In this series you’ll find information about formula and other milks commonly given to young children, presented as may be relevant to breastfeeding mothers and their babies. This is, after all, a site speaking mainly to mothers who wish to learn about breastfeeding.
I hope I don’t come across as a breastfeeding snob, as this is not a formula-user bashing blog. No one can guarantee that I won’t be a formula feeder myself one day, or that I wasn’t one in a past life… And I myself was a 100% formula baby. I was made from the stuff.
We’ve all heard “breast is best,” but some of us would still be hard-pressed to name all the benefits of breast milk over artificial milk if randomly questioned. Many women admit they didn’t breastfeed simply because they weren’t aware of much difference between human milk and artificial milk, and many say they wish they had tried — if only they’d known.
According to the most recent numbers, lots of mothers do supplement with formula or cow milk or at some point switch to them entirely. As such, a discussion about these alternatives as used by breastfeeding mothers is an unavoidable one.
In no way do I intend to imply with the information in this series that the way a mother feeds her child is any measure of how much she loves her child. I believe that formula feeding and breastfeeding are quite different, yes, but they are both just feeding. They are both often damp with a drizzle of judgments and, at times, drenched by a downpour of pressure.
The pressure to give your baby “the best” by breastfeeding is intense! Unless you live in a bubble of natural parenting gurus, the pressure to keep nursing hidden away can also be intense. But what’s even more intense is a mother’s love for her child and her determined attempts to do the best she can.
The main difference is that breastfeeding can also be used as a method of parenting. Formula feeding cannot really in the same way; however, mothers who formula feed DO make up for what they’re missing without exclusive breastfeeding by holding their babies close when they give bottles, babywearing, enjoying lots of skin-to-skin time, bedsharing, and more.
With that said…
“Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers” – The World Health Organization and UNICEF
**Also look for the upcoming parts of this series (at the bottom of post).**
Recommendations by Health Authorities
The most recent guidelines stated by world health authorities are based on the newest research, which shows that duration, intensity and exclusivity of breastfeeding DOES matter. From the science-based “Global Strategy for Infant and Young Child Feeding,” WHO (emphasis mine):
“The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.
…For infants who do not receive breast milk, feeding with a suitable breast-milk substitute…should be demonstrated only by health workers, or other community workers if necessary, and only to the mothers and other family members who need to use it; and the information given should include adequate instructions for appropriate preparation and the health hazards of inappropriate preparation and use. Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group.”
The following breast milk alternatives were recommended for mothers who cannot or will not breastfeed, in this order of most to least preferred (UNICEF, WHO, UNESCO: Facts for Life: A Communication Challenge, 1989):
- The mother’s own expressed milk
- Breast milk from a wet-nurse or milk bank
Most recently however, the WHO and UNICEF have listed the same alternatives with no explicit hierarchy, though they added that breast-milk substitutes (which include formula) should be given by cup rather than a traditional bottle.
Also in the WHO and UNICEF’s “Acceptable Medical Reasons for Use of Breast-Milk Substitutes” you can find the list of true medical contraindications to breastfeeding.
Per a missive by WHO regarding “follow-on/follow-up” milk/formulas:
“In 1986, the World Health Assembly stated that ‘the practice being introduced in some countries of providing infants with specially formulated milks (so-called ‘follow-up milks’) is not necessary.’ The Organization further maintains that as well as being unnecessary, follow-up formula is unsuitable when used as a breastmilk replacement from six months of age onwards. Current formulations lead to higher protein intake and lower intake of essential fatty acids, iron, zinc and B vitamins than those recommended by WHO for adequate growth and development of infants and young children.”
