This study explores the current market value of the care provided by unpaid family members and friends to ill and disabled adults. Using large, national data sets we estimate that the national economic value of informal caregiving was $196 billion in 1997. This figure dwarfs national spending for formal home health care ($32 billion) and nursing home care ($83 billion). Estimates for five states also are presented. This study broadens the issue of informal caregiving from the micro level, where individual caregivers attempt to cope with the stresses and responsibilities of caregiving, to the macro level of the health care system, which must find more effective ways to support family caregivers.

We interviewed women who participated in a breast-feeding promotion intervention study about whether and how participation affected their infant feeding choices, and if they would recommend such an intervention to others. The larger study, a randomized controlled trial (RCT) of an individualized, pre- and post-natal lactation consultant (LC) intervention, enrolled 382 low-income primarily Black and Hispanic women in New York City. Twenty-one women completed qualitative exit interviews for this study (11 from the Intervention group and 10 Controls). Several of the Controls stated that the post-partum study interviews were a source of support, and made them more conscious of how they fed their infant. The Intervention Group was asked about contacts with the study 'Mother-Baby specialist' (i.e. LC), including what was and wasn't helpful. The Intervention Group participants described the Mother-Baby Specialist as key in their decision to initiate and maintain breastfeeding. They credit her direct skills and positive reinforcement with their confidence and perseverance to breastfeed. The success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement, guidance and support.

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