Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.

OBJECTIVE: To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California. DESIGN: Cost-savings analysis. SUBJECTS/SETTING: Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal. MAIN OUTCOME MEASURES: Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%. RESULTS: Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from $3,442 to $4,944 (4% discount) to $4,475 to $6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between $459 and $659 (4% discount) and $597 and $808 (0% discount) per family. APPLICATIONS: Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.

Determinants of infant feeding choices among southeast Asian immigrants in northern California.

OBJECTIVE: This study documents obstacles to successful lactation among Southeast Asian women. DESIGN: We assessed the infant feeding practices of 65 Hmong and 57 Vietnamese women. The women were recruited and interviewed at clinics of the Special Supplemental Food Program for Women, Infants, and Children (WIC) and neighborhoods in northern California. Analysis included logistic regression and odds ratios. RESULTS: Only 5 of the Hmong women and 3 of the Vietnamese women in our initial sample breast-fed their youngest child. Primary reasons for formula-feeding included convenience, the intent to return to work or school (although few did so), desire to allow others to feed, and the expectation of insufficient milk. In addition, most perceived that formula-feeding was more popular in the United States, and 19 of the Vietnamese women believed formula-feeding was healthier than breast-feeding. Variables positively related to breast-feeding included the number of times the mother was enrolled in WIC (for Hmong women) and the number of children previously breast-fed (for both groups). Breast-feeding was negatively related to the total number of children (for Hmong women), maternal age (for Vietnamese women), and receiving formula at the time of discharge from the hospital (for both groups). APPLICATIONS/CONCLUSIONS: Promotion of breast-feeding among Southeast Asian women should focus on increasing the number of women who initiate breast-feeding, addressing attitudes regarding the popularity and convenience of formula-feeding, and discouraging hospital practices that may impede breast-feeding.