Breastfeeding "Non-Compliance" Costs US $13 Billion A Year

| Fri Apr. 16, 2010 12:38 PM EDT

A study released last week from the journal Pediatrics points to subpar breastfeeding rates in the US when it comes to first six months of a baby's life. The consequence is a rash of health problems; the list is long and frightening: necrotizing enterocolitis (tissue death), otitis media (ear infections), gastroenteritis (stomach pain), hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes, and childhood obesity.

Jimminey Christmas, that's a lot of sick. And more than 900 babies die a year as a result of these, and the health care delivery system is beset with $13 billion in cost overruns thanks to formula-feeding. All this because, while three-quarters of new mothers start breastfeeding at birth, only 12% of infants are breastfed exclusively for six months, a far, far cry from the recommended 90%. Rates in countries like Sweden and Kenya are much better.

The problem often is, mothers operate on such slim margins (of time, energy, resources, sanity) and breastfeeding can be a casualty of that balancing act. So formula is on one side of an unfortunate Sophie's Choice: sanity or breastfeeding. Which would you choose?

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To be fair, the study authors are certainly not blaming moms but it's still hard to read such headlines and not wonder how it can be so difficult, really. One of its coauthors, Melissa Bartick, details some the incredible barriers to breastfeeding mothers face:

Since your pediatrician got very little training on breastfeeding, he doesn't know how to help you, but is concerned that your baby has lost too much weight, and advises giving some formula. You don't know what to do because the lactation consultant's advice was different...Eventually, things miraculously end up working out, just because you persevere through thick and thin, and your partner and family and friends are very supportive. By about 4 weeks, your baby is now exclusively breastfeeding, and gaining well. And you are enjoying what time is left of your unpaid leave under the Family Medical Leave Act. But, you have only two more weeks before you go back to work. You can't afford any more time off.

You start pumping to build up a stash of frozen milk for your return to work. You arrange with your employer a place to pump -- how lucky you are that it won't be a bathroom! You go back to work, and before long you discover your milk supply is dwindling and now your baby wants to nurse all night long. You are exhausted.

You call the lactation consultant who tells you that it's common to see a drop in milk supply when moms go back to work. She explains that pumps aren't as efficient at removing milk as your own baby is, so your milk supply may drop, and your baby makes up for it by nursing more when you are with him -- it just so happens that that's at night. "It's called reverse cycle feeding," she tells you. You wonder why you never heard about this before, in any of your follow-up visits with your pediatrician or OB.

You want to see the lactation consultant again, but your insurance will only reimburse you for visits during the newborn period. Well, you think, at least my insurance paid for something -- my friend's insurance doesn't reimburse anything for lactation help.

You nearly fall asleep at the wheel driving to work. "This is crazy," you think. "My baby needs me to be alive, more than he needs me to be breastfeeding." Finally, you give up. You just can't do this anymore. You are very sad and disappointed.

You become a statistic: one of the 41% of US mothers who wean before 3 months. You feel guilty as hell, especially when all you ever hear is how great breastfeeding is, and now how that new study shows it could save the US economy $13 billion/year, and how everyone says it saves lives and how it will make you healthier too. You just wish all these people would just shut the heck up.

The health care reform bill mandates "reasonable" breaks for working moms to breastfeed (or pump, as it were) but the breaks are unpaid, and as Jill Lepore deftly put it in The New Yorker last year, unpaid time to pump translates into less time actually touching your child.

Some WIC officers have begun to worry that pump promotion might be backfiring, having “the unintended effect of discouraging breastfeeding.” But such cautions have hardly stopped the anti-formula fire and brimstone. Between 2004 and 2006, a National Breastfeeding Awareness Campaign included TV ads that likened a mother feeding her baby formula to a pregnant woman riding a mechanical bull: “You’d never take risks before your baby is born. Why start after?” No one seems especially worried about women whose risk assessment looks like this: “Should I take three twenty-minute pumping ‘breaks’ during my workday, or use formula and get home to my baby an hour earlier?”

A 90% compliance rate will take a raft of changes in healthcare delivery: doctors and hospitals need to provide adequate information and training for new mothers, insurance needs to cover lactation plans (consultations, follow-up, and support), the workplace needs to adjust to pay for women to take time to pump for six months (or they just won't, can't), and low-income women in particular need these supports in place. We're asking women, some of whom are barely hanging on, to their jobs, their sanity, their own health, to assist in a public health sea change, to improve outcomes for children on a grand scale. The least we can do is show them the way and give them the means.

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