The health and financial costs of not breastfeeding

Breast milk can help protect babies and toddlers against diarrhoea and pneumonia. — Positive Parenting

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 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, i.e. within one hour of birth; exclusive breastfeeding for the first six months of life; and introduction of nutritionally-adequate and safe complementary (solid) foods at six months, together with continued breastfeeding up to two years of age or beyond.

The 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 six months old, continuing until two years of age.

Complementary foods should be given from six months of age.

Breastfeeding practices that are not in accordance with the WHO and Unicef recommendations have an impact on human life, quality of life and national economies.

Inadequate breastfeeding could affect a child's ability to learn, and thus, their future earning potential. — Photos: FilepicInadequate breastfeeding could affect a child's ability to learn, and thus, their future earning potential. — Photos: Filepic

Counting the cost

World Breastfeeding Week this year (2022) was commemorated on Aug 1-7, with the theme “Step up for breastfeeding: Educate and support”.

ALSO READ: Give your baby the best start with breast milk

In conjunction with the event, the 2022 report 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 (FHI) group of organisations, and funded by the Gates Foundation, Irish Aid and other international donors.

The Cost of Not Breastfeeding 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 as the 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, were not included in the analysis.

In Malaysia

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

This is below the global target of 50% by 2025, which was agreed to by Malaysia at the World Health Assembly in 2012.

The Cost of Not Breastfeeding report for Malaysia addressed the issues below:

> Increased vulnerability to disease resulting in more maternal and child death

Children who are not exclusively breastfed for the first six months and who do not continue to receive breast milk up to two years of age, are more susceptible to diarrhoea and pneumonia, two leading causes of childhood death worldwide.

When mothers practice recommended breastfeeding practices, about half of the deaths of children aged under two years old that are caused by diarrhoea and pneumonia, can 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 II diabetes annually in Malaysia.

> Healthcare costs to treat children and mothers

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

The current healthcare cost due to inadequate breastfeeding is estimated to be about USD$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 USD$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 a healthcare facility.

Based on estimates from other countries, the economic losses that result from lost productivity and transportation costs could amount to one-quarter of the cost of the treatment itself.

> Formula costs are significant and reduce a family’s disposable income

Many companies market their breast milk substitute products, i.e. formula milk, to mothers.

The cost to purchase economy brand infant formula can be significant compared to breast milk, which is free, safe, and hygienic for all babies.

Going forward

Feeding babies formula milk can be a significant cost for many families, compared to free breast milk.Feeding babies formula milk can be a significant cost for many families, compared to free breast milk.

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, as well as maternal well-being.

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

It stated that: “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 Breast-milk 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 breast feeding 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% 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 Practitioners Associations and the Malaysian Medical Association. For more information, email The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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