Breastfeeding Duration, Costs, and Benefits of a Support Program for Low-Income Breastfeeding Women Linda C. Pugh, PhD, RNC, Renee A. Milligan, PhD, RNC, Kevin D. Frick, PhD, Diane Spatz, PhD, RNC, and Yvonne Bronner, ScD, RD ABSTRACT: Background: Breastfeeding can ameliorate some of the complex health issues faced by low-income families. Women who breastfeed and their infants have lower health care costs compared with those who formula feed. Increasing the duration of breastfeeding is recognized as a national priority, particularly for low-income women. This community-based randomized clinical trial involving low-income mothers compared usual care with an inter- vention comprising hospital and home visits, and telephone support by a community health nurse/peer counselor team for 6 months after delivery. Methods: Forty-one women were recruited after delivery of a full-term singleton infant and randomly assigned to intervention or usual care groups. Results: Women receiving the community health intervention breastfed longer than the women receiving usual care. The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group. The intervention cost ($301/mother) was partially offset by cost savings on formula and health care. Conclusions: Community health nurse and peer counselor support can increase breastfeeding duration in low-income women, and has the potential to reduce total costs including the cost of support. (BIRTH 29:2 June 2002) The United States national health objectives, Healthy People 2010, includes the goal of increasing breast- feeding duration to 6 months for 50 percent of women who initiate breastfeeding (1). Other health organizations (American Academy of Pediatrics, American Dietetic Association, UNICEF, UNAIDS, World Health Organization) have also recommended that women exclusively breastfeed for 6 months (2–5). The 2010 goals specifically focus on increasing breastfeeding among low-income women, a popula- tion in which breastfeeding duration continues to be low (1). In 2000 only 20.1 percent of low-income mothers breastfed for 6 months (6). Increased duration of breastfeeding offers health benefits to mothers and infants (3,7,8), many of which are specific to low-income women. They may find that breastfeeding is empowering (9) and helps with pregnancy spacing (10). Furthermore, breast- feeding may also save the mother and society resources (11). Compared with formula feeding, breastfeeding is associated with lower formula and health care costs, and it may take less time (12; Frick, Racine, Pugh, Milligan, unpublished manuscript, 2002). The cost savings may even be sufficient to offset the costs of promoting breastfeeding. Facilitating breastfeeding among low-income women includes comprehensive and culturally Linda Pugh is an Associate Professor at Johns Hopkins University School of Nursing in Baltimore, Maryland. Renee Milligan is an Adjunct Faculty at Johns Hopkins University School of Nursing and a Clinical Associate Professor at Georgetown University School of Nursing in Washington, DC; Kevin Frick is an Assistant Professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland; Diane Spatz is an Assistant Professor at the University of Pennsylvania School of Nursing in Philadelphia, Pennsylvania; Yvonne Bronner is the Director of the Department of Public Health at Morgan State University in Baltimore, Maryland. The National Institute of Nursing Research, Bethesda, Maryland, funded this study (R55 NR04958). Address correspondence to Linda C. Pugh, PhD, RNC, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, Maryland 21205. Ó 2002 Blackwell Publishing, Inc. BIRTH 29:2 June 2002 95