Skip to main content Accessibility help

Economic impact of breast-feeding-associated improvements of childhood cognitive development, based on data from the ALSPAC

  • Niels Straub (a1), Philipp Grunert (a1), Kate Northstone (a2) and Pauline Emmett (a2)

The aim of this study was to assess the economic benefits of improved cognitive development related to being breast-fed. Breast-feeding rates were assessed in the Avon Longitudinal Study of Parents and Children. Educational attainment was assessed at age 16 years with higher attainment defined as gaining five General Certificate of Secondary Education (GCSE) passes at a high grade. The economic benefit of being breast-fed was calculated in a decision model using a child’s educational attainment and the corresponding expected value of average income in later life. There was a positive association between being breast-fed and achieving higher educational attainment, which remained significant, after adjustment for possible confounders: being breast-fed <6 months yielded an OR of 1·30 (95 % CI 1·13, 1·51) and for ≥6 months yielded an OR of 1·72 (95 % CI 1·46, 2·05), compared with never breast-fed children. On the basis of UK income statistics, the present value of lifetime gross income was calculated to be £67 500 higher for children achieving 5 high-grade GCSE passes compared with not achieving this. Therefore, the economic benefit of being breast-fed <6 months would be £4208 and that for ≥6 months would be £8799/child. The model shows that the increased educational attainment associated with being breast-fed has a positive economic benefit for society, even from small improvements in breast-feeding rates. Within a total UK birth cohort of 800 000/year an increase by 1 % in breast-feeding rates would be worth >£33·6 million over the working life of the cohort. Therefore, breast-feeding promotion is likely to be highly cost-effective and policymakers should take this into consideration.

Corresponding author
* Corresponding author: N. Straub, fax +49-89-9789 1045, email
Hide All

Disclaimer: This paper was published as part of a supplement to British Journal of Nutrition, publication of which was supported partially by UNILEVER, NUTRIMENTHE EU Project and an unrestricted educational grant from the University of Granada. The papers included in this supplement were invited by the Guest Editor and have undergone the standard journal formal review process. They may be cited.

Hide All
1. Koletzko, B, Decsi, T, Molnar, D et al., (editors) (2009) Early Nutrition Programming and Health Outcomes in Later Life: Obesity and Beyond. New York: Springer. Adv Exp Med Biol; 646, 1–196.
2. Owen, C, Martin, R, Whincup, P, et al. (2005) Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 115, 13671377.
3. Martin, R, Gunnell, D & Davey Smith, G (2005) Breastfeeding in infancy and blood pressure in later life: systematic review and meta-analysis. Am J Epidemiol 161, 1526.
4. Arenz, S, Ruckerl, R, Koletzko, B, et al. (2004) Breast-feeding and childhood obesity – a systematic review. Int J Obes Relat Metab Disord 28, 12471256.
5. Dewey, KG (1998) Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate 74, 94105.
6. Hoddinott, P, Tappin, D & Wright, C (2008) Breast feeding. BMJ 336, 881887.
7. Kramer, MS, Aboud, F, Mironova, E, et al. (2008) Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 65, 578584.
8. Anderson, JW, Johnstone, BM & Remley, DT (1999) Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 70, 525535.
9. Der, G, Batty, D & Deary, IJ (2006) Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis. BMJ 333, 945.
10. Horta, BL, Bahl, R, Martines, JC, et al. (2007) Evidence on the Long-term Effects of Breastfeeding: Systematic Reviews and Meta-Analyses. Geneva: WHO.
11. Hibbeln, JR, Davis, JM, Steer, C, et al. (2007) Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 369, 578585.
12. Beyerlein, A, Hadders-Algra, M, Kennedy, K, et al. (2010) Infant formula supplementation with long-chain polyunsaturated fatty acids has no effect on Bayley developmental scores at 18 months of age – IPD meta-analysis of 4 large clinical trials. J Pediatr Gastroenterol Nutr 50, 7984.
13. Feinstein, L (2003) Inequality in the early cognitive development of children in the 1970 cohort. Economica 70, 7397.
14. Lanting, CI, Fidler, V, Huisman, M, et al. (1994) Neurological differences between 9-year-old children fed breast-milk or formula-milk as babies. Lancet 344, 13191322.
15. Richards, M, Hardy, R & Wadsworth, M. (2002) Long-term effects of breastfeeding in a national birth cohort: educational attainment and midlife cognitive function. Public Health Nutr 5, 631635.
16. Horwood, L & Fergusson, D (1998) Breastfeeding and later cognitive and academic outcomes. Pediatrics 101, E9.
17. Feinstein, L, Sabates, R, Sorhaindo, A, et al. (2008) Dietary patterns related to attainment in school: the importance of early eating patterns. J Epidemiol Community Health 62, 734739.
18. Behrman, JR (1996) The impact of health and nutrition on education. World Bank Econ Rev 11, 2337.
19. Currie, J & Thomas, D (1999) Early Test Scores, Socioeconomic Status and Future Outcomes. Working Paper. Cambridge: National Bureau of Economic Research; No. 6943.
20. OECD (2012) Education at a Glance 2012: OECD Indicators. OECD Publishing, Paris. DOI: (accessed March 2013).
21. Anjos, T, Altmäe, S, Emmett, P, et al. (2013) Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project. Eur J Nutr 52, 18251842.
22. Boyd, A, Golding, J, Macleod, J, et al. (2013) Cohort profile: the ‘Children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children. Int J Epidemiol. 42, 111127.
23. United Kingdom Office for National Statistics (2012) Labour market statistics. (accessed September 2013).
24. Gebel, M & Pfeiffer, F (2010) Educational expansion and its heterogeneous returns for wage workers. Schmollers Jahrbuch 130, 1942.
25. Corso, PS & Haddix, AC (2003) Time effects. In AC Haddix, SM Teutsch and PA Corso, editors. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation, 2nd ed. London: Oxford University Press.
26. Renfrew, MJ, Pokhrel, S, Quigley, M, et al. (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. UNICEF; (accessed March 2015).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed