Sophia Zhao, Senior Illustrator

While the 2022 baby formula shortage in the United States sparked calls for an increase in support for breastfeeding nationwide, a group of researchers at the Yale School of Public Health and Yale School of Medicine sought to demonstrate how breastfeeding can impose significant financial burdens on families as well. 

A recent study led by Sarah Mahoney MED ’29, a second-year medical student and PhD candidate, Sarah Taylor, a professor of pediatrics at YSM and Howard Foreman, a professor of radiology and biomedical imaging and the director of the MD/MBA program at Yale, found that breastfeeding a child can cost more than $11,000 a year — a significantly greater cost than that of baby formula. 

According to Foreman, quantifying the costs of breastfeeding is important because it can help to inform health policy that aims to reduce barriers preventing women from breastfeeding. 

“The most important thing is to recognize that there are genuine obstacles including economic obstacles for women being able to breastfeed,” Foreman said. “If we want to give women the true choice between breastfeeding and formula feeding… then we have to reduce [these] obstacles, which are greatest for those who are of lower income and or work low wage jobs.”

Mahoney, who is the first author of the study, said she focuses her research primarily on the intersection between medicine, science and economics. 

She first became interested in breastfeeding during a class in her first year of medical school, where she learned about a recent change in policy regarding the provision of donor milk — human milk donated for other infants whose mothers cannot provide — in the neonatal intensive care unit at one of Yale’s hospitals. Mahoney worked with a neonatologist at the hospital who guided her through a study conducted on the effects of this change in policy. 

Mahoney and her mentor Foreman were initially considering researching the economics and policies behind donor milk when the formula shortage struck and changed their plans.

“Suddenly breastfeeding was thrust into the limelight, and families struggling to feed their babies in wake of the shortage were told to ‘just breastfeed, it’s free,’” Mahoney told the News. “But as any half-baked economist knows, nothing is free, and public rhetoric to the contrary may engender shame in non-breastfeeding mothers.”

In the study, the researchers identified several categories of costs for a woman breastfeeding her child: pumping supplies, increased nutritional intake for the breastfeeding mother, vitamin D supplementation — which is recommended for breastfeeding mothers by the American Academy of Pediatrics — and opportunity cost. 

Summing up estimates on all of these costs, the researchers estimated the cost of breastfeeding an infant in the first year of their life to be between $8,640.07 and $11,611.32. 

This is in stark contrast to the costs of baby formula. Mahoney and the team cited other researchers that have estimated formula costs for an infant in the first year of life; these estimates include $1500 to $1900 in 2022, $760 to $2280 in 2020 and $2528 in 2014.

“We believed that quantifying the cost of breastfeeding would enable researchers, policymakers and physicians to address this as an often-significant barrier and better support mothers who choose to breastfeed,” Mahoney wrote.

The greatest component of the researchers’ final estimate was the opportunity cost of breastfeeding.

For the purpose of quantifying time lost, the researchers valued one hour of a breastfeeding parent’s time at the federal minimum wage of $7.25. Assuming that breastfeeding takes about 3-4 hours a day, the total opportunity cost over a year ends up being approximately $7,938.75 to $10,585.00.

“[C]onsider the U.S. federal poverty level for a family of two (e.g. single mother plus child) or three (e.g. two-parent household plus child) at $18,310 and $23,030 annual household income, respectively,” Mahoney wrote. “In 2021, 17.5 percent of children under the age of five live in households below the poverty level; for the families of these children, breastfeeding could very well cost a significant portion of their annual income.”

According to Mahoney, one of the most challenging parts of the study was deciding which items to include in the cost analysis. Mahoney explained that the final decision relied on extensive literature reviews, guidance from medical organizations and the advice from Taylor — the third author on the study. 

In addition, quantifying the opportunity cost of breastfeeding also proved to be a challenge. The researchers said they eventually chose to use the federal minimum wage as the price floor because they believed it would be “perspicuous to a broad audience.” 

Mahoney also noted that this study only included direct and marginal costs of breastfeeding. Other costs that weren’t included but may be incurred, she mentioned, include women’s long-term earnings and a flattened career potential, as well as the potential psychological, emotional and physical costs of breastfeeding. 

Taylor emphasized the overall importance of breastfeeding and explained that more must be done to help support those who choose to breastfeed their children. 

“Investment in breastfeeding will decrease childhood diabetes and cancer; infant infections and women’s cancer, cardiovascular disease and diabetes,” Taylor wrote. “Insurers have increased their coverage for lactation support, although more is needed … [T]he current system of family leave worsens the breastfeeding disparities. We need policies that decrease the work burden for all women.”

The Yale School of Public Health is located at 60 College St.