As a passionate supporter of breastfeeding - I'm the mother of three breastfed children, a volunteer peer supporter in the NHS in Derbyshire and the editor of Breastfeeding: stories to inspire and inform, a collection of real-life accounts of breastfeeding designed to encourage and support mothers - the report made fascinating reading: although it aims to answer the question of how much money could be saved by increasing breastfeeding rates in the UK, in doing so it touches on many other aspects of the reality of breastfeeding in today's society.
What the report shows, in a nutshell, is that not breastfeeding is costing the NHS a lot of money. Or, to look at it the other way round, breastfeeding could save the NHS a fortune every year if it could only invest in the programmes, of training, information and support, that would enable women to breastfeed and to keep going for longer. The good news is that these programmes are relatively cheap (under £500,000 in the first year for an area the size of Lancashire, less year-on-year) and show a rapid return on investment, maybe even within one year. The NHS has precious few opportunities for such cost-effective health interventions - let us hope that the health planners and commissioners seize on the findings of this report and act on them immediately.
The picture painted in the report of the current state of breastfeeding in the UK is bleak. Across the country some 81% of mothers begin breastfeeding (although this varies from 42.5% to 92.5% by locality), but the number exclusively breastfeeding at one week drops to 45%. At 6-8 weeks the rate of any breastfeeding varies from 19.4% to 83.2% by locality. By five months 75% of babies get no breastmilk at all. Just 1% of mothers are exclusively breastfeeding at six months (see WHO guidelines). Women are clearly encountering problems or social barriers to breastfeeding and stopping early, often before they want to, and this is certainly my experience of working with breastfeeding mothers, even though I live in an area with high rates of breastfeeding initiation.
The costs of not breastfeeding, for the purposes of this report, are the costs to health services. (The costs to families of artificial feeding are not included). And the savings, even at modest increases in breastfeeding rates, are not to be sniffed at: for the five illnesses where the best quality evidence exists (gastroenteritis, necrotising enterocolitis (NEC), acute otitis media (ear infection), lower respiratory tract infections and breast cancer in mothers) the annual savings amount to over £40 million per year. Then there’s another set of outcomes (SIDS, cognitive outcomes, obesity) for which the authors couldn’t carry out the same statistical analysis as for the ‘top five’, but where cost savings are still suggested, and a further list of outcomes where breastfeeding is likely to have an effect (diabetes, ovarian cancer, cardiovascular disease, among others) but where more research is needed. That £40 million, it seems, might be just the start.
In terms of achieving the suggested increases in breastfeeding rates, the report acknowledges that breastfeeding promotion and support have not yet been consistently implemented, even in the areas where breastfeeding rates are lowest. The social, economic and political barriers to breastfeeding are clearly explained:
‘…an unsympathetic public attitude to breastfeeding outside of the home, an acceptance of formula feeding as a normal and safe way to feed babies, a lack of expertise and experience of breastfeeding among health service staff and, in many communities, a dearth of practical experience of breastfeeding among grandparents… Breastfeeding is... commonly associated with images of sexuality, or of feeding difficulties, rather than being seen as a normal, unremarkable, and fundamental aspect of parenting… As a result, when women encounter serious but preventable problems with breastfeeding (such as embarrassment and isolation when breastfeeding in public, painful breasts and nipples as a result of not understanding how to effectively attach the baby to the breast, and anxiety about their milk supply), they may struggle to find appropriate care and support. This may lead to their families, friends, and health professionals advocating that they solve the problem by using formula instead... Women’s choice to start or to continue to breastfeed is therefore constrained by the culture and community in which they live.’
One of the great strengths of the report is that it shows how putting programmes of breastfeeding promotion and support in place will show a rapid return on investment, as well as improving health outcomes for mothers and babies and addressing health inequalities (babies who are not breastfed are at increased risk of ill-health, and the babies most likely not to be breastfed are in the lowest socio-economic groups). The case studies in the report show how this can be achieved in practice.
There is more good news. The report takes what the authors call ‘a robust, systematic, conservative, UK-specific approach’ - it’s likely that, if anything, the cost savings to the NHS (and, by extension, the other positive outcomes) have been underestimated by the methodology used. It is clear from the findings that the more common breastfeeding becomes, particularly exclusive and continued breastfeeding, the higher the cost savings to the health service will be. This is great news for those of us already working in supporting breastfeeding: it confirms that our aim to encourage mothers to breastfeed and to keep going for as long they want to is not only the right thing for individual mothers and babies, but also for society as a whole. It also busts the old myth about breastfeeding only being best for developing countries where they don't have clean water or enough money for formula - this report, which uses only evidence from the UK or comparable industrial societies, couldn't be clearer about the impact of not breastfeeding on British babies.
The report both calls for a wider debate on infant feeding and contributes to that debate. The findings have implications that reach beyond the health service; we all have a role to play in normalising breastfeeding and every individual can make a difference. Breastfeeding your baby in public, smiling at another mother doing the same, or becoming a peer supporter - all these can help, in a small way, to change how breastfeeding is viewed in our society. Ultimately, we'll all be better off.
NB: It's important to be clear, in talking about improving breastfeeding rates and the risks of not breastfeeding, that we are referring to changing behaviour across the whole population of the UK. People's individual circumstances will vary, and what mothers need to know is that any breastfeeding will provide some protection against illness, and more breastfeeding will provide a greater protective effect. It's not the intention - of the report or this post about it - to put pressure on individual women to breastfeed (see here for a great post about pressure). But wouldn't it be great if, in the course of the discussion of the report, we could open a few people's minds to the idea of breastfeeding, or breastfeeding for longer?