The cost of not breastfeeding in Southeast Asia

Abstract

Rates of exclusive breastfeeding are slowly increasing, but remain suboptimal globally despite the health and economic benefits. This study estimates the costs of not breastfeeding across seven countries in Southeast Asia and presents a cost-benefit analysis of a modeled comprehensive breastfeeding strategy in Viet Nam, based on a large programme. There have been very few such studies previously for low- and middle-income countries. The estimates used published data on disease prevalence and breastfeeding patterns for the seven countries, supplemented by information on healthcare costs from representative institutions. Modelling of costs of not breastfeeding used estimated effects obtained from systematic reviews and meta-analyses. Modelling of cost-benefit for Viet Nam used programme data on costs combined with effects from a large-scale cluster randomized breastfeeding promotion intervention with controls. This study found that over 12 400 preventable child and maternal deaths per year in the seven countries could be attributed to inadequate breastfeeding. The economic benefits associated with potential improvements in cognition alone, through higher IQ and earnings, total $1.6 billion annually. The loss exceeds 0.5% of Gross National Income in the country with the lowest exclusive breastfeeding rate (Thailand). The potential savings in health care treatment costs ($0.3 billion annually) from reducing the incidence of diarrhoea and pneumonia could help offset the cost of breastfeeding promotion. Based on the data available and authors’ assumptions, investing in a national breastfeeding promotion strategy in Viet Nam could result in preventing 200 child deaths per year and generate monetary benefits of US$2.39 for every US$1, or a 139% return on investment. These encouraging results suggest that there are feasible and affordable opportunities to accelerate progress towards achieving the Global Nutrition Target for exclusive breastfeeding by 2025.

The World Health Organization Code and exclusive breastfeeding in China, India, and Vietnam

“…Decree 21, passed in 2006, prohibited advertising of breastmilk substitutes for children under 1 year of age (Alive & Thrive, ). In 2013, a new advertisement law built upon this law, banning the marketing of breastmilk substitutes for children under 2 years of age (Walters et al, ). In terms of breastfeeding environment, Vietnamese legislation mandates 26 weeks of paid maternity leave.…”

Media audit reveals inappropriate promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes in South-East Asia

“…By adhering to international breast-feeding recommendations, more than 800 000 deaths of children under 5 years of age and 20 000 deaths of women from breast cancer could be prevented annually (1) . Adopting optimal breast-feeding practices would prevent 12 400 child and maternal deaths each year in seven countries in South-East Asia (Cambodia, Indonesia, Laos, Myanmar, Thailand, Timor-Leste and Vietnam) (4) . Optimal breast-feeding practices also contribute to economic development through decreased expenditure on health and baby foods and a strengthened future workforce (4)(5)(6) .…”

“…Adopting optimal breast-feeding practices would prevent 12 400 child and maternal deaths each year in seven countries in South-East Asia (Cambodia, Indonesia, Laos, Myanmar, Thailand, Timor-Leste and Vietnam) (4) . Optimal breast-feeding practices also contribute to economic development through decreased expenditure on health and baby foods and a strengthened future workforce (4)(5)(6) . The WHO's Global Nutrition Targets seek to increase the rate of exclusive breast-feeding in the first 6 months from 38 % to at least 50 % by 2025 (7) .…”

Interference in public health policy

“…(See cases of Philippines and Vietnam below.) It also highlighted the industry's employment and job creation contributions (Nestlé S.A., 2007), while not addressing the evidence-based health and socioeconomic burden of their activities (Sobel et al, 2012;Walters et al, 2016;UNICEF & Alive & Thrive, 2016).…”