A sideways look at economics

After recently becoming a first-time dad, I have started dedicating more thought to ways that I can optimise my time and improve my multi-tasking skills: hold Baby and watch football; go for a walk and get Baby to sleep; clean the flat while resting in between exercise sets, and so on. It being my turn to write this week’s TFIF blog, I have decided to multi-task once more by writing about a baby-related topic I’ve come across in my new world. It’s a subject that isn’t much discussed outside parenting circles but is nonetheless hugely important: breastfeeding.

The more I have researched this subject, the more it has become apparent that breastfeeding, understandably, prompts powerful reactions. The Unicef UK Baby Friendly Initiative sums it up well:

Breastfeeding is a highly emotive subject in the UK because so many families have not breastfed, or have experienced the trauma of trying very hard to breastfeed and not succeeding. The pain felt by so many parents at any implication that they have not done the best for their child can close down conversation. It is time to stop laying the blame for the UK’s low breastfeeding rates in the laps of individual women, and instead acknowledge that this is a public health imperative for which government, policy makers, communities and families all share responsibility.

For context, the World Health Organisation (WHO) recommends that women feed their babies exclusively with breast milk until they are six months old, yet just 1% of children in the UK are exclusively breastfed until this age. Instead of shying away from the issue, I think it is important to talk about it, so my blog is a small effort to raise awareness of this important public health issue.

If you are like me, you probably didn’t have much of a clue about babies, or even notice them, never mind think about the difficulties, complications and importance of breastfeeding — until you had your own little one, that is. We were told in our antenatal classes about the benefits of breastfeeding versus the alternative of bottle-feeding using formula. According to the WHO, breastfeeding boosts a baby’s immunity, reduces the risk of disease and death for baby and mother, is an important way for them to bond, and on top of all that is good for family finances.

Like many things baby-related, the reality only hits once you are back at home with your baby and figuring out what to do. Goal number one: keep your child alive. Way to achieve that: make sure it eats. What they don’t tell you is just how difficult that can be, especially when it comes to breastfeeding. Bottle-feeding isn’t a walk in the park either, but in some cases bottle-feeding with formula is the only option, due to breastfeeding complications. Some mums might also choose not to breastfeed, for a variety of reasons. But there are many cases where mums can breastfeed, want to breastfeed, but give up — due to difficulties that could have been overcome with some relatively simple support.[1] It seems to me that this number is too high, and this bothers me.

As doctor and lactation expert Katie Hinde explains, just because something is evolutionarily ancient, doesn’t mean that it’s easy or that we are instantly good at it. Help is needed early on, since there is a high risk in those early days that due to breastfeeding difficulties parents will turn to formula. If this continues, even for a short while, there are risks that the mother’s milk supply will run dry (nature and biology are wonderfully impressive – milk generation is naturally regulated by demand). There is also a chance that your baby will not accept the breast after getting used to a bottle, as it requires more effort on the baby’s part. The bottom line is that there is a very short window to get it right before you are on formula for good.

I would assume, given the reported health benefits of breastfeeding, that there would be good economic reasons for doing this too. And indeed, studies claim that there are. One report concluded that policies aimed at promoting breastfeeding rates were among the most effective public health interventions, with an estimated return of US$35 per dollar invested.

There are difficulties with quantifying the costs of formula-feeding versus breastfeeding. Curiously, not breastfeeding might boost GDP figures in the short run: a) from additional money spent on formula; b) from an increase in hospital visits and healthcare spending. Of course, this would likely damage productivity and act as a drag on GDP growth in the long run. Plus, the money spent on formula and healthcare could, of course, be spent on other goods and services. Most studies I came across therefore classed these expenditures as a cost. Logically, it would be better to spend money on preventing a problem, than treating it. Indeed, the WHO has concluded that increasing breastfeeding could save 800,000 children and nearly 0.5% of global GDP each year.

The costs and risks of not breastfeeding relate not just to the formula itself, but to its use and preparation, with dangers including not properly sanitising bottles, inadequate storage of formula or preparing it using water which is not clean. This is especially problematic in lower income and hotter countries, where finances are also often tighter and there can be pressure to make it last by mixing the formula with too much water, over-diluting its nutrient content. Malnourishment due to formula-feeding has been a real issue in some emerging economies, and it turns out that some western multinationals engaged in shocking practices to boost formula sales in the past.[2] Things have evolved since then but some issues remain.

That being said, it is also true that formula feed, first developed in the 19th century, can be a lifesaver for babies that cannot breastfeed. As with many things, the extra options provided by technology and new products are a good thing in their own right; but it is the implementation, application, corporate behaviour, regulations (or lack of) and poor understanding of the side effects and risks that are the cause of the issues.

Whatever your take is on this topic, there is a surprising lack of literature on it. Anecdotally, I found this to be true while doing research for this blog using search engines. According to Katie Hinde, there are more than 70 times as many academic articles about pregnancy as there are about breast milk.  She also explains how there are more articles about coffee, tomatoes and wine than about breastmilk. Don’t get me wrong: coffee and wine are super important, but surely not as much as the recommended primary form of sustenance for the first six months of a human’s life. (Tomatoes can get lost!)

There are of course many dedicated professionals doing something about this, and important work is being carried out. In 1981 the WHO developed an ethical code for the marketing of breast milk substitutes. In 1992, the WHO and Unicef launched the Baby Friendly Hospital Initiative (BFHI), an accreditation standard for hospitals designed to provide early support and care for newborns to encourage higher rates of breast feeding. Obtaining the accreditation requires maternity units and hospitals to train staff, educate and provide post-natal support to parents, create standards and processes to measure and encourage breastfeeding, including seeking feedback from parents.

But according to Katie Hinde’s 2016 Ted Talk, more than 20 years after the BFHI began just a fifth of hospitals in the United States were baby-friendly. A more recent study, published in the International Breastfeeding Journal, revealed that little more than half of British hospitals are baby-friendly, while just 5% of hospitals in Italy and France met the criterion. And from my own experience, even if a hospital is designated baby-friendly, the support is not always as good as you might hope. The bottom line: the intention is sometimes there, but not always; and even when it is, the execution leaves a lot to be desired. More can, and should, be done.

To conclude, I’d like to put on the record that while breastfeeding does not appear in the national accounts as GDP, it is not ‘free’: women spend a huge amount of time and effort to get it done. I give a huge shoutout and big respect to them for doing that, and to mums that are bottle feeding too. I give a mini shoutout to myself and other Dads, for the extra work that we need to do and the multi-tasking that is required. And a huge shoutout to all of the single mums raising children on their own: they are the massive heroes in my new world.

One final thing to point out — which also does not appear in the GDP statistics, perhaps because they would be off the scale if it was — is the huge amount of good feelings and love generated by something so little and cute.

Babies and breastfeeding

[1] This can include issues as simple as how to hold a baby or burp them, to more complicated things like baby latching technique; watching a video is one thing, but sometimes you just need an expert there to help.

[2] https://www.nber.org/system/files/working_papers/w24452/w24452.pdf