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The Cost Of Not Breastfeeding

According to World Bank data, only 40.6 per cent of infants in Malaysia are exclusively breastfed for six months.

Image by freepic.diller from Freepik.

The benefits of breastfeeding have been emphasised by international health organisations ad infinitum. It is one of the most effective ways to ensure child health and survival.

Breast milk is ideal for infants. It is safe, clean, and contains antibodies that protect against many childhood infections.

Breast milk contains all the nutrients and energy needed in the first six months of life, about half of an infant’s needs during the second six months of life, and up to a third during the second year of life.

Breastfed children are less likely to be overweight or obese, or get diabetes later in life. 

Women who breastfeed also have a decreased risk of breast and ovarian cancers.

Breastfeeding is free and does not burden household budgets unlike artificial feeding, and it contributes to poverty reduction.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early initiation of breastfeeding within an hour of birth, exclusive breastfeeding for the first six months of life, and the introduction of nutritionally-adequate and safe complementary (solid) foods at six months, together with continued breastfeeding up to 2 years of age or beyond.

Malaysian breastfeeding policy, which is not very different from the WHO and UNICEF recommendations, states that all mothers are encouraged to breastfeed their children with breast milk from birth until 6 months old, continuing until 2 years of age. Complementary foods should be given from 6 months old. 

Breastfeeding that is not in accordance with WHO and UNICEF recommendations has an impact on the costs of human life, quality of life, and national economies.

World Breastfeeding Week this year was commemorated on August 1 to 7, with the theme ‘Step Up for Breastfeeding: Educate and Support’. 

In conjunction with the event, the 2022 report ‘The Cost of Not Breastfeeding’ was released by Alive and Thrive, a global nutrition initiative managed by FHI Solutions, a member of the Family Health International group of organisations, and funded by the Gates Foundation, Irish Aid, and other international donors. 

The report, which utilised a tool based on open access data, was developed to assist policymakers and advocates on the estimated human and economic costs of not breastfeeding at the country, regional, and global levels.

Although the aim of the tool is to capture the majority of the costs, the estimates are likely to be conservative, since economic costs of increased household caregiving time (mainly borne by women), and treatment costs related to other diseases, attributable to not breastfeeding according to recommendations, are not included in the analysis.

The initial report of Cost of not breastfeeding: global results from a new tool was first reported in Health Policy and Planning, Volume 34, Issue 6, July 2019, Pages 407–417.

The Cost Of Not Breastfeeding In Malaysia

According to World Bank data, only 40.6 per cent of infants in Malaysia are exclusively breastfed for six months. This is below the global target of 50 per cent by 2025, which was agreed to by Malaysia at the World Health Assembly in 2012.

The 2022 Cost of Not Breastfeeding Report for Malaysia addressed the issues below.

Increased Vulnerability To Disease Results In Increased Maternal And Child Mortality 

Children who are not exclusively breastfed for the first six months and continue to receive breastmilk up to 2 years old are more susceptible to diarrhoea and pneumonia, two leading causes of childhood deaths worldwide.

When mothers practise recommended breastfeeding practices, about 50 per cent of under-two child deaths caused by diarrhoea and pneumonia could be prevented annually, compared to no breastfeeding.

It is estimated that improved breastfeeding practices could save 110 children’s lives annually and prevent 458 maternal deaths from cancers and Type 2 diabetes annually in Malaysia.

Health Care Costs To Treat Children And Mothers 

Inadequate breastfeeding causes over 400,000 avoidable cases of childhood diarrhoea and pneumonia; 5,507 cases of Type 2 diabetes in women, and 4,339 cases of childhood obesity annually.

The current health care cost due to inadequate breastfeeding is estimated to be about US$6.7 million (RM27.8 million). This cost could rise dramatically as treatment for diarrhoea and pneumonia increases, but could also be reduced with increased breastfeeding practices.

Cognitive Losses Result In Lost Wages For Individuals 

Inadequate breastfeeding impairs a child’s ability to learn, and consequently hinders their future earning potential.

Malaysia stands to lose more than US$1.2 billion (RM4.97 billion) annually due to future cognitive losses associated with inadequate breastfeeding.

Indirect Costs To Treat Diseases Result In Significant Costs For Families 

When children have diarrhoea and pneumonia caused by inadequate breastfeeding, parents and caregivers incur costs to take them to seek treatment at health care facilities.

Based on estimates from other countries, the economic losses that result from lost productivity and transportation costs could amount to 25 per cent of the cost of the health care treatment itself. 

Formula Costs Are Significant And Reduce A Family’s Disposable Income 

Many companies market their breastmilk substitute products to mothers. The cost to purchase economy brand infant formula can be significant compared to breastmilk, which is free, safe, and hygienic for all babies.

Summary

The 2022 Cost of Not Breastfeeding Report reported that optimal breastfeeding practices have the potential to, in every year:

  • Prevent 110 child deaths, an important contribution to reducing under-five mortality. 
  • Prevent 458 maternal deaths from cancers and Type 2 diabetes. 
  • Save over US$6.7 million (RM27.8 million) in treatment costs related to inadequate breastfeeding.
  • Generate an additional US$1.3 billion (RM5.4 billion) for the economy, or 0.4 per cent of its gross national income (GNI), over children’s productive years by increasing cognitive capacity and preventing premature mortality in the early years. 
  • Reduce families’ out of pocket expenditures to treat diarrhoea and pneumonia.

Going Forward

Policymakers and advocates have to remember that breastfeeding is best supported by practices that keep mother and baby together and ensure quality professional and peer support and maternal well-being.

The 2022 Cost of Not Breastfeeding Report for Malaysia emphasised the need to scale up breastfeeding at a national level.

It stated: “Policymakers should move quickly to adopt, strengthen, and implement the following policies and programmes to support mothers to optimally breastfeed”. 

  • Policies and Practices in Health Facilities: Include nutrition counselling and the 10 Steps to Successful Breastfeeding in hospital standards and accreditation systems.
  • International Code of Marketing of Breastmilk Substitutes: Enact and enforce national legislation to restrict the aggressive marketing of products that undermine breastfeeding, and strengthen the consequences for violators. 
  • Paid Leave and Workplace Policies: Expand paid family leave and workplace breastfeeding policies for all workers in the formal and informal sectors, and allocate public funding. 
  • Social and Behaviour Change Communication: Use multiple communication channels tailored to the local context, including community networks and community-based workers”.

Can the target of 50 per cent exclusive breastfeeding for the first six months of life be achieved by 2025? Only time will tell.

Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova. 

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