The Economics of Breastfeeding: A Cost-Benefit Analysis
Friday, April 24, 2009 This month two very different positions have emerged about the economics of breastfeeding. Someone reading either of these stories on their own could be led to believe a conclusion about the financial aspects of breastfeeding that is not entirely complete. I want to tell you a bit about what they both said and then try to create a more objective view of the economic pros and cons of breastfeeding.
Image credit: epSos.de on flickr
Nursing by the Numbers: How Breastfeeding Boosts the National Economy
This month Mothering posted a web exclusive article by Olivia Campbell called Nursing by the Numbers: How Breastfeeding Boosts the National Economy. In this article, Campbell mentions that we all know how breastfeeding is beneficial to a baby's health and parents' finances (to the tune of the $700 to $3000 that a year of formula would cost). However the article says that few people understand the extent to which breastfeeding benefits the mother's health and how breastfeeding results in savings for the whole country.
A few examples:
- In 2001, the USDA concluded that if breastfeeding rates were increased to 75 percent at birth and 50 percent at six months, it would lead to a national government savings of a minimum of $3.6 billion (and this only considered a few of the health benefits of breastfeeding, not all of them).
- The AAP says each formula-fed infant costs the healthcare system between $331 and $475 more than a breastfed baby in its first year of life. The cost of treating respiratory viruses resulting from not breastfeeding is $225 million a year.
- Health benefits for the nursing mother include a reduction in risk of many cancers and other serious diseases, during and after lactation. The National Cancer Institute reported the national expenditure on breast cancer treatment in 2004 was $8.1 billion, meaning extended nursing could save upwards of $4 billion a year. (I posted about this my post called Save Yourself, Save our Healthcare System, where I documented the estimated costs in breast cancer treatments in Canada resulting from formula feeding at $225 million per year).
- There would be a drastic reduction in required treatment for type 2 diabetes for women that breastfed. Currently, the cost of their treatment and lost wages is roughly $78 billion a year.
- For WIC, supporting a breastfeeding mother costs about 45 percent less than a formula-feeding mother. Every year, $578 million in federal funds buys formula for babies who could be breastfeeding. (for more info on this topic see WIC and infant formula by Emily @ Adventures in [Crunchy] Parenthood).
- For employers, there is a cost due to formula feeding moms taking more days off to care for sick children, resulting in decreased productivity.
This study has some fabulous statistics on the cost of formula feeding to our healthcare system, social programs and company productivity. What it doesn't do, however, is look at the costs of breastfeeding to a mother's earning potential and it doesn't look at the cost, to a company, of holding a position for a woman who is on extended maternity leave and back-filling her position while she is gone.
Is Breastfeeding Truly Free? The Economic Consequences of Breastfeeding for Women
This is a case of Hanna Rosin strikes again. When she wrote her "Case Against Breastfeeding", I responded. Many other people responded too. And now she's come back for more. Yesterday, on Slate, she posted an article called Breast-feed More, Earn Less. In her post, she references a study by Phyllis L. F. Rippeyoung from Acadia University and Mary C. Noonan from the University of Iowa called Is Breastfeeding Truly Free? The Economic Consequences of Breastfeeding for Women.
In this study, the researchers hypothesized that:
...it is plausible that the relationship between breastfeeding and women's work status also operates in the opposite direction. Particularly considering that, temporally, the act of breastfeeding a newborn precedes a mother's return to work after childbirth, it seems plausible that, compared to a mother who formula feeds her child, a mother who breastfeeds her child may be more likely to leave paid employment, either partially or fully, or be more likely to switch to a "family-friendly" job in order to accommodate breastfeeding. These modifications in work behaviour may, in turn, lower the breastfeeding mother's current and future earnings. Furthermore, a mother who combines breastfeeding and paid work may be viewed by her employer as less committed and productive than another, similar employee who formula feeds her child.
Essentially, this study is trying to address exactly the gap that I mentioned above with regards to the Mothering article. However, it is doing so to the exclusion of most of the data presented in the Mothering article.
