The United States has the unfortunate distinction of spending more than any other country in the world on health care, and receives significantly less benefit. The Institute of Medicine provides an excellent infographic presentation of the costs of healthcare through The Healthcare Imperative. Missed prevention opportunities account for $55 BILLION USD per year. Per. Year. Bartick and Reinhold (2010) examined the direct and indirect cost savings to the United States per year if 90% of infants were breastfed exclusively for the first 6 months of life. Their conservative direct and indirect health care cost savings estimates totaled $3.4 billion USD and 911 preventable deaths. Per year. As compelling as these findings are, Rippeyoung and Noonan (2012) analyzed just the income consequences for women in the United States who breastfed for short, long, or no duration. The results indicated that the least negative impact on income (all women who gave birth suffered negative consequences compared to women who did not) came to those who breastfed for up to 6 months (short duration). It is important to note that long duration breastfeeding, even after controlling for the ability to leave the work force due to a spouse or partner with sufficient income, those who breastfed for more than 6 months suffered a greater loss of income in the short and long term than those who breastfed for short duration. So, breastfeeding as defined in these significant studies saves the country and individual families money in the short and long term – with caveats. Why then is there no communication between these topics? Why not a concerted and sustained effort to increase lactation support for working parents?
Workplace Barriers to Lactation
According to Pew Foundation estimates, a record 40% of families in the United States with children under 18 rely solely or primarily on the income of a Female parent. This translates to 40% of the primary or exclusive income providers in this country facing the knowledge that their income potential is impacted by lactation decisions – and never positively. Particularly for those in the low wage work place, the decision to persevere in lactation goals is complex. Parents know that there are serious and costly health consequences to formula in addition to the cost of the formula and feeding equipment. They also know that it is less likely to be accommodated by a low wage employer. For excellent discussion of the issues of lactation in the low wage work place,please explore the work of Janet Vaughan, WIC Breastfeeding Counselor for Monterey, CA. Many families with primary income from low wage jobs are also at risk of health disparity due to other demographic characteristics, such as ethnicity. For these families, provision of human milk is particularly important to stop the cycle of disparity.
Meeting in the Middle
If we know that billions of dollars per year can be saved directly related to health care cost, and that a reduced negative impact on the wages of recently pregnant workers can be achieved through short term breastfeeding, what is the gap and how to we bridge it? The most obvious gap is the lack of lactation support in the work place. Having a functional and comprehensive policy regarding lactating employee rights in the United States would go a long way to resolve this gap. If more families can benefit from working and lactating and move away from the deficit of formula feeding financially, it is a win for the family. If more families are able to achieve these benefits, it is a win for health care direct costs and begins to chip away at the $55 billion dollar deficit in health realization due to prevention. These two goals are therefore not mutually exclusive, and are much more likely to be mutually beneficial.
As these policies are coming into place, it is conceivable that providing breast milk through PAMS can help to alleviate some of the health cost. Many in the health community, even among those who are genuinely supportive and knowledgeable about lactation, believe that the perceived level of risk with PAMS obtained milk outweigh potential benefits. In light of no known reports of infectious disease, milk contamination, or other serious health outcomes negatively associated with PAMS, this staunch belief is dubious. In light of the potential contribution toward potentially millions to billions of dollars in savings, from a practice that is founded on donation, it seems as though more consideration and support for moderating risk would be in order.
Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the united states: A pediatric cost analysis. Pediatrics, 125(5), e1048-e1056. doi:10.1542/peds.2009-1616
Rippeyoung, P. L. F., & Noonan, M. C. (2012). Is breastfeeding truly cost free? income consequences of breastfeeding for women. American Sociological Review, 77(2), 244-267. doi:10.1177/0003122411435477