Benefits of Breastfeeding
Large, good quality, well controlled studies and good quality systematic reviews demonstrate that in developed countries, not breastfeeding significantly increases the risk of gastro-intestinal disease (1, 2), lower respiratory tract infection (1,2), and sudden infant death syndrome for infants (1); necrotising enterocolitis for preterm infants (3); childhood cancers (4) and maternal breast cancer (4). The epidemiological evidence supported by related physiological and immunological evidence suggests that not breastfeeding is likely to increase the risks of illnesses including Type 2 diabetes (5), coeliac disease (6), otitis media (1), obesity (7), and indicators of future cardiac disease (8) in the child, and ovarian cancer in the mother (1). Increasingly strong evidence indicates a significant impact on cognitive and behavioural outcomes for the child (9). No other health behaviour has such a broad spectrum and long-lasting impact on population health, with the potential to improve life chances, a key policy priority (10), as well as survival and health.
The fundamental importance of infant feeding to health and development has been recognised in national and international policy recommendations and guidance. The World Health Organisation (WHO) recommends that babies are exclusively breastfed until six months (11), as do all four UK Departments of Health. Despite this policy position, breastfeeding rates in the UK have remained low for several decades. Virtually no babies are exclusively breastfed to the recommended six months, and only 34% are breastfed at all at six weeks after birth. These rates are in contrast to other developed countries (Norway, Sweden) where the vast majority of women breastfeed for at least two months.
Health and development outcomes related to not breastfeeding are associated with a substantial cost burden. A recent US study found that if 90% of mothers complied with breastfeeding recommendations, then 900+ deaths would be prevented and $13 billion saved annually from the US health budget (12). A UNICEF UK study examining the cost burden of not breastfeeding has recently been published and the findings will be used to inform this study.
Not breastfeeding is both an outcome and a cause of health and social inequality. It is an outcome of inequality because (i) low income families have the lowest rates of breastfeeding; (ii) there is a marked inter-generational effect that perpetuates these low rates (13) (iii); the long-term health and development of the child is affected by whether or not she/he is breastfed and (iv) the social patterning of infant feeding results in the greatest burden of ill health and adverse effects falling on the poorest families. At the same time, breastfeeding provides a solution to this longstanding problem, and is in itself an intervention to tackle inequalities in health; a child from a low income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula fed (14). In Sheffield, neighbourhood level six week breast feeding rates are negatively associated with Index of Multiple Deprivation with a correlation of -0.4 (95% CI -0.20 to -0.56).
Relatively little is known about the costs and health benefits of breastfeeding interventions in the general population and even less is known about the costs and outcomes within sub-populations stratified by socioeconomic status. To date, economic models of breastfeeding interventions have been small scale (15). Our study will be informed by the results of ongoing UNICEF UK cost analysis of breastfeeding outcomes (led by Mary Renfrew & Julia Fox-Rushby), which is available to download at the right-hand link.
1. Ip S et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment No 153. Rockville, Maryland: Agency for Healthcare Research and Quality; 2007
2. Quigley MA, Kelly YJ, Sacker A. Breastfeeding and hospitalization for diarrhoea and respiratory infection in the United Kingdom Millennium Cohort Study. (2007) .Pediatrics. 119(4):e837.
3. Henderson L, McMillan B, Green JM, Renfrew MJ. 2011 Men and infant feeding: perceptions of embarrassment, sexuality, and social conduct in white low-income British men. Birth. Mar;38(1):61-70. doi: 10.1111/j.1523-536X.2010.00442.x. Epub 2011 Jan 4. Henderson, L., Kitzinger, J. & Green, J. Representing infant feeding: content analysis of British media portrayals of bottle feeding and breast feeding. BMJ, 2008; 321, 1196-1198.
4. UK Childhood Cancer Study Investigators. 2001 Breastfeeding and childhood cancer. Br J Cancer. Nov 30;85(11):1685-94
5. EURODIAB Substudy 2 Study Group. 2002 Rapid early growth is associated with increased risk of childhood type 1 diabetes in various European populations. Diabetes Care. Oct;25(10):1755-60.
6. Akobeng AK, Ramanan AV, Buchan I et al. 2006 Effect of breast feeding on risk of coeliac disease: systematic review & meta-analysis of observational studies. Arch Dis Child. Jan;91(1):39-43. Epub 2005 Nov 15.
7. Singhal A, Lanigan J. 2007 Breastfeeding, early growth and later obesity. Obes Rev. Mar;8 Suppl 1:51-4.
8. Pearce MS, Relton CL, Parker L, Unwin NC. 2009 Sex differences in the association between infant feeding and blood cholesterol in later life: the Newcastle thousand families cohort study at age 49-51 years. Eur J Epidemiol.;24(7):375-80. Epub 2009 May 29
9. Iacovou M, Sevilla-Sanz A. 2010. The effect of breastfeeding on children’s cognitive development. Institute for Social and Economic Research, University of Essex. 2010-40.
10. Field F (2010) The Foundation Years: preventing poor children becoming poor adults. The report of the Independent Review of Poverty and Life Chances
11. World Health Organisation. Global Strategy for Infant and Young Child Feeding. Geneva: WHO; 2003.
12. Bartick M, Reinhold A. 2010 The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. May;125(5):e1048-56. Epub 2010 Apr 5.
13. Bolling, K., Grant, C. & Hamlyn, B. Infant Feeding Survey 2005. 2007; The Information Centre for Health and Social Care: London
14. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. 1998 Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. Jan 3;316(7124):21-5.
15. NICE (May 2005) ‘Breastfeeding for longer: what works?’ Systematic review summary and NICE. (2007) Modelling the cost effectiveness of interventions to promote breastfeeding.