The other thing the researchers said in their introduction that was conveniently not mentioned by Hanna Rosin in her article is that "should breastfeeding be shown to have a negative impact on work outcomes, our study will provide evidence that breastfeeding promotion needs to be coupled with protections for women's work and earnings". They said protection for women's work and earnings....not formula feeding. They also mused about the findings potentially opening up further discussion on breastfeeding and feminism (I'm always up for discussion).
The study puts a lot of emphasis on the possibility that employed breastfeeding mothers may reduce their work hours, take longer maternity leaves, switch to more family-friendly work, or quit work altogether in order to breastfeed. What the study did not consider is that perhaps professional women choose to do these things because they want to and because they can afford to. That they are making the choice to stay home with their children as part of an overall package deal of being a dedicated parent, which happens to also include breastfeeding. It isn't about breastfeeding or not breastfeeding. It is about choosing to care for your own child or choosing to have someone else care for them. When you choose to care for your child yourself, then yes it is easier and cheaper to breastfeed. This is a luxury. I understand that. But it isn't a case against breastfeeding.
In the study, they do attempt to prove the opposite, but don't really do a convincing job of it. They say that public health pressures on women to breastfeed are so great that if a mother finds it difficult to balance the demands of breastfeeding and work, they may feel greater pressure to sacrifice work for breastfeeding in order to be "good mothers".
The researchers did a really good job of citing references in almost all parts of the paper. And then this. They come out with a whammy of a sentence, with no reference, no footnote. This unsubstantiated finding is that "increased breastfeeding duration has had no effect on overall physical or pscychological health outcomes of either children or mothers." Says who? (Note: The researchers have since provided me with the missing reference : Maternal Employment, Breastfeeding, and Health: Evidence from Maternity Leave Mandates. I read it and commented on it in my post on the Scientific Benefits of Breastfeeding )
The researchers do some really interesting demographic analysis around who breastfeeds and who doesn't. This is good information and I'll bookmark it for use in other posts. But after saying that white married Northern educated professional women are more likely to breastfeed than those with the opposite characteristics, they end with this:
Although a general picture of the differences between breastfeeders and formula-feeders can be seen from these descriptive statistics, further analyses will be conducted shortly to assess how breastfeeding versus formula feeding impacts women's wages and work characteristics over time.
Hardly the cut and dry conclusion that Hanna Rosin was talking about in her article. Now, either Hanna Rosin linked to the wrong study from her article or she is making up quotes. In her article, Rosin quotes this from the study:
Although, at two years before birth, both breastfeeding groups earned statistically higher incomes than the formula feeders, by year 10 this advantage has disappeared - formula feeders and short-duration breastfeeders do not have significantly different incomes, and long-duration breastfeeders earn significantly less than formula feeders.
That quote is nowhere to be found in the study that Rosin linked to, so I have no way of evaluating the context (we know Rosin is good at taking things out of context) or the validity of the approach used. Assuming that this is in a follow-up study that Rosin conveniently forgot to link to, without seeing the context, my reaction would be that they probably did not differentiate between long-duration breastfeeders that wanted to go back to work quickly versus long-duration breastfeeders that wanted to stay home.
The cost-benefit analysis
Yes, I do this for a living. Yes, I'm fed up with doing economic cost-benefit analysis at the moment because I'm a bit burned out from a few intensely difficult projects that I managed to work on while breastfeeding and increasing my earning potential...oh my! But, just for you, dear readers, I will do a high-level analysis of the economic costs and benefits of breastfeeding (sorry, I'm not pulling out my spreadsheet for this, but maybe if I actually get access to the mystery survey Rosin mentioned, I might do that one day).
Economic Pros of Breastfeeding
- Money saved by not buying formula
- Decreased healthcare costs for the baby
- Decreased healthcare costs for the mother
- Fewer work days lost to care for sick children or to tend to mother's health
- Lower costs for government agencies and not-for-profit organizations that provide formula to low income mothers
Economic Costs of Breastfeeding
- Decision to take longer maternity leave limits short-term earnings and may limit long-term earning potential (still looking for the link to the "missing" study that Rosin quotes)
- Decisions to take on "family friendly" jobs, which frequently have a lower earnings trajectory
- Decision to work part-time, resulting in lower earnings
- Pumping at work may take time away from the job - the researchers propose a total of 15 workdays during the child's first 6 months (note: most women that I know that pump at work do it on the breaks that they are already entitled to or pump hands-free while working)
- If pumping at work, the mom will need to buy a pump
- Mom may choose to buy nursing bras and nursing clothing (although I rarely wore them)
- Perceived lower productivity of breastfeeding mother leads to her being passed by for promotions
- Fewer tax dollars earned taxing the profits of formula producers
One important thing to note about these benefits and costs is that the benefits are benefits of breastfeeding. Period. However, on the cost side, most of the costs are costs of the decisions that women may or may not make with regards to the way that they choose to balance breastfeeding and work. The costs are changeable. The benefits are here to stay.
