not breastfed or have been weaned early have an increased likelihood of contracting otitis media, gastroenteritis, respiratory infections, necrotizing enterocolitis, diabetes and asthma and of succumbing to Sudden Infant Death Syndrome (SIDS), while mothers who have not breastfed have an increased likelihood of developing breast cancer, ovarian cancer, diabetes and coronary heart disease.1,2
These possible outcomes can have significant health care costs related to increased physician visits, treatment of infections and disease, and increased hospitalizations.3 A recent report from the United Kingdom showed that the economic costs of treating just three of these infant diseases (gastroenteritis, lower respiratory tract infections, acute otitis media) associated with not breastfeeding was £75.5 million (about CAD $121.8 million) per year.3,4 A further study investigated the potential health care cost savings that could be realized by investing in support services for breastfeeding mothers. Increasing exclusive breastfeeding rates to 65% at four months could result in potential health care cost savings of £17 million (CAD $27.5 million) annually for those three diseases.4 This increase in exclusive breastfeeding was also shown to result in net savings of £21 million (CAD $33.9 million) in breast cancer treatment costs over the lifetime of each annual cohort of first-time mothers.3,4 Although these results are not directly transferable to Canada, they demonstrate the potential for cost savings to the health care system through strengthening and investing in services that support breastfeeding mothers in Canada.
Breastfeeding went out of favour in Canada during the middle part of the 20th century, but has been on the rise since the 1970s.5 Now more than ever, Canadian mothers and newborns are getting off to a good start, with at least 89% of new moms breastfeeding in 2011-2012.6 Unfortunately, these numbers drop to 51% of babies by four months and only 26% by six months.6 Exclusive breastfeeding is recommended for the first six months of a healthy-term infant’s life.7 Canadian mothers give up breastfeeding earlier than desired because of concerns about their milk supply or difficulty with breastfeeding technique.8,9 These issues may arise, in part, through any of the following: a lack of support, hospital practices that separate babies from their mothers, babies not being allowed to feed on demand or who receive pacifiers, or mothers receiving free formula samples.9
What can be done in Canada? The Baby-Friendly Initiative (BFI) is a first step.10 BFI, an initiative developed by WHO and UNICEF in 1991 that supports, promotes and protects breastfeeding, was launched in Canada at that time and is being implemented by the provinces and territories. The Breastfeeding Committee for Canada (BCC), a volunteer not-for-profit organization dedicated to the protection, promotion and support of breastfeeding and its implementation in Canada, supports this initiative.11,12 However, most babies in Canada are not born in a Baby-Friendly hospital environment, with only 12 out of the 350 maternity hospitals in Canada having achieved BFI designation.13,14 This designation has been shown to increase breastfeeding duration and exclusivity.15 Lack of endorsement from government and hospital administrators, training for health care workers and integration with the community seems to be contributing to the lack of BFI-designated hospitals.12
- Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment, Number 153. 2007;1-186.
- Bartick M. Breastfeeding and health: A review of the evidence. Journal of Women, Politics and Policy 2013;34(4):317–29.
- Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child 2015;100:334–40.
- Renfrew M, Pokhrel S, Quigley M, et al. Preventing disease and saving resources: The potential contribution of increasing breastfeeding rates in the UK. London, UK: UNICEF, 2012.
- Quintessence Foundation. The History of infant feeding: Part II. Quintessence Newsletter. 2003. Available at: www.babyfriendly.ca/ClientData/Modules/NewsLetter/attachments/QF_Newsletter_2003n1_Winter.pdf (Accessed February 27, 2015).
- Gionet L. Breastfeeding trends in Canada. Health at a Glance. Statistics Canada Catalogue no. 82-624-X. 2013.
- Health Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. Food and Nutrition. Updated April 25, 2014. Available at: www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php (Accessed February 27, 2015).
- Brown CRL, Dodds L, Legge A, Bryanton J, Semenic S. Factors influencing the reasons why mothers stop breastfeeding. Can J Public Health 2014;105(3):e179–85.
- Public Health Agency of Canada. What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa, Ontario, 2009.
- Breastfeeding Committee for Canada. Business case for Baby-Friendly Initiative. Available at: breastfeedingcanada.ca/BFI.aspx (Accessed March 11, 2015).
- Breastfeeding Committee for Canada. The Baby-Friendly Initiative (BFI) in Canada: Status Report 2014. Available at: breastfeedingcanada.ca/BFI.aspx (Accessed March 25, 2015).
- Chalmers B. Breastfeeding unfriendly in Canada? CMAJ 2013;185(5):375–76.
- Breastfeeding Committee for Canada. Baby-Friendly Facilities in Canada - Compiled January 30, 2015.
- Ministère de la Santé et des Services sociaux. Établissements « Amis des bébés » au Québec. Available at: breastfeedingcanada.ca/BFI.aspx (Accessed March 13, 2015).
- Semenic S, Childerhose JE, Lauzière J, Groleau D. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): An integrative review. J Hum Lact 2012;28:317–34.