In Focus
Costs Related to Promoting Breastfeeding Among Urban Low‐Income Women

https://doi.org/10.1111/j.1552-6909.2011.01316.xGet rights and content

ABSTRACT

Objective

To describe the costs of providing support to breastfeeding low‐income women and compares costs to cost offsets of the intervention.

Design

Secondary analysis of data from a randomized controlled trial of an intervention to promote breastfeeding among low‐income women with full‐term infants.

Setting

A university hospital and a community hospital in Baltimore, Maryland.

Participants

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligible breastfeeding women (N = 328) were randomized to usual care or the community health nurse/peer counselor intervention.

Methods

The researchers collected and described personnel and mileage costs over the entire duration of the intervention (24 weeks). Researchers also compared (using t tests) change in resources associated with breastfeeding including the number of clinic visits, hospital nights, emergency room visits, prescriptions, and formula feedings per day up to 12 weeks.

Results

The cost of the personnel and travel required for the intervention was $296 per woman. The use of medical care and number of formula feedings per day were similar for the intervention and usual care groups. When differences in use of medical care and formula feeding were statistically significant, the intervention group used fewer resources.

Conclusion

Support for breastfeeding by community health nurses and peer counselors is partially offset by reducing medical care utilization and formula feeding costs.

Section snippets

Design

The data for this secondary analysis were obtained from a randomized controlled trial (RCT) designed to determine what effect a Breastfeeding Support Team had on breastfeeding duration for low‐income women during the first 24 weeks postpartum. The study was approved by the Institutional Review Boards at the Johns Hopkins Hospital and Mercy Medical Center in Baltimore, Maryland. Women (N = 328) who were WIC eligible were recruited within 24 to 48 hours of delivery of their full‐term infants. The

Results

Characteristics of the sample of mothers have been reported previously (Pugh et al., 2010). The time and mileage resources required for the intervention are reported in Table 1. The intervention included more than 3 hours of in‐person time (M = 223 minutes, 95% CI [206, 241]). The actual telephone time was over one hour (M = 84 minutes, 95% CI [75, 92]). The extra time attempting contact on the phone had a mean of 9 minutes (95% CI [8, 10]). The total direct time spent by the peer counselors

Discussion

Similar to the pilot study of the breastfeeding support team for low‐income women (Pugh et al., 2010), we found that the personnel and transportation costs of the Breastfeeding Support Team in this study were also approximately $300 per woman. Nursing wages have substantially increased over the past 7 years. As such, the fact that the intervention costs the same amount per woman suggests that the intervention, as implemented in the current study, required less time. This fact is supported from

Nursing Implications

Nurses with or without peer counselor support often are identified as first‐line professionals in the promotion of breastfeeding. Community health nurses working alone or in conjunction with peer counselors have the appropriate skill set to support breastfeeding (Langston, Pugh, Franklin, Brown, & Milligan, 1998; Pugh et al., 2001; Pugh et al., 2002; Rice, Craig, McCormick, & Renfrew, 2010). Nurses have educational expertise, possess psychosocial intervention skills, understand symptom

Policy Implications

This intervention to increase breastfeeding duration among low‐income women is not very expensive. If it is targeted at the most vulnerable highest risk women and children, this will not necessarily lower the cost per woman, but the total expense will not be very large. Our data do not suggest that all the costs are offset, but that they are somewhat offset. An insurer might not find this convincing as a cost‐saving measure in the short run, but a local public health agency or organization or a

Acknowledgment

Supported by the National Institute of Health, National Institute of Nursing Research, Grant 1RO1NR007675.

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