The true costs of formula

The price of bottle-feeding is an issue for finance ministers as well as families. From China to Zambia, when developing countries import breastmilk substitutes, they are exporting scarce foreign exchange that is desperately needed for other vital priorities. On top of that, precious health care funds are spent on illnesses wrought by artificial feeding. 

If the 51 per cent of Indian mothers who exclusively breastfeed were to stop, replacing all their breastmilk with formula would cost about $2.3 billion. In Indonesia, a study in the 1980s calculated that mothers produced over 1 billion litres of breastmilk annually; equivalent supplies of commercial milk would cost $400 million. Savings in health costs and reduced fertility rates related to breastfeeding were estimated to be another $120 million. In Haiti, where just 3 per cent of infants are exclusively breastfed, infant formula costs $10 a week, or more than twice a typical income. 

That is why it is so devastating when free samples end and the mother finds that her milk has diminished. For those who cannot afford adequate supplies of formula, the temptation to over-dilute it is enormous. 

Compare the cost of formula with the cost of feeding a mother so that she can properly breastfeed. Ideally, she needs an additional 500 calories a day above her normal diet, something easily achieved at far less than the cost of formula. In India, for example, five days’ worth of that extra food costs less than 15 rupees (45 cents). By comparison, a five-day supply of formula costs about 130 rupees ($3.70). In the Philippines, Jose Fabella Hospital saved more than $100,000, an astounding 8 per cent of its annual budget, within one year of becoming a baby-friendly hospital, promoting and supporting exclusive breastfeeding of infants. 

The Baby-Friendly Hospital Initiative is one approach to improving breastfeeding rates. A hospital is designated ‘baby-friendly’ when staff have agreed not to distribute or otherwise promote artificial baby milk and to implement specific steps to support breastfeeding. 

This is an excellent initiative, but it does not protect women after they go home from the hospital, nor does it protect the many women in developing countries who give birth at home. There, messages promoting formula reach them via the media, formula company sales representatives and the commercial influence of health care workers through so-called professional education.

To rein in the multinationals, we need rigorous laws to enforce the International Code of Marketing of Breast-milk Substitutes in all countries. Such laws are crucial both to redress practices that have undermined breastfeeding and to prevent such practices in countries where commercial pressures have yet to gain a foothold. Compliance with the Code must be enforced by committed governments. 

Such national laws are not easily enacted. The industry grows more powerful every day, thanks to economic globalization. Yet 16 countries have managed to achieve full compliance with the Code, meaning that they have adopted appropriate laws. (See league table.) Of course, whether those laws are adhered to completely is another question.