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No such thing as a free lunch: The direct marginal costs of breastfeeding


Understanding costs associated with breastfeeding is critical to developing maximally effective policy to support breastfeeding by addressing financial barriers. Breastfeeding is not without cost; direct costs include those of equipment, modified nutritional intake, and time (opportunity cost). Breastfeeding need not require more equipment than formula feeding, though maternal equipment use varies by maternal preference. Meeting increased nutritional demands requires increased spending on food and potentially dietary supplementation, the marginal cost of which depends on a mother’s baseline diet. The opportunity cost of the three to four hours per day breastfeeding demands may be prohibitively high, particularly to low-income workers. These costs are relatively highest for low-income individuals, a group disproportionately comprising racial and ethnic minorities, and who demonstrate lower rates of breastfeeding than their white and higher-income peers. Acknowledging and addressing these costs and their regressive nature represents a critical component of effective breastfeeding policy and promotion.

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  1. These estimates of per-unit cost represent an average of over-the-counter (i.e. without insurance subsidy) prices from approximately a dozen online and retail pharmacies, including the largest national corporate pharmacies and retail operations in the United States.


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Authors and Affiliations



SEM and HPF conceived of the study. SNT contributed clinical expertise, and HPF provided guidance on methods. SEM performed the calculations and wrote the manuscript with support from SNT and HPF.

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Correspondence to Sarah N. Taylor.

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SNT serves as a consultant for the Vermont Oxford Network. The other authors declare no competing interests.

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Mahoney, S.E., Taylor, S.N. & Forman, H.P. No such thing as a free lunch: The direct marginal costs of breastfeeding. J Perinatol 43, 678–682 (2023).

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