7 Important Facts About the Real Economics of Breastfeeding
In February 2022, the United States began experiencing a formula shortage that shined a light on the challenges many parents face in feeding their infants. A voluntary formula recall and formula plant closures worsened the COVID pandemic-induced stress on the supply chain. The situation raised a number of questions, not only about formula production and regulation but on what could be done to better support breastfeeding parents. Only about 25% of American babies meet the American Academy of Pediatrics’ recommendation of exclusive breastfeeding for the first six months of life. Let’s take a closer look at some important facts that affect the economic impact of breastfeeding and the tradeoffs parents face when deciding how to best meet the nutritional needs of their babies.
1. Poor Early Nutrition Has Long-Range Consequences
Numerous health and medical agencies, including the World Health Organization and the U.S. Centers for Disease Control and Prevention, strongly recommend exclusive breastfeeding during a baby’s first six months of life. Human milk possesses distinctive nutritional characteristics, like immune-system-boosting antibodies. Recent studies from the United Kingdom have also demonstrated breastfeeding can boost children’s cognitive abilities. Food security during infancy plays a big part in a child’s future healthy growth. Early malnutrition can have irreversible, lifelong consequences for children's neurodevelopment and mental functioning. Breast milk naturally supplies many essential macro- and micronutrients. Commercial infant formula is designed to imitate breast milk to supply many of these nutrients, as well.
2. Breastfeeding Wanes Over Time
Initially, most parents (about 84%) report breastfeeding their infant at some point. This figure drops dramatically with time, with less than 25% of parents following the AAP recommendation of exclusive nursing until six months of age. Lower rates of breastfeeding are strongly correlated with poverty. According to the CDC, only about 40% of mothers living below the poverty line report any breastfeeding at six months compared to about 70% of mothers with high incomes. Mothers who are less educated, unmarried, and younger have also noted fewer incidences of their infants receiving any breast milk at six months.
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3. Social and Financial Support for Breastfeeding is Inconsistent in the US
While breastfeeding was the norm during the 1800s, it was gradually replaced with the general adoption of medically-directed artificial infant feeding (formula). In the 1970s, breastfeeding in the US hit an all-time low, and rates have been steadily increasing since then. What this means, though, is that many of today’s parents lack older family members they can rely on for advice or support. Access to professional lactation support is essential since many parents stop breastfeeding sooner than they intended due to lactation problems or worry about milk supply. Additionally, the United States does not follow international standards on formula marketing, allowing formula manufacturers to engage in aggressive marketing strategies, like urging healthcare workers to send parents home with free formula samples. Racial inequalities continue as well, with black infants being more likely to be introduced to formula during their hospital stay following delivery. Birthing facilities that follow baby-friendly practices (like rooming in and limited use of breastfeeding supplements) are also less prevalent in neighborhoods with a higher percentage of black residents.
4. Formula is Expensive, but Nursing Isn’t Free Either
Breastfeeding proponents often reference the cost of formula and boast an annual savings of up to $1,500 by nursing. The truth, however, is that breastfeeding also has a lot of hidden costs: breast pumps, potential loss of wages (in order to take pump breaks), special storage bags for pumped milk, nursing bras, etc. Some estimates have calculated that if a baby nurses for the typical 8 to 12 times daily for 20 to 40 minutes each time, the time cost of breastfeeding for a nursing parent making federal minimum wage would be between $588-$1,765 in the first month alone.
5. Many American Parents Must Choose Between Breastfeeding and a Paying Job
Nursing parents who go back to full-time employment shortly following childbirth are less likely to plan to exclusively breastfeed, have lower rates of breastfeeding initiation, and have shorter breastfeeding durations. However, studies have shown that paid family leave (PFL) increases the overall duration of breastfeeding by nearly 18 days, and the likelihood of breastfeeding for at least six months by 5 percentage points, with substantially larger effects of PFL on breastfeeding duration for some disadvantaged mothers. Unfortunately, nursing parents who go back to work often face a massive shortage of professional support in terms of accommodations, bias, and even harassment.
Provisions from the 2010 Patient Protection and Affordable Care Act updated Section 7 of Fair Labor Standards Act (FLSA) so that employers are required to offer “reasonable break time” and “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public” for employees to express breast milk. However, this leaves out approximately 9 million employees of childbearing age who are exempt from Section 7 of the FLSA, which includes the majority of salaried employees. A recent bill, the PUMP Act, would have extended those protections to salaried employees but failed to pass the Senate in June 2022 during the peak of the formula shortage.
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6. Formula is a Great Resource But Subject to Fluctuations in Price and Availability
Market consolidation, high tariffs, and supply chain issues all contribute to rising prices and supply shortages issues when it comes to formula. Additionally, formula production is vulnerable to contamination from some of the few organisms that can exist in powdered formula (like the Cronobacter sakazakii bacteria that led to the February 2022 formula factory shutdown). The lack of available infant formula had harmful implications for many babies as some caregivers and parents began rationing formula or making homemade formula to deal with the fallout.
7. WIC Plays a Powerful Role in Affecting Formula Supply and Influencing Feeding Decisions for Lower Income Families
Women, Infants, and Children (WIC) is a federally funded program that has proven to be one of the most successful early intervention nutritional supports available. Its main goal is to promote breastfeeding by ensuring support for its beneficiaries, training its staff on breastfeeding promotion, and offering more generous food packages for fully or partially breastfeeding moms. Nevertheless, breastfeeding rates among WIC participants remain below the national average. Program participants frequently report a lack of support at home, the need to go back to work, and scarcity of time as impediments to breastfeeding. Correspondingly, approximately half of all infant formula sold in the U.S. is purchased with WIC benefits. To adjust for this, WIC has sole source contracts with formula companies receiving rebates that reduce costs, which lets WIC serve more eligible families. However, it also restricts the kinds of formula beneficiaries can receive.
The Bottom Line: What It All Means
The tradeoffs and economic benefits of breastfeeding are complicated and multi-faceted. Babies who don’t have their nutritional needs properly met early in life may face challenges to healthy, normal development. Though most of today’s parents appear to have accepted the “breast is best” recommendation and acknowledge the nutritive significance of human breast milk, the reality is that there is tremendous opposition in terms of policy support for families. Breastfeeding is also in conflict with industry drivers for the manufacturing and promotion of formula. Many working families don’t have access to paid family leave and have limited access to workplace protections for lactating parents. Access to lactation consultants and insurance coverage for breastfeeding supplies (like pumps) is not consistent for all families. Even hospitals, the place where more than 90% of births occur, offer inconsistent support for breastfeeding. Feeding options are especially limited for low-income parents employed in jobs where they’re not able to pump. This may be part of the reason why there are such striking inequities in breastfeeding rates by race and socioeconomic status. Most American families rely on formula in some form or fashion, and as the recent formula shortage demonstrated, more work is needed to guarantee the safety of the product and the market’s ability to bounce back from supply chain issues.
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