Formula v breastfeeding: Should the state step in?

baby breastfeeding

New York City has put forth an initiative to end free formula milk samples and make it more difficult to access formula in hospital. Will the measures promote breastfeeding or add to a culture of shame for those who use formula?

When New York City Mayor Michael Bloomberg announced the specifics of a new initiative called Latch On NYC, it seemed at first glance like another aggressive move by the health-focused mayor.

Bloomberg, who already made international headlines for banning the sale of giant-sized soft drinks in the city, said that as of September, the 11 city hospitals and 16 participating private hospitals would restrict access to formula milk. For mothers who choose to breastfeed, this means treating formula similarly to medication, requiring that it be doled out only for specific reasons, and signed out and noted on the baby's chart when administered. Mothers who chose to formula feed can still do so.

Participating hospitals would also eliminate discharge bags, full of formula samples and paid for by the formula companies. Recently, Massachusetts and Rhode Island banned this practice as well.

The Latch On program is designed to promote breastfeeding. But some mothers worry that it contributes to a culture that pressures and shames women who want or need to use formula. It's part of an ongoing battle over who really has women's best interests at heart.

Deborah Kaplan, assistant commissioner of New York City's bureau of maternal, infant and reproductive health, says that setting up good nursing habits in the hospital is crucial when breastfeeding, since the first few days after birth help set the pace of milk production.

"In the body it's a supply and demand system. Nursing and pumping stimulates to make more milk," she says, noting that 73% of women in New York City hospitals reported that their babies were fed with formula during their stay. "If the baby gets some their tummy is full, they don't nurse, mother's body doesn't make enough milk and it starts a vicious cycle."

Breastfeeding benefits

Compared to formula-fed babies, babies who breastfeed:

  • Score 5.2 points higher on IQ tests (American Journal of Clinical Nutrition)
  • Are 40% less likely to develop diabetes before 40 in some communities (The Lancet)
  • Have more immune-boosting flora in their digestive systems (Genome Biology)
  • Are half as likely to suffer from asthma symptoms (European Respiratory Journal)

Limiting access, she says, will help prevent this from happening.

Diane Spatz, a professor perinatal nursing at the University of Pennsylvania school of nursing, says the free formula bags also send the wrong message.

"If you're giving them the company bag, you're endorsing that you think those companies are a good thing," she says. "At three in the morning when mom is alone and exhausted and doesn't have anyone around to help her, she will open it up and say 'well, the hospital gave it to me'."

But Jessica Valenti, author of the upcoming book Why Have Kids, worries that these initiatives will only further stigmatise mothers who can't - or don't wish - to nurse.

"I don't care about the gift bags," she says. "But if you're talking about keeping formula under lock and key, treating it as a medicine, making women explain why they want formula and giving them a lecture is so condescending.

"It comes from an assumption that women who don't want to breastfeed don't know better."

For their part, the formula companies say that women deserve to be presented with all their options. In a statement provided to the BBC, Mardi Mountford, executive vice president of the International Formula Council, said:

"Restricting access to samples and information from formula manufacturers is not the answer to increasing breastfeeding rates. A way to help mothers is to be supportive of the feeding choice they make for their infants regardless if they choose breastfeeding, formula feeding or a combination of both."

Breast is best, but by how much?

Baby drinks from bottle

Some women have questioned how much more beneficial breastfeeding is than formula feeding. In her 2009 Atlantic article "The Case Against Breastfeeding" Hanna Rosin found that "the medical literature looks nothing like the popular literature. It shows that breast-feeding is probably, maybe, a little better ... A couple of studies will show fewer allergies, and then the next one will turn up no difference. Same with mother-infant bonding, IQ, leukaemia, cholesterol, diabetes. Even where consensus is mounting, the meta studies—reviews of existing studies—consistently complain about biases, missing evidence, and other major flaws in study design."

In researching her upcoming book, Madeleine Morris found that it's difficult to prove causation in breastfeeding studies. "What you can't account for is that a woman has chose to breastfeed for a reason, and that reason is she's more concerned about health outcomes," she says. "She might have better health practices elsewhere in her life. She might wash her hands more, she may talk to her baby more." Those factors are difficult to control for in scientific studies, and may contribute to the beneficial findings.

Though breastfeeding activists are quick to assert that no woman should be made to feel ashamed of their choices, mothers who have turned to formula feeding report feeling judged and criticised.

Valenti always planned to breastfeed, but her daughter was born prematurely and she wasn't able to produce enough milk. After struggling to make breast feeding work, she switched to formula feeding - and instantly felt more bonded to her baby. However, she said stigma endured. "I had people tell me I should have never had children," she said. Other women stopped her in public to lecture about the virtues of breast milk.

The persistent messages that breast milk is better has lead to a counter-narrative: that formula is poison. And when breastfeeding is unilaterally presented as far preferable to formula, it's easy to feel like a failure for not providing what's best for your baby.

"There's a dichotomy of 'good mothers breast feed, bad mothers formula feed'," says journalist Madeleine Morris, who is writing a book about the topic.

In fact, she says, in the UK many mothers utilise formula. Her research shows that only about a third of women in the UK breastfeed exclusively, while half use formula at least some of the time. In the US, she says, the numbers are slightly higher - but still point to a culture of women who turn to formula while at the same time believing it's substandard parenting.

"Because breast feeding is pushed so hard, even though most women formula feed, there is a taboo, a social stigma attached with it, and women self-judge and judge other women."

In the end, she says, a well-fed baby is more important than where that food comes from. "If you feed formula to your child, and a healthy loving home, and your baby was full term and healthy weight, then there are going to be minimal differences in the outcome of child," she says.

But Anne Merewood, director of the breastfeeding centre at Boston Medical Center, says that women deserve to be given every opportunity to breastfeed if they want to, and hospitals should be proactive in helping women get started.

