A new analysis estimates that approximately 800,000 childhood deaths and 20,000 breast cancer deaths could be averted if nearly all women worldwide breast-fed their infants and young children. That decrease in children’s deaths is equivalent to 13 percent of all deaths in children younger than 2 years of age, the study authors reported in a two-part series published online Jan. 28 in The Lancet.
According to figures compiled for the report, only one in five children in high-income countries is breast-fed for 12 months, and only one in three children in low- and middle-income countries is exclusively breast-fed for the first 6 months. This means that millions of children and women don’t receive the full benefits offered by breastfeeding, which has been shown to be healthy for both mothers and children, the study authors said.
“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth,” series author Dr. Cesar Victora, of Federal University of Pelotas in Brazil, said in a journal news release. “Our work for this series clearly shows that breast-feeding saves lives and money in all countries, rich and poor alike. Therefore, the importance of tackling the issue globally is greater than ever.”
Benefits of Breastfeeding
In a detailed worldwide analysis, the researchers identified a number of major benefits of breastfeeding. For example, breastfeeding lowers the risk of sudden infant death in high-income countries by more than one-third, they said. The study also found that breastfeeding could prevent about half of all cases of diarrhea and one-third of respiratory infections in low- and middle-income countries. Breastfeeding also boosts children’s intelligence and may protect them against obesity and diabetes later in life, the study found. And among mothers, long-term feeding reduces the risk of breast and ovarian cancer, the researchers added.
The researchers also said that current breastfeeding practices cost the world’s economy hundreds of billions of dollars a year. They estimated that poorer thinking skills among children who aren’t breast-fed cost the global economy about $302 billion in 2012. The loss in high-income countries alone was $231 billion, the study concluded.
Increasing breastfeeding rates for infants younger than 6 months to 90 percent in the United States, China and Brazil, and to 45 percent in the United Kingdom, would lower treatment costs of common childhood illnesses — such as pneumonia, diarrhea and asthma. This could save health care systems about $2.5 billion in the United States, $29.5 million in the United Kingdom, $224 million in China and $6 million in Brazil, according to the study.
The authors say that by not doing enough to promote and encourage breastfeeding, the world’s nations — both rich and poor — are overlooking one of the most effective ways to improve maternal and child health. While about 80 percent of newborns receive some breast milk, the study found that just 35.7 percent of children globally are breastfed exclusively from birth to 6 months — meaning that nearly 65 percent are not meeting the minimum recommendation set by the World Health Organization. Rates are lowest in high-income countries, the study showed.
“Breastfeeding is one of the few positive health behaviors that is more common in poor than richer countries, and within poor countries, is more frequent among poor mothers,” Victora explained. “The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider. Our findings should reassure policymakers that a rapid return on investment is realistic and feasible, and won’t need a generation to be realized.”
Barriers to Breastfeeding
Reasons for low breastfeeding rates include poor promotion and low support of breastfeeding, limited maternal leave and inflexible workplace policies, inaccurate information and/or lack of lactation counseling, and aggressive marketing and rising sales of infant formula, the study authors said. (It’s also important to note that some women cannot breastfeed due to various physical conditions.)
“Currently, breastfeeding promotion focuses on encouraging women to breastfeed without providing the necessary economic and social conditions such as supportive health-care systems, adequate maternity entitlements and workplace interventions, counseling, and education,” said Dr. Nigel Rollins, a researcher at the World Health Organization.
“But the success or failure of breastfeeding should not be seen solely as the responsibility of the woman,” Dr. Rollins told The Guardian. “Her ability to breastfeed is very much shaped by the support and the environment in which she lives. There is a broader responsibility of governments and society to support women through policies and programs in the community.”
According to Flavia Bustreo, WHO’s Assistant Director-General for Family, Women’s and Children’s Health, mothers are 2.5 times more likely to breastfeed when the practice is protected, promoted and supported. “This requires targeted interventions through education and health services, such as accurate information and breastfeeding support from health staff or peers,” Bustreo said.
“But beyond health interventions, a political and societal shift are needed. For example, adequate maternity protection policies, and breastfeeding-friendly workplaces and public spaces. Organizations should review and seek to continuously improve their policies and support systems … Governments also have a critical role, including in regulating the breast-milk substitutes industry,” she added.
The United States is one of only three countries worldwide — along with Papua New Guinea and Oman — not to guarantee any paid maternity leave. Studies show that this is one of the primary barriers to breastfeeding among U.S. women, as women who plan to go back to work earlier are less likely to initiate breastfeeding, and working mothers tend to stop breastfeeding earlier than those who aren’t working.
The right to breastfeed or express breast milk at work was established under federal law in 2010, as a provision of the Affordable Care Act, aka ‘Obamacare’. Under the law, employers must give eligible employees “reasonable” break times to express milk for a nursing baby, for up to a year after the baby’s birth. They must also provide a clean, private location that isn’t a bathroom. But many employers are not complying with the mandate, leaving major challenges for working moms who want to continue breastfeeding.
According to a 2011 Surgeon General’s report on breastfeeding in the U.S., “Women often face inflexibility in their work hours and locations and a lack of privacy for breastfeeding or expressing milk, have no place to store expressed breast milk, are unable to find child care facilities at or near the workplace, face fears over job insecurity, and have limited maternity leave benefits.”
As Bustreo reminds us, “we have a duty [as a society] to ensure that breastfeeding is encouraged, supported and celebrated. The cost of not doing so in lives – and dollars – is far too high.”