Public health initiatives, by definition, are meant to improve public health.
[pullquote align=”right” color=””]We waste millions on a public health campaign that produces no discernible return on investment.[/pullquote]
They are usually based on solid scientific evidence, their implementation saves thousands if not millions of lives, and they pay for themselves many times over in lives saved, earnings preserved and medical expenditures averted.
Consider the classic public health campaigns to promote vaccination and to reduce tobacco smoking.
This graph from E&K Health Consulting shows the dramatic drop in incidence of vaccine preventable disease after the introduction of the vaccine for the specific disease:
Notice that the y-axis is logarithmic, which means that the actual changes were far more dramatic than a glance at the graph would indicate. For example, there were approximately a one hundred thousand cases of smallpox per year prior to the introduction of the vaccine. In 2012 there were no cases at all. For each and every vaccine, the number of cases decreased by several orders of magnitude after the introduction of the vaccine.
The public health campaign to reduce tobacco smoking has had similarly spectacular results.
This graph originally published in the National Cancer Institute Bulletin shows that in the wake of the Surgeon General’s report of 1964 warning about the link between smoking and lung cancer, per capita cigarette consumption dropped dramatically. After a lag period, lung cancer deaths began to drop dramatically, too.
We have spent millions of dollars promoting vaccination and reducing smoking and it has paid off in both lives and money saved.
How about breastfeeding?
In the past 20 years we have spent millions of dollars promoting breastfeeding despite scientific evidence that is weak, conflicting and riddled with confounders.
An entire industry, the lactation industry, has arisen to promote and profit from efforts to increase breastfeeding rates. For example, lactation consultants did not exist prior to the mid 1980’s. Now they are everywhere, in hospitals, in doctors’ offices and in private practice. There have been multimillion dollar health campaigns and there is now a certification costing hospitals more than $10,000 each to be designated as breastfeeding friendly.
Breastfeeding initiation rates have risen in response. But the breastfeeding rate appears to have had no impact on the infant mortality rate. The graph below illustrates the steep drop in infant mortality over the course of the 2oth Century. I’ve added markers for the breastfeeding rate at various points. As you can see, the precipitous drop in breastfeeding rates did not have an impact on infant mortality and the rising rate of breastfeeding initiation does not seem to have an impact, either.
Breastfeeding initiation rates have tripled since 1970 rising from 25% to over 75% today.
So where is the return on investment?
Where is the evidence that thousands of lives have been saved? Where is the evidence that millions of cases of disease have been prevented? Where is the evidence of millions of dollars in healthcare expenditures averted? Where is the evidence that the dramatic rise in breastfeeding has had any impact at all on infant or child health?
The only evidence for the beneficial effects of breastfeeding on infant mortality come from premature infants, not term babies.
Sure there are papers making claims about theoretical health and spending benefits of breastfeeding for term babies, but I haven’t found any evidence of actual health and spending benefits. If it exists, I invite anyone who has seen such information to share it with the rest of us.
In fact, there is a growing body of evidence that the aggressive promotion of breastfeeding is harming babies through an increased incidence of dehydration and starvation due to insufficient breastmilk (affecting up to 15% of first time mothers) as well as smothering in mother’s hospital beds or falling from them because of mandated 24 hour rooming in policies in hospitals.
That doesn’t mean that breastfeeding is a bad thing. It’s a good thing, but the benefits for term babies in first world countries are trivial. If those benefits were anything other than trivial, we should have seen a dramatic impact on infant health and pediatric care expenditure in the past 45 years when breastfeeding initiation rates rose by 200%, but we haven’t seen anything of the kind.
No doubt the lactation industry has benefited. The number of lactation consultants in the US has increased from 0 in 1980 to 3.5/1000 live births in the 2013 (14,000 lactation consultants). Tens of millions of dollars have been spent on public health campaigns, and tens of millions of dollars are spent by mothers themselves.
What do we have to show for it?
Nothing.
Unless, of course, you count the soul searing guilt and feelings of inadequacy among women who can’t or choose not to breastfeed.
Going forward we should dramatically scale back spending on breastfeeding promotion. In an era of scarce healthcare dollars, we can’t afford to waste millions on public health campaigns that produce no discernible return on investment.
Breastfeeding should be a private choice. There is no reason, scientific or economic, to spend millions promoting it.
Adapted from a piece that first appeared in August 2015.
What gets to me is the hypocrisy where many of the same people that are so strident with regards to breastfeeding are also often anti-vax, pro-home birth and other forms of woo. They just want people to be informed of the (theoretical, minor) risks of formula, and yet people are somehow scare mongering when they mention the very real, demonstrable and actually deadly risks of home birth.
Their reasoning only becomes consistent when you realize that it has nothing to do with safety or science and everything to do with asserting their privilege and superiority over others.
That’s the thing no one can tell me, what advantages would breastfeeding have given my completely formula fed, now 22 year old daughter? She just graduated as an Engineer with a 3.3 GPA. She’s pretty healthy(since students usually don’t get enough veggies, or sleep, and sometimes drink too much) And she went to school on scholarships. Maybe she would have had a few less colds or tummy upsets as an infant, but I doubt even that since I had to back to work when she was 6 weeks – and when I say Had To I mean I was active duty military and they get Really cranky when you don’t show up for work.
So what MAGIC would breastmilk have conferred on this full term, healthy newborn, whose parents had government paid for health care and vaccinations?
Perhaps the fact that she was an only child whose parents and babysitters read to her and took her to the many museums near us and had the money to encourage her science curiosity had more to do with her success than a year of breastfeeding would have…
“That’s the thing no one can tell me, what advantages would breastfeeding have given my completely formula fed, now 22 year old daughter? She just graduated as an Engineer with a 3.3 GPA.”
Well, duh, if you’d just breastfed her she’d have graduated with a 4.0 GPA! /sarcasm
Ironic that there’s so much money floating around something that’s supposedly free. I didn’t spend much outside the gargantuan bras I now need, but other women spend money left and right on everything from LCs to special pillows and lactation cookies.
And then there’s the condescension and browbeating.
Condescension and browbeatings can be had for free – no need to pay for those!
i noticed
$500 on lactation consultants, $200 on bras, $30 on nipple cream. Plus 500 cals of extra, nutritious food a day doesn’t come cheap. BF is certainly not free. No weight-loss, just a raging hunger, and BF baby has already caught his first cold. Breast feeding is wonderful when it works, but I wish the Establishment wouldn’t over sell the benefits.
hugs. yeah, my bf’d kid had his first cold at 4 weeks. My ffd kid was at least 6 weeks. Being June and November babies may have helped there
There are so many people who will claim here that 500 extra calories doesn’t cost much money and they didn’t need x, y or z to breastfeed. And I say AWESOME for you but quit discounting the experience and the costs that the rest of us had! I was lucky I found nursing bras that fit and worked for me the first go around, I have seen friends who had to buy a lot of bras before they found the right one and those things aren’t cheap.