The costs of suboptimal breastfeeding in Ontario, Canada, and potential economic impacts from improving rates: A health system costing analysis

Abstract

Background Human milk from the breast is the healthiest option for human infants. All other sources of nutrition pose some risk to child, maternal and environmental health. There are significant costs to suboptimal rates of breastfeeding for children, families and society. In Ontario, Canada, breastfeeding initiation rates are high (over 92%), however exclusivity and duration rates drop over time. Suboptimal breastfeeding rates result in an associated cost burden for both families and the health care system. Methods We calculated the savings that the Ontario healthcare system would have benefited from had breastfeeding rates been higher, both from the time of hospital discharge and at 6 months postpartum. Using methods from similar studies carried out in the UK, US, Spain, Mexico and Southeast Asia we estimate the benefits of increased exclusive breastfeeding rates based on the lower incidence of childhood and maternal diseases for which there is robust evidence, including: lower respiratory infections, gastroenteritis, otitis media, childhood leukemia, necrotising enterocolitis, and breast and ovarian cancers. We used existing databases and literature to estimate the monetary cost of these diseases. Results It is estimated that suboptimal exclusive breastfeeding at 6 months of age for infants born in Ontario in 2019 costs the Ontario healthcare system about US $211 million per annum in treatment costs for five childhood and two maternal illnesses. Increasing exclusive breastfeeding (EBF) rate at 6 months (36.3%) to rate at discharge from hospital after delivery (64.9%) would save about US$73 million dollars per annum and about US$134 million if EBF rate at 6 months were increased to initiation rates (92.1%). Conclusions Interventions that facilitate the breastfeeding relationship and support families who want to feed their children human milk are cost effective, upstream investments in public health. Evidence based strategies aimed at helping to establish and maintain an exclusive breastfeeding relationship would contribute to lowering both the health burden on families and the associated fiscal burden on the Ontario healthcare system.