Economic Implications of Exclusive Breastfeeding
Abstract
Breastfeeding is the most effective method of nourishing infants and promoting child health and it provides significant benefits for maternal health. Although extensive scientific evidence supports its health-related advantages, studies evaluating its economic impact remain limited. This study aims to review the existing literature on the economic impact of exclusive breastfeeding and to identify future research directions. A literature search was conducted using the PubMed, Scopus, Web of Science, and Cochrane databases, selecting 21 articles published in Spanish or English over the past ten years. Studies focused on the economic evaluation of specific interventions were excluded. The reviewed articles included 14 cost estimation models, 4 observational studies, and 3 narrative reviews. Considerable heterogeneity was observed across studies in terms of study populations, economic perspectives, methodologies, and parameters analyzed. Most studies focused on direct medical costs, particularly those associated with acute pediatric conditions, and adopted the payer’s perspective. However, there is a growing body of research addressing chronic diseases, maternal health conditions, and broader social perspectives. All studies concluded that breastfeeding leads to economic savings. Nevertheless, the limited number and methodological heterogeneity of the studies preclude the possibility of conducting a meta-analysis. Our findings highlight the need for multidisciplinary research using real-world data and adopting more comprehensive economic approaches to adequately assess the full economic implications of breastfeeding.
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1. Eidelman AI. Breastfeeding and the use of human milk: an analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement. Breastfeed Med Off J Acad Breastfeed Med. 2012;7(5):323-4.
2. Organization WHO. Infant and young child feeding : model chapter for textbooks for medical students and allied health professionals [Internet]. World Health Organization; 2009 [citado 6 de mayo de 2025]. Disponible en: https://iris.who.int/handle/10665/44117
3. Arts M, Mehra V, Taylor G, Krasevec J, Hayashi C, Bégin F, et al. Breastfeeding: A mother’s gift, for every child [Internet]. UNICEF DATA. 2018. Disponible en: https://data.unicef.org/resources/breastfeeding-a-mothers-gift-for-every-child/
4. United Nations Children’s Fund (UNICEF). Infant and young child feeding [Internet]. 2025. Disponible en: https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/
5. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Report Technology Assess. 2007;(153):1-186.
6. León-Cava N, Lutter C, Ross J, Martin L. Quantifying the benefits of breastfeeding: a summary of the evidence. 1st ed. Piraí: Pan American Health Organization (PAHO); 2002. 1 p.
7. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet Lond Engl. 2016;387(10017):475-90.
8. Bartick MC, Jegier BJ, Green BD, Schwarz EB, Reinhold AG, Stuebe AM. Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs. J Pediatr. 2017;181:49-55.e6. Disponible en: https://www.jpeds.com/article/S0022-3476(16)31096-4/abstract
9. Breastfeeding and Health Outcomes for Infants and Children [Internet]. [citado 6 de mayo de 2025]. Disponible en: https://effectivehealthcare.ahrq.gov/products/breastfeeding-health-outcomes/protocol
10. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):3-13.
11. Colaizy TT, Bartick MC, Jegier BJ, Green BD, Reinhold AG, Schaefer AJ, et al. Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. J Pediatr. 2016;175:100-105.e2.
12. Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, et al. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients. 2018;10(6):707.
13. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018;6(6):CD002971.
14. Lodge CJ, Tan DJ, Lau MXZ, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):38-53.
15. Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):30-7.
16. Su Q, Sun X, Zhu L, Yan Q, Zheng P, Mao Y, et al. Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. BMC Med. 2021;19(1):90.
17. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008;65(5):578-84.
18. Horta BL, Loret de Mola C, Victora CG. Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):14-9.
19. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):96-113.
20. Brown A. Breastfeeding as a public health responsibility: a review of the evidence. J Hum Nutr Diet Off J Br Diet Assoc. 2017;30(6):759-70.
21. Jegier BJ, Smith JP, Bartick MC. The economic cost consequences of suboptimal infant and young child feeding practices: a scoping review. Health Policy Plan. 2024;39(9):916-45.
22. Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child. 2015;100(4):334-40.
23. Colchero MA, Contreras-Loya D, Lopez-Gatell H, González de Cosío T. The costs of inadequate breastfeeding of infants in Mexico. Am J Clin Nutr. 2015;101(3):579-86.
24. 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. 2016;6(1):54.
25. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504.
26. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2016;13(1)
27. Walters D, Horton S, Siregar AYM, Pitriyan P, Hajeebhoy N, Mathisen R, et al. The cost of not breastfeeding in Southeast Asia. Health Policy Plan. 2016;31(8):1107-1116
28. Walters DD, Phan LTH, Mathisen R. The cost of not breastfeeding: global results from a new tool. Health Policy Plan. 2019;34(6):407-17.
29. Stuebe AM, Jegier BJ, Schwarz EB, Green BD, Reinhold AG, Colaizy TT, et al. An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs. Breastfeed Med Off J Acad Breastfeed Med. 2017;12(10):645-58.
30. Siregar AYM, Pitriyan P, Walters D. The annual cost of not breastfeeding in Indonesia: the economic burden of treating diarrhea and respiratory disease among children (< 24mo) due to not breastfeeding according to recommendation. Int Breastfeed J. 2018;13:10.
31. Quesada JA, Méndez I, Martín-Gil R. The economic benefits of increasing breastfeeding rates in Spain. Int Breastfeed J. 2020;15(1):34.
32. Pretorius CE, Asare H, Kruger HS, Genuneit J, Siziba LP, Ricci C. Exclusive Breastfeeding, Child Mortality, and Economic Cost in Sub-Saharan Africa. Pediatrics. 2021;147(3):e2020030643.
33. Elsisi GH, Chedid F, Khan J, Shankar S, Hamed Y, Saeed S, et al. A budget impact analysis of exclusive human milk diet in very low birth weight infants in United Arab Emirates. J Med Econ. 2024;27(1):1421-33.
34. Hui LL, Liao E, Yeung KHT, Wong CKH, Loganathan T, Nelson EAS. An economic evaluation on sub-optimal breastfeeding in Hong Kong: Infant health outcomes and costs. Acta Paediatr. 2025;114(1):65-73.
35. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology. 2015;107(4):271-6.
36. Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact Off J Int Lact Consult Assoc. 2019;35(2):340-8.
37. Lechosa-Muñiz C, Paz-Zulueta M, Sáez de Adana Herrero M, Cornejo del Rio E, Mateo Sota S, Llorca J, et al. Health Care Costs Associated to Type of Feeding in the First Year of Life. Int J Environ Res Public Health. 2020;17(13):4719. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369965/
38. Ajetunmobi O, McIntosh E, Stockton D, Tappin D, Whyte B. Levelling up health in the early years: A cost-analysis of infant feeding and healthcare. PloS One. 2024;19(5):e0300267.
39. Rouw E, Hormann E, Scherbaum V. The high cost of half-hearted breastfeeding promotion in Germany. Int Breastfeed J. 2015;9(1):22. Disponible en: https://doi.org/10.1186/s13006-014-0022-5
40. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low-Birth-Weight Infants123. Adv Nutr. 2014;5(2):207-12. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951804/
2. Organization WHO. Infant and young child feeding : model chapter for textbooks for medical students and allied health professionals [Internet]. World Health Organization; 2009 [citado 6 de mayo de 2025]. Disponible en: https://iris.who.int/handle/10665/44117
3. Arts M, Mehra V, Taylor G, Krasevec J, Hayashi C, Bégin F, et al. Breastfeeding: A mother’s gift, for every child [Internet]. UNICEF DATA. 2018. Disponible en: https://data.unicef.org/resources/breastfeeding-a-mothers-gift-for-every-child/
4. United Nations Children’s Fund (UNICEF). Infant and young child feeding [Internet]. 2025. Disponible en: https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/
5. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Report Technology Assess. 2007;(153):1-186.
6. León-Cava N, Lutter C, Ross J, Martin L. Quantifying the benefits of breastfeeding: a summary of the evidence. 1st ed. Piraí: Pan American Health Organization (PAHO); 2002. 1 p.
7. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet Lond Engl. 2016;387(10017):475-90.
8. Bartick MC, Jegier BJ, Green BD, Schwarz EB, Reinhold AG, Stuebe AM. Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs. J Pediatr. 2017;181:49-55.e6. Disponible en: https://www.jpeds.com/article/S0022-3476(16)31096-4/abstract
9. Breastfeeding and Health Outcomes for Infants and Children [Internet]. [citado 6 de mayo de 2025]. Disponible en: https://effectivehealthcare.ahrq.gov/products/breastfeeding-health-outcomes/protocol
10. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):3-13.