Concluding Thoughts
I want to go back to the remark made in the study about the economic consequences of breastfeeding for women. The researchers said: "breastfeeding promotion needs to be coupled with protections for women's work and earnings". I agree. I think this is important because of breastfeeding and it is also important outside of the breastfeeding context. Having these types of protections in place will allow more parents to make the decision to care for their families at such a critical time in a child's development without it impacting their long-term earning potential. I'm not sure that we can entirely escape it having some short-term impact (but if we could, that would be great).
We need people with influence in our society to push for those changes. I know that the woman who is earning minimum wage at a low-skill job in a poor economy is not likely to feel that she can insist on accommodations for pumping at work or a flexible schedule that would allow her to breastfeed her child frequently. However, people like me and people like Hanna Rosin are in a position to be able to take a leadership role on those types of issues. It is too bad that Rosin chose to use her soapbox and megaphone for her ongoing diatribe against breastfeeding rather than using it to promote greater support for breastfeeding women in the workplace.
Where I live, we are also seeing an increasing number of men taking paternity leave, with 1 out of 2 men in Quebec now using some of the leave that is available to parents. It would be interesting to look at the impact of those decisions on the earning potential of those men. I have a feeling that the decreased earning potential raised in the study that Rosin quotes is related more so to the decision by a parent, who happens to be a breastfeeding mother, to stay at home for a while and make parenting a priority, than it does with breastfeeding.
What do you think? Is there a strong economic case against breastfeeding? Or is there a strong economic case for breastfeeding? Leave a comment or write a post (if you write a post and link back here, I'll link up to you too).
Note: I wrote a follow-up post to this called More questions than answers: A follow-up on economic consequences of breastfeeding.
Reader Comments (67)
[...] We need to keep providing medical, technical and moral support to women who are struggling with breastfeeding. That will always be a requirement. But to truly facilitate breastfeeding, we need to break down these barriers so that all families and all babies can benefit from the health benefits of breastfeeding and the economic benefits of breastfeeding. [...]
[...] for both the baby and the mother. It can lead to deaths as well as increased health problems and increased health costs (whether you have a public system or a private insurance system, you do pay for other [...]
Excellent article. I don't understand why people argue so vehemently against something that is clearly what nature intended. My "decision" to breastfeed did not impact my potential earnings. In fact, while I was on maternity leave (and yes, I took 22 weeks off), I was offered a promotion upon my return. My management did not see the fact that I was breastfeeding and would need to take breaks to pump as a negative (I was fortunate and we had a nursing mother's room specifically for pumping). However, I decided not to return to work after my maternity leave. That decision was in no way impacted by the fact that I was breastfeeding. We just decided it was best for our family for me to stay home with our daughter.
[...] The Economics of Breastfeeding: A Cost-Benefit Analysis [...]
[...] deaths could be prevented and $13 billion could be saved (a topic I also addressed last year in my economic cost-benefit analysis of breastfeeding). Please also see Best for Babes excellent analysis of the horrible ABC coverage of the study on [...]
Its so many years since I finished breastfeeding. And, I'm still at home! While my husband works such ridiculous hours, someone needs to look after our 5 children. I reckon 1 or 2 will be moved out before I even look at returning to work. Are we financially secure? Hell no! Are our children secure? You better believe it! Is my income trajectory lower for breastfeeding/parenting/staying home? Maybe. Whatever.
Breastfeeding for me is the only choice for my children. I do not remember even considering how much more or less it would cost me in the long run.
Thanks for the article, quite a good read. I always consider it a pleasure to hear what others are saying especially on matters touching on parenting.
Now that I have discovered your site I will keep coming back.
