Department of Health Administration & Public Health, Baptist Health Sciences University, 1003 Monroe Ave, Memphis, TN 38104, United States.
National Centre for Epidemiology and Population Health, Australian National University, Canberra, 62 Mills Rd, Acton ACT 2600, Australia.
Health Policy Plan. 2024 Oct 15;39(9):916-945. doi: 10.1093/heapol/czae069.
Breastfeeding is important for women and children's health, but less than half of infants worldwide begin life with optimal breastfeeding. A growing literature shows consistently large economic costs of not breastfeeding, with global studies showing economic losses of around US$300 billion globally. However, existing studies are highly diverse in approaches, methods, data sources and country results. Building on a landmark 2012 UNICEF UK review focused on high-income countries, we conducted a scoping review to map and characterize the expanding literature and identify future research directions in this research area. We included studies (n = 36) in diverse country settings and outcomes for women and children. We used PubMed, Web of Science, EMBASE, MEDLINE, ProQuest and manual searches of cost of not breastfeeding studies published between 1996 and 2023. Articles were excluded if they were macroeconomic evaluations, did not assign monetary values or only evaluated breastfeeding or formula feeding costs and not outcomes or were cost of programs studies. We found considerable diversity in disciplinary approaches and differences in methodologies. Though there were different cost measurement perspectives (societal, institutional/payer and individual), all but two excluded the costs of unpaid care. Studies typically measured costs of medical treatment, with more recent studies using dynamic simulation models. The largest economic costs were derived from lifetime estimates of human capital losses, namely cost of premature death and loss of intelligence quotient points. Medical and death costs varied widely depending on method of calculation, but total costs consistently exceeded $US100 billion annually for the USA, and around $US300 billion in global studies. Our findings suggest that greater interdisciplinary collaboration is needed particularly to better define infant feeding exposures, and advance comprehensive measurement of costs and outcomes across lifetimes, in order to prioritize breastfeeding as a public health strategy of economic importance.
母乳喂养对妇女和儿童的健康至关重要，但全球只有不到一半的婴儿从生命开始就接受最佳母乳喂养。越来越多的文献表明，不进行母乳喂养会带来巨大的经济成本，全球研究表明全球经济损失约为 3000 亿美元。然而，现有的研究在方法、数据来源和国家结果方面存在很大差异。在 2012 年联合国儿童基金会英国的一项具有里程碑意义的审查的基础上，该审查侧重于高收入国家，我们进行了范围界定审查，以绘制和描述不断扩大的文献，并确定该研究领域的未来研究方向。我们纳入了来自不同国家背景和母婴结局的研究（n=36）。我们使用了 PubMed、Web of Science、EMBASE、MEDLINE、ProQuest 和 1996 年至 2023 年期间发表的关于未进行母乳喂养成本的研究的手工搜索。如果文章是宏观经济评估、没有分配货币价值、只评估母乳喂养或配方奶喂养成本而不评估结果、或成本是方案研究，则将其排除在外。我们发现学科方法存在相当大的差异，方法学也存在差异。虽然有不同的成本衡量视角（社会、机构/支付方和个人），但除了两项之外，所有研究都排除了无偿护理成本。研究通常衡量医疗费用，最近的研究使用动态模拟模型。最大的经济成本来自人力资本损失的终身估计，即过早死亡和智商点损失的成本。医疗和死亡成本因计算方法而异，但美国的总费用每年都超过 1000 亿美元，全球研究中约为 3000 亿美元。我们的研究结果表明，需要加强跨学科合作，特别是为了更好地定义婴儿喂养暴露，并推进终身成本和结果的综合衡量，以便将母乳喂养作为具有经济重要性的公共卫生战略。