11. Colaizy TT, Bartick MC, Jegier BJ, Green BD, Reinhold AG, Schaefer AJ, et al. Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. J Pediatr. 2016;175:100-105.e2.
12. Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, et al. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients. 2018;10(6):707.
13. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018;6(6):CD002971.
14. Lodge CJ, Tan DJ, Lau MXZ, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):38-53.
15. Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):30-7.
16. Su Q, Sun X, Zhu L, Yan Q, Zheng P, Mao Y, et al. Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. BMC Med. 2021;19(1):90.
17. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008;65(5):578-84.
18. Horta BL, Loret de Mola C, Victora CG. Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):14-9.
19. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):96-113.
20. Brown A. Breastfeeding as a public health responsibility: a review of the evidence. J Hum Nutr Diet Off J Br Diet Assoc. 2017;30(6):759-70.
21. Jegier BJ, Smith JP, Bartick MC. The economic cost consequences of suboptimal infant and young child feeding practices: a scoping review. Health Policy Plan. 2024;39(9):916-45.
22. Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child. 2015;100(4):334-40.
23. Colchero MA, Contreras-Loya D, Lopez-Gatell H, González de Cosío T. The costs of inadequate breastfeeding of infants in Mexico. Am J Clin Nutr. 2015;101(3):579-86.
24. 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. 2016;6(1):54.
25. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504.
26. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2016;13(1)
27. Walters D, Horton S, Siregar AYM, Pitriyan P, Hajeebhoy N, Mathisen R, et al. The cost of not breastfeeding in Southeast Asia. Health Policy Plan. 2016;31(8):1107-1116
28. Walters DD, Phan LTH, Mathisen R. The cost of not breastfeeding: global results from a new tool. Health Policy Plan. 2019;34(6):407-17.
29. Stuebe AM, Jegier BJ, Schwarz EB, Green BD, Reinhold AG, Colaizy TT, et al. An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs. Breastfeed Med Off J Acad Breastfeed Med. 2017;12(10):645-58.
30. Siregar AYM, Pitriyan P, Walters D. The annual cost of not breastfeeding in Indonesia: the economic burden of treating diarrhea and respiratory disease among children (< 24mo) due to not breastfeeding according to recommendation. Int Breastfeed J. 2018;13:10.
31. Quesada JA, Méndez I, Martín-Gil R. The economic benefits of increasing breastfeeding rates in Spain. Int Breastfeed J. 2020;15(1):34.
32. Pretorius CE, Asare H, Kruger HS, Genuneit J, Siziba LP, Ricci C. Exclusive Breastfeeding, Child Mortality, and Economic Cost in Sub-Saharan Africa. Pediatrics. 2021;147(3):e2020030643.
33. Elsisi GH, Chedid F, Khan J, Shankar S, Hamed Y, Saeed S, et al. A budget impact analysis of exclusive human milk diet in very low birth weight infants in United Arab Emirates. J Med Econ. 2024;27(1):1421-33.
34. Hui LL, Liao E, Yeung KHT, Wong CKH, Loganathan T, Nelson EAS. An economic evaluation on sub-optimal breastfeeding in Hong Kong: Infant health outcomes and costs. Acta Paediatr. 2025;114(1):65-73.
35. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology. 2015;107(4):271-6.
36. Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact Off J Int Lact Consult Assoc. 2019;35(2):340-8.
37. Lechosa-Muñiz C, Paz-Zulueta M, Sáez de Adana Herrero M, Cornejo del Rio E, Mateo Sota S, Llorca J, et al. Health Care Costs Associated to Type of Feeding in the First Year of Life. Int J Environ Res Public Health. 2020;17(13):4719. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369965/
38. Ajetunmobi O, McIntosh E, Stockton D, Tappin D, Whyte B. Levelling up health in the early years: A cost-analysis of infant feeding and healthcare. PloS One. 2024;19(5):e0300267.
39. Rouw E, Hormann E, Scherbaum V. The high cost of half-hearted breastfeeding promotion in Germany. Int Breastfeed J. 2015;9(1):22. Disponible en: https://doi.org/10.1186/s13006-014-0022-5
40. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low-Birth-Weight Infants123. Adv Nutr. 2014;5(2):207-12. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951804/
Melero Guardia, P., & Ciriza Barea, E. (2026). Economic Implications of Exclusive Breastfeeding. Revista De Lactancia Materna, 4, e34101. https://doi.org/10.14201/rlm.34101
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