Breastfeeding as a public health investment : a narrative review of evidence on economic value

Abstract

BACKGROUND : Breastfeeding improves infant and maternal health, reducing mortality, disease, and healthcare costs. Despite global recommendations, exclusive breastfeeding (EBF) remains suboptimal due to various factors including formula marketing and maternal employment. Limited economic value evidence hinders policy development. This narrative review examines the economic value of breastfeeding to strengthen the case for promoting, protecting, and supporting breastfeeding initiatives. METHODS : We searched PubMed, ProQuest, Web of Science, and Scopus databases for studies from 1999 to February 2025 on the economic value of breastfeeding and breast milk. Eligible studies were screened, extracted, and analysed. All reported costs were adjusted to 2024 U.S. dollars using annual national exchange rates and U.S. inflation rates. RESULTS : We reviewed 26 articles across diverse income settings. Breastfeeding-related cost savings varied widely, with global breast milk valued between US$1.4–64 billion, while formula costs reached up to US$394.5 million annually. EBF saved up to US$90.9 million in lifetime maternal cancer treatment costs and US$1.26–73.5 million annually in paediatric healthcare costs. In Sub-Saharan Africa, improved EBF was linked to US$23.9 billion in non-health gross domestic product gains. Three studies showed high economic returns on breastfeeding promotion, with up to 139% investment return. CONCLUSION : Breastfeeding provides economic benefits in all settings, underscoring the need for prioritising breastfeeding as a public health investment. Stronger policies accompanied by implementation commitments and multi-stakeholder collaboration in breastfeeding promotion initiatives are essential to improve EBF rates, leading to better health outcomes and economic returns. Standardized costing approaches and longitudinal designs, especially in low-income settings, are needed to capture the full economic potential.