Interview Prof. Guido Moro
The value of human milk
Health and economic benefits
Mothers' milk has adapted through evolution to meet the needs of the healthy newborn infant, by supporting its survival, growth and development. Mother’s milk is unique in providing all of the components an infant needs: macronutrients, micronutrients, developmental factors, bacteria that become part of the gut microflora and even stem cells.
Although scientists have already found thousands of human milk components, new ones are continuously being discovered. These components, their complex interactions, and their bioactive role in infants are unique to human milk, making it irreproducible. That is why breastfeeding has such a powerful impact on infant health, compared to formula feeding.
Human milk also lowers the rate of some of the most serious complications in newborns, and significantly improves an infant’s short-term and long-term health (1).
Better health and an improved quality of life also lead to economic advantages through lowered hospital and healthcare costs and higher productivity (2).
Health benefits: human milk offers the best start in a healthier life
It is well known and accepted by researchers and medical practitioners that breastfeeding provides infants and mothers with maximum benefits which last a lifetime. Compared to formula-fed infants, infants who receive human milk experience significant nutritional advantages, lower risk of infection and chronic disease, and improved gastrointestinal maturation and neurodevelopment.
Mothers who breastfeed also benefit significantly from reduced risk of breast and ovarian cancer.
Among infants that are born too early or too small, feeding human milk reduces the risk for some of the most devastating complications, which are often chronic or lead to rehospitalisation, lifelong disabilities, deficits in life quality and even early death. A detailed analysis of the health and economic benefits of human milk for preterm infants can be found here (5).
Economics of human milk: advantages for the healthcare system and society as a whole
Considering the lifelong health benefits of human milk, it becomes clear that breastfeeding must also provide an enormous economic value. This value reaches far beyond individual infants, their families, or single hospitals. Increased breastfeeding positively affects the entire healthcare system by providing direct and indirect cost savings, and it benefits society by improving productivity and overall quality of life.
Suboptimal breastfeeding rates in the US are associated with USD 3 billion in direct medical costs, USD 1.3 billion for non-medical costs and USD 14.2 billion for premature maternal and child death costs (9).
The improved cognitive development through feeding all infants breast milk for the first 6 months of life would lead to a worldwide increase of USD 302 billion (EUR 260 billion) in gross national products (2).
Increasing breastfeeding rates for the first 6 months of life by 10% would translate into savings of USD 351.6 million (EUR 303.1 million) in childhood disorder treatments in the US, UK, urban China and Brazil (2).
The health benefits of human milk feeding are even greater for preterm and low birthweight infants, and the economic benefits are proportional to that.
Preterm and low birthweight infants
The York Health Economic consortium conducted a meta-study of all published clinical outcomes and associated costs for premature infants in the UK10 and Germany. They modelled the cost savings and the increase in productivity from feeding a preterm infant human milk instead of formula, and applied this model to the English and German healthcare systems and economies. The entire detailed analysis can be found here (5).
The results are clear: On average, in England and Germany every preterm infant who receives human milk instead of formula contributes direct healthcare cost savings of EUR 1 356.54 (USD 1 573) and increases national productivity by EUR 3 425 (USD 3 973) (5).
For Germany, and England and Wales, the combined economic benefits are powerful:
Interview Prof. Guido Moro
Interview Prof. Matthias Keller
In the United States, Johnson et al. published a series of health and economic analyses of very low birth weight (VLBW) infants. They measured the direct healthcare costs that could be saved at the Rush University Medical Center (USA) by increasing human milk from a low dose to a high dose:
For every VLBW infant, the increase in human milk dose from below 25 ml/kg/day to over 50 ml/kg/day saved USD 31 514 (EUR 27 167) by reducing the incidence of sepsis (11).
For Necrotising Enterocolitis (NEC), published hospital costs were USD 8 167 (EUR 7 041) higher for formula-fed infants than for infants receiving human milk (12).
The average costs of a case of Bronchopulmonary Dysplasia (BPD) is USD 41 929 (EUR 36 146) in the US. A reduction by 63% in odds of BPD can be achieved by feeding 100% own mothers milk to VLBW infants. This results in an average cost reduction of USD 7 925 for each VLBW infant that receives 100% own mother's milk instead of no own mother's milk (7).
Ultimately, these benefits make every individual a stakeholder in breastfeeding. Insurers, governments and society should support mothers and healthcare professionals in their effort to provide breastmilk to all infants.
To convert the economic numbers from the original references' currency, the following conversion rate was used: 1.00 EUR = 1.16 USD (November 6, 2017)
- Victora,C.G. et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet 387, 475-490 (2016).
- Rollins,N.C. et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet 387, 491-504 (2016).
- McClellan,H.L., Miller,S.J., & Hartmann,P.E. Evolution of lactation: Nutrition v. protection with special reference to five mammalian species. Nutr Res Rev 21, 97-116 (2008).
- Collaborative Group on Hormonal Factors in Breast Cancer Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. Lancet 360, 187-195 (2002).
- Brochure: “Human milk for preterm infants: Health and economic benefits”
- Mahon,J., Claxton,L., & Wood,H. Modelling the cost-effectiveness of human milk and breastfeeding in preterm infants in the United Kingdom. Health Econ Rev 6, (2016).
- Patel,A.L. et al. Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch Dis Child Epub ahead of print, F1-F6 (2016).
- Zhou,J., Shukla,V.V., John,D., & Chen,C. Human Milk Feeding as a Protective Factor for Retinopathy of Prematurity: A Meta-analysis. Pediatrics 136, e1576-e1586 (2015).
- Bartick,M.C. et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern. Child Nutr.(2017).
- Russell,R.B. et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 120, e1-e9 (2007).
- Patel,A.L. et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol 33, 514-519 (2013).
- Johnson,T.J., Patel,A.L., Bigger,H.R., Engstrom,J.L., & Meier,P.P. Economic benefits and costs of human milk feedings: A strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants. Adv Nutr 5, 207-212 (2014).