Breastfeeding to reduce GP workload

You’ve probably all read lots about how formula feeding is associated with higher levels of illness for mothers and babies. The problem with knowing this, is that many of us feel our lack of time and skills reduce us to giving meaningless, patronising, exhortations disguised as ‘health advice’.

The health economic case for effective breastfeeding causing savings in secondary care is well known. Less NEC in premature babies, fewer infant admissions with gastroenteritis and respiratory infections. The impact on primary care has historically been less well researched. On an admittedly time limited cruise through the evidence I could find, the best was a recent UNICEF modelling exercise.  The original is here https://core.ac.uk/display/20457314 and there is a linked peer reviewed journal article in the Archives of Disease in Childhood https://adc.bmj.com/content/100/4/334

The National Childbirth Trust published a very fair and concise summary of the 105 page academic report which I am shamelessly quoting from below. https://www.nct.org.uk/about-us/professional/research/feeding-babies/evidence-health-outcomes/first-uk-study-showing-investment-breastfeeding-could-save-nhs-money

“Four categories of diseases were identified with different levels of available evidence. Reliable costs could only be modelled for a few of the conditions where not breastfeeding has been linked to an increased risk, so the costs are likely to be only a proportion of the potential savings.

Summary of the four groups:

1 Clear evidence making economic modelling possible [respiratory illness, gastroenteritis, ear infection, necrotising enterocolitis]

2 Where evidence was good but not clear enough for full economic models, the authors considered three conditions [effects on IQ, sudden infant death syndrome, childhood obesity] to predict the likely impact of increasing breastfeeding rates.

3 Illnesses where research finds a plausible or likely link with not breastfeeding, but where the evidence is not suitable for reliable modelling. For example, although raised blood pressure and cholesterol levels in childhood are markers of future cardiac disease that are related to not being breastfed, it is not possible to calculate the costs of cardiac disease based on these markers alone. This category includes diabetes (Type 2 for mothers and mainly Type 1 for children), cardiovascular disease, ovarian cancer, asthma, leukaemia, coeliac disease, and neonatal sepsis.

4 For 45 conditions there is some evidence of breastfeeding providing protection, but the authors considered current data unreliable.

So, if we increased breastfeeding prevalence so that 45% of babies were exclusively breastfed for four months, and 75% of babies were breastfed on discharge from neonatal units, each year there would be:

• for respiratory illness, 22,248 fewer GP consultations

• for gastroenteritis, 10,637 fewer GP consultations

• for ear infection, 21,045 fewer GP consultations

I make that 54,000 fewer consultations per year. And there are about 7,500 practices in the UK.

Taking this very conservative estimate we’d expect an average practice to save at least 7 consultations per year. It doesn’t sound much. But that’s a minimum of half a locum session wasted by every practice every year on just 3 preventable illnesses, and in only one age group.

And don’t get me started on postnatal depression, poor infant sleep, colic, reflux, CMPA, wheeze, constipation. There are many more consultations likely to be directly averted by reducing the population illness burden due to our high prevalence of formula feeding, though for chronic diseases, this may take a while.

I’ll let the NCT have the last word.

The report makes it clear that, if health services invest in enabling women to breastfeed for as long as they want to, they would achieve a rapid return on investment, reduce illness and improve the quality of life for thousands of families. 

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