September 2001

Grant Results

SUMMARY

From 1999 to 2000, researchers at the Montefiore Medical Center, Bronx, N.Y. designed a study to determine whether encouraging women to breast-feed their infants would reduce health-care costs as well as improve children's health.

To prepare for their study on the economic benefits of breast-feeding, the research team gathered preliminary data about breast-feeding practices through focus group interviews with pregnant and postpartum women, surveys of health-care providers, and medical record reviews.

Data were gathered chiefly at two sites where the full study will be conducted, the Family Health Center and Comprehensive Health Care Center, clinics affiliated with Montefiore Medical Center, located in the Bronx, New York.

Key Findings
Analysis of these data revealed the following:

  • Women were predisposed towards breast-feeding but had not received strong encouragement from their prenatal providers. Women felt that support for breast-feeding from a lactation consultant would be welcome in the pre- and post-natal period.
  • Providers were highly knowledgeable about the health benefits of breast-feeding and felt it was their role to recommend breast-feeding to expectant mothers.

    In practice, however, one-third had provided lactation counseling to five or fewer women and most had never taught a woman how to use a breast pump. Among support staff, the majority (57 percent) would accept the mother's choice rather than recommend breast-feeding.
  • Middle ear infection, gastrointestinal illnesses, and respiratory infections (termed "breast-feeding sensitive" morbidities) accounted for 23 percent of all diagnoses among the 82 children seen at Family Health Center whose medical charts were reviewed. The number of breast-feeding sensitive morbidities tripled in the second six months of life compared with the first six months (from a mean of 0.73 to 2.16).

Funding
The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $48,571 between August 1999 and August 2000.

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THE PROBLEM

In the first year of life, breast-feeding is the preferred feeding method for most infants because it is associated with significantly fewer cases of common childhood illnesses, including respiratory infections, gastrointestinal (GI) illnesses, and otitis media, or middle ear infection, the most frequently diagnosed childhood illness.

While national breast-feeding rates have increased, they remain lower among low-income women, less-educated women, younger women, and African American women.

Despite clear evidence of the health benefits and potential cost savings from breast-feeding, breast-feeding education and support services are rarely covered by private or public insurance. Lactation support is the type of service that managed care plans might cover, however, if the costs and benefits were known.

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THE PROJECT

Researchers at the Montefiore Medical Center, Bronx, N.Y. designed a study to determine whether encouraging women to breast-feed their infants would reduce health-care costs as well as improve children's health.

To prepare for their study on the economic benefits of breast-feeding, the research team gathered preliminary data about breast-feeding practices through focus group interviews with pregnant and postpartum women, surveys of health-care providers, and medical record reviews.

Data were gathered chiefly at two sites where the full study will be conducted, the Family Health Center and Comprehensive Health Care Center, clinics affiliated with Montefiore Medical Center, located in the Bronx, New York.

The researchers also reviewed medical records at the Family Health Center to analyze patterns of prenatal care utilization, infant visit rates, and attrition rates in order to determine the appropriate number of women to recruit for the study.

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FINDINGS

Analysis of these data revealed the following:

  • Women were predisposed towards breast-feeding but had not received strong encouragement from their prenatal providers. Women felt that support for breast-feeding from a lactation consultant would be welcome in the pre- and post-natal period.
  • Providers were highly knowledgeable about the health benefits of breast-feeding and felt it was their role to recommend breast-feeding to expectant mothers.

    In practice, however, one-third had provided lactation counseling to five or fewer women and most had never taught a woman how to use a breast pump. Among support staff, the majority (57 percent) would accept the mother's choice rather than recommend breast-feeding.
  • Otitis media, GI illnesses, and respiratory infections (termed "breast-feeding sensitive" morbidities) accounted for 23 percent of all diagnoses among the 82 children seen at the Family Health Center whose medical charts were reviewed. The number of breast-feeding sensitive morbidities tripled in the second six months of life compared with the first six months (from a mean of 0.73 to 2.16).

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AFTER THE GRANT

The research team used these data to strengthen the design of the breast-feeding promotion intervention and to develop a full proposal to conduct the study. To carry out the study, the team secured three federal grants, totaling approximately $1.7 million, from the U.S. Department of Agriculture ($400,000), the Maternal and Child Health Bureau ($1,026,869), and the Agency for Healthcare Research and Quality ($331,000).

The four-year study, dubbed MILK (Moms Into Learning about Kids), was launched in July 2000. Some 190 pregnant women at the two clinics will be enrolled and divided randomly into intervention and control groups.

Women in the intervention group will receive one-to-one support from a lactation consultant in the prenatal period as well as hospital and home visits in the postpartum period. Women in the control group will receive the clinic's standard of care but no individualized lactation support.

To determine if the lactation intervention is effective, the two groups will be tracked during the 12-month period following childbirth and compared for three key outcomes:

  • Women's rates of initiating and continuing breast-feeding.
  • Children's health overall and with regard to the three "breast-feeding-sensitive" illnesses.
  • Children's health-care costs.

Key findings from the planning grant were incorporated into an article, The Economic Impact of Breast-Feeding Promotion Interventions: A Public Policy Perspective, which has been accepted for publication with the Journal of Perinatology.

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GRANT DETAILS & CONTACT INFORMATION

Project

Study to Evaluate the Economic Impact of Breast-Feeding Interventions

Grantee

Montefiore Medical Center (Bronx,  NY)

  • Amount: $ 48,571
    Dates: August 1999 to August 2000
    ID#:  037046

Contact

Karen A. Bonuck, Ph.D.
(718) 798-4285
kbonuck@montefiore.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Bonuck K, Arno PS, Memmott MM, Freeman K, Gold M and McKee D. "Breast-Feeding Promotion Interventions: Good Public Health and Economic Sense." Journal of Perinatology, 22(1): 78–81, 2002. Abstract available online.

Presentations and Testimony

Karen A Bonuck, Kathy Freeman, Diane McKee and Michelle Trombley, "Economic Impact of Breast-Feeding Promotion Interventions," at the Department of Family Medicine, Montefiore / Albert Einstein College of Medicine, March 19, 2000, New York, N.Y.

Survey Instruments

"The MILK Study: Baseline and Follow-Up Interviews." Montefiore Medical Center, fielded Spring 2000.

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Report prepared by: Jayme Hannay
Reviewed by: Robert Narus
Reviewed by: Janet Heroux
Program Officer: Robert Hughes

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