Nursing Your Child May Be Priceless, But It's Not Without Cost

This week, I woke up to an interesting headline: "A Year of Breastfeeding Costs Families As Much As $11,000, Study Finds." Published on March 22, the report spearheaded by Sarah Mahoney, a second-year Yale M.D.-Ph.D. student, assigns dollar values to aspects of breastfeeding or chestfeeding, including extra food, pump supplies, Vitamin D supplementation, and time.

I joined in the collective groan. I had my son in February 2022, the same week Abbott, the company that produces Similac formula, announced it was shutting down its plant. The move sparked a nationwide formula shortage that prompted insensitive hot takes from the likes of Bette Midler, encouraging people to "TRY BREASTFEEDING."

I'll be the first to tell a guilt-ridden formula-feeding parent that their baby loves them no matter what. But when I struggled to breastfeed during a formula shortage, that is one of the last things I wanted to hear—right up there with "fed is best" and "they all eat Cheerios off the floor."

I was hesitant to do a story on the Yale study. After finally getting support and exclusively nursing for over a year, I didn't feel like contributing to another conversation that labeled breastfeeding "too hard and not worth it."

But I decided to speak with the researchers and have a nuanced conversation (as I nursed my toddler down for a nap).

Disclaimer: The Issue is Systemic

The topic of lactation gets emotionally fraught. A big issue is that many breastfeeding or chestfeeding individuals view the switch to formula as a personal failure because we live in a culture bent on shaming us no matter what path we take. This was part of my problem with the framing of the research: The $11,000 figure was a personal cost. Breastfeeding or chestfeeding is not a product, nor is it an individual act. It's a learned process, and the responsibility should lie on communities and systems. We saw that earlier this month when an orangutan at a Richmond zoo who was orphaned as a little one learned to nurse her baby from a human mother.

Individuals do not fail to nurse. Systems fail to help us nurce, and I encourage you to view the rest of this critique from that lens. It's not an attack on you. I'm not about shaming parents for their feeding choices. But 83.2% percent of lactating people in the U.S. initiate the process at birth, and 24.9% still feed their infant exclusive human milk at six months. The initiation rates are lowest for Black parents, with 60% starting at birth.

We need to talk about these numbers.

The Reported Hidden Costs of Nursing

Can assigning numbers—in the form of costs—help the conversation? I feared that it would merely prop up the idea that breastfeeding was far too challenging with far too few benefits to bother trying, even though literally every major health organization says otherwise.

But Mahoney hopes it meets money-driven policymakers where they are: Staring at the bottom line.

"As a cold-hearted economist, I know people respond to dollars and cents," Mahoney says. "It's hard to go to a legislature or a policymaker at any level and say, 'We ought to make policy to address this barrier,' and they say, 'What is the barrier? Quantify it for me.' If we just say, 'Breastfeeding is expensive,' they can say, 'No, it's free. We'll give them a closet in the corner.'"

Here's a breakdown of what Mahoney and the research team found about the cost of nursing:

• Supplies: Limited to pumping supplies like milk bags (not nice-to-haves like nursing clothes and pillows): $125-$445 per year.
• Food: Researchers and the Centers for Disease Control and Prevention (CDC) admit it's challenging to give a precise caloric need for breastfeeding because it varies based on age, activity level, and metabolism. But ultimately, like exercise, producing milk burns energy, so it's recommended you replenish it, in part to help with supply. The general recommendation from the CDC is an extra 330-400 calories daily. Researchers estimated the total annual cost to be $508.32.
• Vitamin D: Breastfed infants and their lactating parents require vitamin D supplementation, something babies consuming at least 32 oz. of formula do not. Researchers put the annual price tag of this supplementation at $73.

That adds up to somewhere between $706.32-$1,026.32 annually.

So how did we get to $11,000?

Add in time. There's a saying: "Breastfeeding is only free if you feel a woman's time has no value."

"The greatest contributor to breastfeeding is the opportunity cost," Mahoney says. "I think that's very hard for people to wrap their minds around. We don't tend to think of time in terms of dollars and cents... That time is not free."

I have thoughts on that, but first, the numbers: Researchers used the federal minimum wage of $7.25 (side note: yikes) and multiplied it by three and four, representative of the number of hours it takes per day to breastfeed directly or express milk. The total cost was $21.75-$29 per day, or $7,938.75-$10,585 annually.

The Study Has Some Holes

Researchers didn't account for the time it takes a parent who could have lactated to feed formula, find the formula (in a shortage, no less), and sterilize and clean parts. Mahoney says the authors looked at what was absolutely necessary for the lactating person. Any qualified caregiver can bottle-feed a child formula, find it, and purchase it.

"In formula feeding, [lactating parents] will bear some of that cost in terms of time, but it's not necessarily required," Mahoney says.