How about the American Academy of Pediatrics (AAP)’s stance on breastfeeding and formula? Per the 2012 policy statement “Breastfeeding and the Use of Human Milk”:
“Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”
The AAP recommends “exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.“
The American Academy of Family Physicians (AAFP) says:
“Routine supplementation of healthy, term breastfeeding infants is not recommended unless medically indicated. Mothers who supplement their nursing infants with infant formula are at risk for a decrease in their milk supply caused by decreased demand. In addition to potential loss of milk, supplementation should only be used when medically indicated because it can also interfere with other psychosocial and neurodevelopmental benefits of breastfeeding.“
In addition to WHO/UNICEF/UNESCO, AAP, and AAFP, some other organizations** that support and encourage similar pro-breastfeeding guidelines:
- American College of Nurse Midwives
- American Congress of Obstetricians and Gynecologists
- Baby-Friendly Hospital Initiative
- Centers for Disease Control and Prevention
- European Milk Bank Association (EMBA)
- European Lactation Consultants Alliance (ELACTA)
- Human Milk Banking Association of North America (HMBANA)
- Lactation Consultants of Australia and New Zealand (LCANZ)
- La Leche League International
- National Alliance for Breastfeeding Advocacy
- U.S. Breastfeeding Committee
- U.S. Food and Drug Administration
- U.S. Lactation Consultant Association (USLCA)
- Wellstart International
- World Alliance for Breastfeeding Action
- World Breastfeeding Week Organization
- …etc, etc, etc.
- (***even formula companies agree; printed on their product labels is a note that breastfeeding is the absolute best source of infant nutrition)
Why Isn’t Every Baby Breastfed?
Alternatives to breastfeeding are introduced for many reasons, usually professional (return to work), personal (family preference or another individual’s influence), and medical (conditions in the mother or baby). Other mothers choose not to breastfeed for different personal reasons, including fear of emotional trauma such as with a history of sexual abuse or psychiatric instability, prior breast surgeries that compromised duct tissue, a working mom who is unresponsive to a breast pump, concern about negative reactions from family or friends, lack of confidence or trust in her body, and most rampant are, unfortunately, misinformation and lack of education.
Social pressure is another reason why a woman would choose to not breastfeed. She may be under the impression (or believe herself) that breastfeeders must stay hidden away, or she might feel as if by breastfeeding, it would be expected of her to also take on the role of the extremist, pushy, flaunting ‘Lactivist’ depicted in modern media, and she’s really not comfortable with speaking out so loudly about her baby’s eating habits.
Children are less likely to be breastfed if they are orphaned, adopted, if the mother has been imprisoned, if she has mental or physical disabilities, or if she is an adolescent. Children who are part of a set of multiples (twins, triplets, and so on) are also less likely to be exclusively breastfed.
Many breastfeeding mothers give formula to their infants on regular or irregular occasion. This is why exclusive breastfeeding rates are published as inaccurately higher than they are in reality, given that infrequent (and thus perceived as arbitrary) supplementing often goes undeclared.
“Data indicate that the rate of initiation and duration of breastfeeding in the United States are well below [national goals]. Furthermore, many of the mothers counted as breastfeeding were supplementing their infants with formula during the first 6 months of the infant’s life. Although breastfeeding initiation rates have increased steadily since 1990, exclusive breastfeeding initiation rates have shown little or no increase over that same period of time. Similarly, 6 months after birth, the proportion of infants who are exclusively breastfed has increased at a much slower rate than that of infants who receive mixed feedings.” – American Association of Pediatrics
Not all moms are emotionally able to breastfeed; medically able to offer their milk; able to afford or gain access to a sufficient supply of donor breast milk; or circumstantially able to breastfeed or offer their milk exclusively, in part, or even at all. Yeah, it’s not ideal but that’s okay.
A mother can ensure she opts for formula because the more ideal choice for virtually all babies wasn’t realistically ideal for her — not because she didn’t know about the ideal choice, was booby-trapped, pressured out of it, or feeling unsupported.
Read another perspective from the self-described “judgy” author of The Alpha Parent who does some make valid points about how our infant feeding choices affect each other: “Why the way you feed your baby is MY business.”
**Coming up next in this series:**
- Cow-Made, Man-Made, or Mother-Made?
- Toxins in Infant Formula
- The Truth About Formula Marketing
- Making a Baby-Friendly Culture
- Mixed Feedings