[...] of her life, all for the contribution, dedication, and time she invested into one of our citizens. (Economics of Breastfeeding) C. Teach young mothers of the financial savings involved in washing her own cloth diapers. ($2,000 [...]
[...] We need to keep providing medical, technical and moral support to women who are struggling with breastfeeding. That will always be a requirement. But to truly facilitate breastfeeding, we need to break down these barriers so that all families and all babies can benefit from the health benefits of breastfeeding and the economic benefits of breastfeeding. [...]
[...] Economics of Breastfeeding – a compilation of research [...]
[...] of her life, all for the contribution, dedication, and time she invested into one of our citizens. (Economics of Breastfeeding) C. Teach young mothers of the financial savings involved in washing her own cloth diapers. ($2,000 [...]
What sort of self-employment have you created? I feel curious to know as I am also self-employed. Flexibility is important to me also, while maintaining level of income, in order to actually spend some of my time raising my own children!! Paying twice the taxes (as employer+employee) make it seem pointless, in addition to finding any sort of childcare particularly for the type of hours that I need to work. In my city, $800 is average cost for care, and nannies are approx $13-15 hr. I do not have family who can help, though if you did that would be very relieving. How have you navigated self-employment, taxes, and childcare? What is your position and income rate? Thanks for any info you'd like to share!
Short term, it might seem that there is a case. If the mom requires galactogogues, a pump ,lactation aids,consultant visits, books, medications for boosting supply,extra calories, and time of off of work. But long term, the benefits outweigh anything anyone can imagine,and every day we discover more benefits. Surely, one lonely case of breast cancer costs many times that of formula cost, or the above cost I mentioned. I am shocked someone compares this, is there a point really? And how about the fact that breastfeeding imposes (not always, but lets assume) healthier choices of food, avoidance or lowering of smoking, alcohol, drugs etc. Has anyone studied this? I meet lots of mums that changed a lot of habits during pregnancy, but the BF moms continue these habits during BFing, where I have noticed mums that do not BF, revert to previous bad habits believing that if the baby doesn't get her milk she need not bother.
I think what also is left out is the question of how many breastfeeding moms choose family friendly jobs not because they are breastfeeding but because they value time with their children over money. While there are plenty who don't have a choice, those who do may choose a job with flexible hours or fewer hours so they can actually spend time with their babies and watch them grow. If you are more willing to hand your baby over to someone else the majority of the time, you might also be less willing to breastfeed as it is seen as a burden (as is child care). In that case it's more correlation rather than cause and effect.
Where would the cost analysis end? If a breastfeeding mother reduces her risk of breast cancer say, are we trying to imagine how much she saves by avoiding this illness (ie: time off work for chemo, or recovery from a mastectomy)? What about the formula feeding mother who stays home with the kids because she wouldn't make much more than the cost of daycare if she went back to work? I like the idea of a cost benefit analysis but Rosin's article is rediculous!
My own story is that I went back to work with both kids at 6 months as I am self employed and didn't have maternity benefits. My husband took the other 6 months off. I breastfed both children for 3 years each. I didn't not own an electric pump but did receive a hand pump (that I rarely used) as a gift. I hand expressed or had my children brought to me when time allowed. I coslept and nursed at night which is why I didn't lose my supply. I stayed away from annoying and expensive breastfeeding shirts. I make a very good wage and it is higher than before I breastfed...my point being that the decision to breastfeed and to continue to do it is so complicated. Costs will vary depending on what people need, buy, what supports they have, how secure their living situation is, how secure and flexible their job is...
We do need to support women and families who breastfeed more. For sure.
Great article.
I feel that this speaks only to women who enjoy a fair bit of privilege. What about those moms who have to work 2+ jobs just to get by and not the type that you can pump at, if you can afford a pump at all? "Low income moms". I don't know any 'low-income moms' myself, but I certainly know some fantastic women raising cool kids despite economic hardship. Just sayin.
Hi,
I'm looking at all the research around this so thanks so much for this article. I wondered if you've ever added environmental cost benefits. i.e. the plastics saved / used if breastfeeding were promoted. This would be on a governmental not individual level but I'm trying to add the two up as it is a big agenda worldwide that breastfeeding is often left off x