It's a bit unrealistic to expect that one parent would forego all time for feeding, no?

"That's a reasonable critique, but we just wanted to include the costs that are the bare necessities," Mahoney says.

But that leads me to my next point. Are pump supplies actually necessary? Should the time "costs" associated with breastfeeding an infant be so detrimental to a lactating person? At its core, lactating requires a parent, child, and maybe $73 worth of Vitamin D.

"Naturally, it's supposed to be this mother-baby dyad with the baby nursing from the breast, which is not the reality in the U.S.," says Sarah Taylor, M.D., a Yale professor of pediatrics and study author.

Dr. Taylor is right. But why is that not the reality in the U.S.?

Because we are the only developed country without access to paid leave. Only a quarter of private-sector Americans had access to paid family leave in March of 2021. Black parents are less likely to have access to this time. Unsurprisingly, their breastfeeding initiation rates are lower than their White peers.

"The leave is a huge part of this," Dr. Taylor says. "We have been trying to figure out why about 80% of women initiate breastfeeding, but only about 25% sustain it exclusively at six months. It has not moved that far, no matter how much we are trying."

Dr. Taylor would like to see the government absorb that cost so more parents can lactate, particularly in historically marginalized communities.

"We're trying to say that there should be an investment besides the lactating mother," Dr. Taylor says. "It's good for society and the country to invest in these costs in order to take the burden off the lactating parent. Until we do that, we are not going to budge that 25% exclusive breastfeeding rate...and the burden is higher for people in lower socioeconomic groups."

Can I get an AMEN? The problem is very few people make money when a parent successfully directly nurses for the entirety of their baby's early feeding journey. Not pump companies. Not milk bag producers. Not employers or the government that would have to figure out what to do without us while we're engaging in a biologically normal process with our children during a year of federal paid leave.

It's More Than Paid Leave

Paid leave is an anchor in increasing breastfeeding rates, but it's not the whole boat. Take the United Kingdom, which offers a mostly fully-paid maternity leave for 39 weeks and has a 1% exclusive breastfeeding rate at 6 months, making even the U.S. look good. Negative attitudes towards breastfeeding in public are cited among the reasons for this abysmally low number.

It goes back to my first point: Breastfeeding is a learned process requiring systemic and societal support. Breastfeeding rates past initiation continue to lag throughout the years. This means many of our mothers, grandmothers, aunts, and sisters did not breastfeed. Lactating parents today did not see the process. Therefore, they didn't become comfortable with the process or learn the process, like the orphaned orangutan at the Richmond Zoo.

"I think what you said is very much a goal of this paper is to change the narrative about breastfeeding in terms of the narrative that this is a motherly activity—go hide away in a broom closet for the one employee who has chosen to breastfeed," Mahoney says. "We should respect mothers who are doing it. It's challenging, economically productive, and contributes to the social good."

Indeed, as the researchers point out in their paper, increasing breastfeeding rates by just 5% could save the U.S. $40 million in reduced morbidity for gastrointestinal issues and ear infections.

"We take the view that it is a productive activity, a healthy activity," says Howard Forman, M.D., MBA, a study author and Yale professor of radiology and biomedical imaging, public health (health policy), management, and economics. "It has a lot of benefits to the mother-child bonding. We should not allow our current policies to dissuade women because of the economic cost."

The Bottom Line

Lactation should always be a choice. But it's challenging to call it that right now, given the lack of social, systemic, and economic support. Instead, parents are having that choice made—stolen—from them by a broken system.

"The whole point of this manuscript and hopefully future work…is to inform and empower families to make a feeding choice that is right for them," Dr. Taylor says. "We have not adequately empowered families to reach their breastfeeding goals."

And that's unfortunate. It's challenging for me to wrap my head around a dollar amount for nursing. While I appreciate and agree that the authors believe my time has value, I'd argue that there was no more valuable use of my time than nourishing my bottle-hating son (I did not have paid leave but do work from home). I know mileage varies. But a survey of nearly 2,000 mothers from Aeroflow last year found that two-thirds stopped breastfeeding sooner than they would have liked. I can't help but feel many of them probably placed the same value on their time that I did, but too many barriers got in the way.

In short, the actual expense in this country is having milk ducts and a uterus (see: Tampon tax and the overturning of Roe v. Wade, another way the system is robbing us of choices over our bodies). But maybe this study will convince policymakers in Washington with dollar signs in their eyes that we need change. If that's what comes of this study, I am all for it.

In the meantime, I'll continue to enjoy my 13.5-month-old: The smiles and the way he claps his hands when he goes on and off my breast; the way my body—something I have had a complicated relationship with through the years—continues to be his favorite home after more than a year on the outside. I'll cherish nursing gymnastics. Those moments are priceless, and I want the system to allow more people to have them.