Defining a New Infant Feeding Paradigm and Refocusing Research to Increase Employer Promotion of Breastfeeding

Since the last Summit, health reform legislation has been signed into law that requires employers with 50 or more employees to provide space and time for breastfeeding women. Although this is a great step forward for breastfeeding employees and a significant accomplishment for advocates, it is simply not enough to achieve meaningful change among employers in implementing additional breastfeeding policies.

In response to a new article entitled “Comfort with the idea of formula feeding helps explain ethnic disparity in breastfeeding intentions among expectant first-time mothers,” ¹ Dr. Ruth Lawrence was quoted as saying:

This approach requires a complete paradigm change. Instead of promoting the tremendous benefits of breastfeeding to this population, the risks of formula feeding and the costs to health and the community of not breastfeeding will have to be incorporated into persuading these women to do the best for their infants and themselves. ²

I suggest that it is time to adopt this approach at the broader community level, rather than just focus it on a single target population, in an effort to change the entire societal paradigm around infant feeding.

Unfortunately, there has not been any new research related to the cost savings of breastfeeding on the metrics of concern to employers since the last Summit. I believe there are funders in the audience who could allocate more funds for this type of research, as well as federal agencies and academics who could refocus their research on areas of greater import to employers, in order to build a stronger evidence base and more robust business case.

Many of the very large employers who are members of the National Business Group on Health have already established on-site lactation rooms for their employees. However, it will take more evidence to persuade smaller employers. According to the 2009 survey of approximately 500 employers, published by the Society for Human Resource Management, 12% of small, 26% of medium, and 38% of large employers have an onsite lactation room, and 2%, 3%, and 10%, respectively, offer a lactation support program to their employees. ³ Because of the new health reform legislation, the numbers of employers providing lactation rooms should increase significantly in the future, but these results indicate that there is still room for growth in the number of employers who provide other types of breastfeeding support as well.

Currently, much of the evidence on cost savings associated with breastfeeding is presented at the national level in the form of huge numbers, often in the millions or even billions of dollars, that are nearly beyond comprehension and essentially meaningless to employers. Employers need much more specific information on which to base their health benefits and wellness program decisions, as well as their budget allocations. If a new parent, male or female, chooses to formula-feed his or her new baby, the employer wants to know how many more days of work he or she will miss, compared to breastfeeding parents, if the baby gets an earache and fever or bronchitis and can't go to child care. How much more time off work will they need for doctor visits, and how many more medical and pharmaceutical claims will have to be paid for this infant than for a breastfed infant?

Private sector vendors understand the employer needs, capitalize on them, and actively market their services to employers:

“Offering employees LifeCare's Mothers at Work program makes tremendous sense for all of these reasons but it also makes sense for its substantial impact to the bottom line,” said Peter G. Burki, LifeCare's CEO. “For every dollar our clients spend on Mothers at Work, they realize an average savings of more than seven dollars. These are direct savings related to lower maternal absenteeism rates, lower medical claims and reduced pharmacy costs.” ⁴

An additional statistic from their website indicates that “Corporate lactation programs can lead to a 28% decrease in absenteeism and 36% reduction in sick child health care claims.” ⁴ However, we need much more than private-sector “evidence” to move employers and society to a new paradigm of infant feeding behavior.

Funders can do more by making more dollars available for employer-based projects and infant feeding. Researchers can redirect their focus to partner with employers on implementing worksite-based prospective studies on infant feeding among new parents. In addition to the health metrics traditionally explored in infant feeding studies, this research should collect data on productivity indicators of specific interest to employers, such as incidental absenteeism, short-term disability, long-term disability, family medical leave, employee morale, satisfaction and retention, health benefits, and pharmaceutical claims. Data should be collected for both new mothers and fathers, as well as for the infant beneficiary.

The vast amount of work that has been done on building the business case for tobacco cessation provides a good model for breastfeeding advocates to emulate in building the research base and support for changing the infant feeding paradigm in society as well.

Health economists at the Centers for Disease Control and Prevention (CDC) have completed much of the employer-focused research in building the evidence base for tobacco cessation. Perhaps now their efforts could be redirected to build a similar case for breastfeeding? Imagine the impact if we could replace these employer costs related to smoking with something similar related to not breastfeeding:

On average, smokers miss 6.16 days of work/year due to sickness compared to nonsmokers who miss 3.86 days/year. ⁵

RTI International and the CDC have developed an Obesity Cost Calculator tool for employers. ⁷ Perhaps the CDC could provide funding to develop a similar employer tool to determine the organizational costs of an employee's decision to formula-feed her infant?