"There are infinite things that need to be done, but many of us in the field would be happy if the hospitals would educate staff well and educate women well. So many hospitals don't even do that.

"It's a patient's right to have a supportive environment."

This article has been updated to clarify details of the Latch On program.


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  • rate this

    Comment number 23.

    When my daughter was born I wasn't producing milk, so I couldn't breastfeed! When my finally came in I had a very bad infection and had been hospitalized while my Mum took care of my daughter. You can "breast is best" all you like the fact is not everyone CAN!!! I think people should try, but some times things make it not possible. I was made to feel like I failed! My child is healthy and bright.

  • rate this

    Comment number 22.

    The mother should decide after being given what are currently the facts, Experts have a track record of getting so many things wrong.

  • rate this

    Comment number 21.

    And if a mother cant produce milk? It does happen you know.

    My wife had post-natal complications and was too weak to breastfeed our first baby; now onto the second who is and they are both strong and intelligent children.

    Besides all that - Mayor Bloomber this is None. Of. Your. Business. you hectoring vile excuse for a human being.

  • Comment number 20.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 19.

    Why do we need to know what is being done in New York? Why are not the "free" people of America, always so vociferous in their defence of "freedom", not challenging this anyway? Why is it anyone's business in the UK - or are our own bunch of silly copycat nannies (aka MPs) thinking of apeing the Yanks yet again, with the usual disastrous results?

  • rate this

    Comment number 18.

    I distinctly remember watching helplessly and nervously as my wife and first child "figured it out" for seemingly an eternity (I was conviced he would starve). We were glad for the nurses who helped make that first experience a success (paved the way for three more). However....this was a decision that my wife (not the state) made long before the delivery room. It needs to remain that way.

  • rate this

    Comment number 17.

    The city woman generally speaking cares more for her breast than the infant while the traditional rural one likes to breast-feed her infant and this is healthy for both.

  • rate this

    Comment number 16.

    My nephew is 6 months old and was only breast fed for 3 weeks due to my sister's ill health and the constant demands he made on her. She ended with bi-lateral mastitis so Charlie was unable to feed anyway! She was stigmatised for it, but when the alternative was for her to make herself so ill that she couldn't look after him, what was she to do?

  • rate this

    Comment number 15.

    "...the debate grows over whether the push for breastfeeding helps or hurts women. What do you think?..."


    I'm quite sure, that no woman considering whether to breastfeed her newborn, cares the least what I think, and absolutely right too.

  • rate this

    Comment number 14.

    Breast is best. How quickly we forget the formula scandal of the 60s and 70s which literally killed babies in the third world. Yes formula can be a wonderful alternative for those who have problems breast feeding.But where is the support for parents in which ever way they need to, in western society? How much paid maternity leave? What support and training is offered to pregnant and new mothers

  • rate this

    Comment number 13.

    I do sympathise with all those mothers who encountered difficulties with breastfeeding or lacked support (breastfeeding is a learned art and most mother and baby pairs need help to get going). Nevertheless, the truth is that this whole debate is not so much about women and babies as multinationals and profits.

  • rate this

    Comment number 12.

    It's got to be better that Mum's make a choice between breast feeding and formula and not just use formula because it is there and it is free.
    If a Mum makes an effort to breast feed but it does not work out she has done the best for her child.

  • rate this

    Comment number 11.

    my wife was very fortunate and was able to feed all our children naturally , i understand fully that this is not the case for many mothers who would desperately like to breast feed and cant for medical or other reasons, therefore they use formula, they should not be alienated for this support needs to be given across the board belittlement is a terrible thing when people have tried their best

  • rate this

    Comment number 10.

    I am livid about this.
    Yes we know its good, natural and can bring mother and child closer.
    My wife was put through the ringer when she couldn't produce enough milk for my son. She felt as if she failed, all because of do gooders ramming breast is best down everyone’s throats.
    With formula it helps the fathers bond with the child to; we get a chance to help.

  • rate this

    Comment number 9.

    I agree with the banning companies pushing formula in hospitals. But the difference between bottle and formula feeding should be made. My wife made the choice of breastfeeding our boys, but it was never made clear by health visitors that we should also try to bottle feed breast milk from an early age. As a result our eldest had real trouble weaning from the breast.

  • rate this

    Comment number 8.

    Funny, when my mother was having kids in the late 40's early 50's all the pressure was to bottle feed (she was a bit of a rebel, thought maybe God designed us well). Breastfeeding was considered unhygienic and less nutritious. Now it's all the other way. Only the mother can make this decision. No single answer is right for all.

  • rate this

    Comment number 7.

    I'd also like to ask the same question as ProudAmerican (2) why doesn't the BBC allow us to comment on more news items. It sometimes seems as though there's a lot of selectivity involved and opinions on certain subjects are not wanted - it's a form of censorship.

  • rate this

    Comment number 6.

    Just remember that it is not always a matter of maternal choice.

    When I had a baby I had every intention of breast-feeding her, but my breasts had other ideas, producing a grand total of 25ml of milk! Being premature she did not suck initially and had to be tube-fed, and trying to express milk proved a failure. She got that 25ml, but it had to be formula after that.

  • rate this

    Comment number 5.

    Providing there are no compelling medical reasons favouring one method over another surely it should be the mother's decision. Honestly some people would turn us into unthinking zombies in order to push their agenda.

  • rate this

    Comment number 4.

    It is well-known that there are considerable health benefits for mother and infant. The flip side is the constant demands made on the mother. So, the mother should be allowed to decide and receive support/advice, e.g. it may take a few days until she can nurse.

    The hue and cry over "exposed breasts" in public or "negligent mothers" that don't breastfeed are unhelpful.


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