Monday, September 7, 2009

The economics of breastfeeding

Today, I am sitting at the BWI airport as I write this. A friend on Facebook asked where I was off to this time, and I shared a funny story from an end of summer party on a crisp late summer evening last night.

I'm standing in the kitchen at a friend's house speaking with a pediatrician around my age.
Hostess comes in and asks--"Were you the two talking about breastfeeding?"
We answer, innocently, "Yes."
Hostess, "Figures. Doc [one of the other guests] just came back out after stepping inside and said there were two people talking about breastfeeding but he didn't think either was planning on having more kids. You two explain it. He was a little concerned."

That may not be verbatim, but it was close to that. I suppose it is not every day that a pediatrician and economist get into an extended conversation about the incentives for different methods of child nutrition at an end of summer party...

So, what can I say about the economics of breastfeeding. A few basic things:

(1) There is a good amount of evidence that people really do respond to both money and time incentives when it comes to breastfeeding. On money, if you have the time, it certainly costs less to get enough calories to the mom to breastfeed than to use formula. On time, it can be hard, particularly for women who do not have flexible jobs. Although if the mom has the flexibility, what little evidence there is suggests that formula feeding and breastfeeding take nearly the same amount of time.

(2) We have limited evidence to suggest that a planned rapid return to work not only shortens the time that women who decide to breastfeed at all continue to do so but also may be associated with a lower likelihood of initiation. The best guess I have for that tone is that there is a perceived "getting going" (or startup) cost of breastfeeding. And some mothers may think that if they are only going to do it for a short time, why bother. Well, any is better than none, but there are real issues (like lack of family support in some cases) for getting started.

(3) When we think of policy changes, the humanitarian in me says we should do everything we can to make it easier for mothers and infants to be together. The economist in me asks--how much will behavior change. If a policy that would take a target population from 50 percent to 75 percent of mother's breastfeeding would it make sense to spend money on that. Sure, you change the behavior of one in four women. However, you also end up with a policy that benefits the two of four women who were making the choice to breastfeed already. Do they really need to receive any more incentive?

I don't have the answer for the last one. All I can say, as my friend and colleague Steve Kymes recently reminded me, is that economics gives us the tools to identify unintended consequences. This might be an unintended (and costly) consequence of what seems like a well intentioned policy change. I am not going to England to tell the maternal and infant nutrition meeting that policy to encourage breastfeeding does not make sense. Only that it should be evaluated carefully.

1 comment:

  1. Breastfeeding can be time-consuming due to frequent feedings and that goes against better economics. But it is free compared to pricey formulas. Most of the women I know who breastfeed state they do so for cultural and nutritional reasons. A curious thought is that if breast milk found a financial market (women could sell their breastmilk), there would be lots of policy changes and government involvement.
    It could also bring up other health economics issues like increased pregancies to profit from breastmilk. But that's another complicated discussion not warranted here.