Costs of lower cognitive ability linked with not breastfeeding amount to over $300 billion each year

Jan 29 2016

When countries, rich or poor, support breastfeeding through meaningful investments and programs, it has an impact on their bottom line and the health of women and children. The Lancet Breastfeeding Series, released today, finds that globally, the costs of lower cognitive ability associated with not breastfeeding amount to more than $300 billion each year, a figure comparable to the entire global pharmaceutical market. About 820,000 child deaths could be prevented annually (about 13 percent of all under-5 child deaths) by improving breastfeeding rates, in addition to the lives already saved by current breastfeeding practices.

"Supporting breastfeeding makes economic sense for rich and poor countries and this latest breastfeeding study proves it," said Series co-lead, Dr. Cesar Victora, emeritus professor from the International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas in Brazil. "Breastfeeding is a powerful and unique intervention that benefits mothers and children, yet breastfeeding rates are not improving as we would like them to--and in some countries, are declining. We hope the scientific evidence amassed in this Series will help revert these negative trends and create a healthier society for everyone--mother, child, poor and rich."

The depth and breadth of the Breastfeeding Series included 28 systematic reviews and meta-analyses--22 commissioned specifically for the Series. In total, more than 1,300 studies were reviewed to provide the most exhaustive look at the benefits, determinants, and trends in breastfeeding to date.

The new costing data in the study were derived by modelling the economic benefits of improved cognition based on estimates from a 2015 meta-analysis, showing that longer breastfeeding is associated with higher performance on intelligence tests among children and adolescents. Studies also show that increased intelligence as a result of breastfeeding (three IQ points on average) translated to improved academic performance, increased long-term earnings, and improved productivity.

According to Series co-lead, Dr. Nigel Rollins with the Department of Maternal, Newborn, Child and Adolescent Health at the World Health Organization, "This new research demonstrates that breastfeeding results in improved child development, with huge economics gains for individuals, families, as well as at the national level."

In addition, research in the first paper, Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect, confirms the lifesaving importance of breastfeeding in low-, middle-, and high-income countries, as well as in both rich and poor households, including:

• Promoting breastfeeding would save about 820,000 child lives a year - 87 percent of them infants under six months of age.

• Nearly half of all diarrhea episodes and one-third of all respiratory infections would be prevented with breastfeeding.

• For each of the first two years a mother breastfeeds over her lifetime, she decreases her risk of developing invasive breast cancer by six percent. She also benefits from reduced ovarian cancer risk.

• Approximately 20,000 breast cancer deaths are prevented each year by breastfeeding; improved rates could prevent another 20,000 deaths each year.

• Breastfeeding is one of the few positive health-related behaviors that is more common in poor rather than rich countries, and in poor countries, is a more frequently used behavior among poor mothers. In the absence of breastfeeding, the poor-rich gap in child survival would be even greater.

Research in the second paper, Why invest, and what it will take to improve breastfeeding practices?, finds that despite the overwhelming evidence confirming the importance of breastfeeding, women worldwide lack the necessary support they need to breastfeed and face daily barriers including:

• Limited or nonexistent maternity leave. Short maternity leave (up to six weeks) increases the odds of not breastfeeding or stopping early by 400 percent;

• Gaps in knowledge among healthcare providers that leave women without access to accurate information or support; and

• Lack of strong support systems among family and community, as well as cultural traditions unsupportive of breastfeeding.

In addition, the Series determined that increasing breastfeeding rates to 90 percent in the U.S., China, and Brazil and to 45 percent in the U.K. would cut treatment costs of common childhood illness and save at least US$2.45 billion in the U.S., US$29.5 million in the U.K., US$223.6 million in China, and US$6.0 million in Brazil.

Lastly, the aggressive marketing of breastmilk substitutes (including infant formula) by their manufacturers and distributors undermines breastfeeding. Newly commissioned market research conducted by Euromonitor International for the Series found that the breastmilk substitute industry's reach and influence is growing--the retail value is expected to reach US$70.6 billion by 2019. Such a figure far outpaces the dollars spent to promote the benefits of breastfeeding worldwide.

According to Dr. Rollins, the success of the International Code of Marketing of Breastmilk Substitutes, adopted at the 34th World Health Assembly in 1981, depends upon countries enacting legislation, along with rigorous monitoring and enforcement. "The multi-billion dollar breastmilk substitute industry-and its marketing practices-undermines breastfeeding as the best practice in early life."

Despite international recommendations that all children should be exclusively breastfed from birth to six months of age, these rates globally are only at 35.7 percent. The World Health Assembly's global target is for countries to increase the rate of exclusive breastfeeding for the first six months of life to at least 50 percent by 2025.

Werner Schultink, chief of nutrition at UNICEF, said, "Breastfeeding is a cornerstone of child survival, nutrition and development. More investment is required to promote breastfeeding and to encourage governments, health care professionals, workplaces, communities, and families to create an environment that supports, protects, and encourages it."

Keith Hansen, vice president for human development at the World Bank Group, who wrote a commentary for the Series, said, "When we nourish a child, we drive future economic growth. The Lancet Breastfeeding Series shows why breastfeeding is one of the highest impact interventions providing benefits for children, women, and society."

Dr. Sue Desmond-Hellmann, chief executive officer of the Bill & Melinda Gates Foundation, said, "The evidence from the Series could not be more clear: with its linkages to child survival and development, breastmilk is the ultimate personalized medicine. Breastfeeding helps children to thrive, and set societies on a path toward prosperity. The Series offers a clear call to action for all of us. With greater political will and more investment, we can put children everywhere on the path toward a healthy, prosperous life-starting with breastfeeding."

The Lancet Breastfeeding Series is being launched at a stakeholder event in Washington, D.C., on January 29. The Breastfeeding Series is one of several Series presenting new evidence focusing on key topics highlighted by the Global Strategy for Women's, Children's, and Adolescents' Health. This includes the launch of a dedicated Series on Stillbirths (January), a report by The Lancet Commission on Adolescent Health and Wellbeing (May), and a future Series on Maternal Health and Early Childhood Development. Every Woman Every Child will bring this evidence to the attention of countries and partners in support of the implementation of the Global Strategy.

"Commitment and investments for women's and children's health--including breastfeeding--will bring the global target within reach and drive progress toward other health and development goals," said Dr. Rollins.

Katie Taylor, deputy assistant administrator for global health at the United States Agency for International Development added, "Anyone who has breastfed knows it is 'liquid gold,' and the scientific evidence for the many incredible benefits of breastfeeding are stronger today than ever. It is ready to use and perfectly customized for a child's nutritional needs and immune system. We do not need to spur technological innovations, enhance food production value chains, or incentivize end users. It doesn't have to be manufactured by donors or transported. What we need is a greater sense of urgency to create and provide support for environments that promote breastfeeding."

Source: GMMB