A new mother faces choices whether or not to breastfeed her baby, exclusively or in combination, and for how long. While there are myriad complex reasons why breastfeeding rates in western countries, particularly in Ireland, remain poor, according to health economist Dr Subhash Pokhrel, like any other “lifestyle decision”, this choice offers both incentives and disincentives, of which cost is one. 

Speaking at the 14th international breastfeeding and lactation symposium held earlier this year in London, Dr Pokhrel, head of the department of clinical sciences at Brunel University London, argued that health economists assert that a new mother is more likely to choose to breastfeed if she feels there are more incentives than disincentives.

“My interest is in return on investment analysis in public health and this includes breastfeeding. Breastfeeding is protective in a number of diseases in infants, for example, the infections of the gut and lower respiratory tract. Also, in preterm babies, there is a condition called NEC (necrotising enterocolitis) and breastfeeding is protective against that. 

“If more women chose to breastfeed their babies, then there would be less incidence of those diseases. And therefore healthcare systems will have to spend less money in treating those diseases. And that money could be freed up to spend somewhere else,” he said.

Dr Pokhrel told those attending the symposium that in 2012 he was involved in a UK study which showed the NHS could save a significant amount of money if breastfeeding duration was improved.

“We found out that the NHS could save about £40 million a year by improving breastfeeding rates. And that is simply by supporting those women who have already chosen to breastfeed to continue longer and to breastfeed exclusively,” he said. 

In other words, if the UK government invested in support services to assist those women who are already choosing to breastfeed to sustain breastfeeding for longer, there is a straightforward cost benefit to the exchequer reflecting a positive return on investment.   

Dr Pokhrel said that this was the first time the cost benefit of breastfeeding to the health service had been quantified, as while everyone assumed an economic benefit, it had not actually been demonstrated.  

Dr Subash Pokhrel(click to enlarge)

“It was a study that quantified that breastfeeding is a lifestyle choice that is made by the woman. But, you know, we can support women to make that decision and there are a number of facts that need to be provided to women so that they can make the right decision,” he said.

Due to other factors that have an influence on whether a mother chooses to initiate breastfeeding, Dr Pokhrel said that these disincentives need to be addressed.

“Because it is a choice, women actually look at the incentives and disincentives, such as breastfeeding being time consuming and that the time spent breastfeeding could be used to do something else. Also, there is a negative relationship between employment and breastfeeding, etc, so we need to look at all those disincentives and then think about how to incentivise women to breastfeed, to breastfeed more and to breastfeed for longer,” he said. 

Dr Pokhrel added that if women heading into maternity leave know that they will be returning to a breastfeeding friendly workplace it will encourage them to first choose and then to persevere with breastfeeding as they won’t be forced to start weaning from the breast in a shorter timeframe. The knock-on benefit of this to the economy is fewer cases of illness among babies. 

“What turns out to be disincentive in the first instance can be turned into incentives for women to choose to breastfeed. Breastfeeding is good for infants, but breastfeeding is also good for mothers. And breastfeeding is good for healthcare systems and for society. One of the ways to look at it is that breastfed children usually have better cognitive outcomes, which will eventually lead to better national income, because they have better productivity. 

“So, in the long run, breastfeeding actually pays back all the support costs that we provide to improve the breastfeeding rates now,” said Dr Pokhrel.