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.


More on This Story

In today's Magazine


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 43.

    Breastfeeding = natural, but does not = naturally. Consistent support needed to enable mothers to breastfeed and equally for those who cannot is needed. I was lucky & overcame poor latch, thrush, tongue tie., friends without support did not. No issue with formula as a sometimes lifesaving alternative, but regrets when women find out too late how problems could have been overcome is very sad.

  • rate this

    Comment number 42.

    Present mothers with the facts about breast vs bottle and let them make their own decisions. Limiting formula suggests that new mums cannot be trusted. Seems wierd to me that formula is being demonized yet alcohol/cigarettes are still widely available. People are given the facts the health implications of drinking and smoking, yet they are still allowed to choose what path they take.

  • rate this

    Comment number 41.

    My partner breastfed our daughter, it was obviously difficult for her especially for the first 2 weeks, I was so proud of her, most of the people who say they had no milk just didn't try enough. Such a shame as there are lots of studies to show how good it is, not sure why you wouldn't want your child to have the best possible start in life.

  • rate this

    Comment number 40.

    Breastfeeding should be encouraged because as with the conception of the child natures way is by far the best way.

  • rate this

    Comment number 39.

    What is more important than the health and well being of a mother and child Confuciousfred?

    I have seen the breast vs formula argument from both sides, both as a mother who had difficulties feeding, a friend to someone with a premature baby who had to have formula and as a breastfeeding peer supporter.

  • rate this

    Comment number 38.

    It took my daughter and I 10 days to get the hang of breastfeeding. Being a new mother is stressful enough without adding the problem of your baby not latching on, and the pressure from nursing staff to keep trying. It it is important that midwives encourage women to breastfeed but being pushy about it is not the answer.

  • rate this

    Comment number 37.

    We also have to consider that in the past babies were not only breastfed, but were carried everywhere close to the mothers body, and slept next to their mother. We were attached, felt safe, and felt loved. This is more important than breastmilk vs formula. However, breastmilk usually goes hand in hand with closeness to the mother. In a world so detached and unloving, I think this is what we need.

  • rate this

    Comment number 36.

    There is a strange religion around breast-feeding. During pre-natal classes they went on about. Once we had babies complete strangers would ask is if we were breast-feeding like it was their business! The most interesting part of his article is the bit to the right stating that medical literature and popular literature do not line up. Show me properly controlled clinical trials. Otherwise shut up

  • rate this

    Comment number 35.

    Being a young mother, there is a lot of confusion out there with breastfeeding. It took several days for my milk to come in, and no one told me that - and that it was painful to feed the baby before it properly came in. I also breastfed my child he has suffered with asthma since 6 months old. I'm still pro-breastfeeding as I believe it helps you be closer to your child, but formula isn't evil.

  • rate this

    Comment number 34.

    24.Random16 "Hasn't Bloomberg got anything better to do?"
    Sadly not; he's utterly typical of the oh-so-tolerant, 'progressive' healthists and their insistence that that everyone live exactly as they say or face stigma and disapproval. When a certain approach is pushed with such moralistic venom it's inevitable that those who can't or don't want to comply end up being judged as inferior people.

  • rate this

    Comment number 33.

    Mothers should have the legal right to breast feed in public and remove the stigma / embarrassment some women feel. It can be done very discreetly with loose fitting clothes and maybe more women would choose to breastfeed if people weren't 'gorping' at them when they do. This is then about choice - some will choose to breastfeed and others wont. Why is it any of my business either way?

  • rate this

    Comment number 32.

    This is nothing new, 25 years ago when my daughter was born I was pushed to breast feed with disastrous effects despite lots of help from hospital staff. What you eat good or bad is what your child eats. With breast milk you have to give your baby liquid vitamins to make up for the lack of nutrients. And the idea that a single mother would find formula feeding to be easier at 3:00am is ridiculous!

  • Comment number 31.

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

  • rate this

    Comment number 30.

    Funny how lots of women protest that they really, really tried to breast feed but physically couldn't. The incidence of non-lactation among animals is infintessimal - it's only when given the choice that people give up. Why? It hurts. Western women (and men) are just soft nowadays. Why are we afraid to give 'judgement' when it is undeniably, empircally and emphatically better to breast feed?

  • rate this

    Comment number 29.

    If your really concerned about your child's health ban them from eating burgers and fizzy drinks.

  • rate this

    Comment number 28.

    Society needs to decide whether it wants mothers to return to work a few weeks after giving birth, or to stay at home to raise their children. This is much more important than whether babies suckle the breast or the bottle.

  • rate this

    Comment number 27.

    Breast feeding, I'm in favour. Now how about HYS discussing something more important, like the end of democracy in the UK.

  • rate this

    Comment number 26.

    Several factors affect one's choice. A mother who could not produce enough milk would not watch her baby starve while waiting for breast milk. A combiunation of the two is good and with more enlightenment on the benefits of breast milk, the woman would put her baby to breast as often as possible; not for feeding alone but the satisfaction that both mother and child derive from the act.

  • rate this

    Comment number 25.

    I think its a great idea. Formula should really only be used when absolutely necessary

  • rate this

    Comment number 24.

    Hasn't Bloomberg got anything better to do?


Page 7 of 9



Try our new site and tell us what you think. Learn more
Take me there

Copyright © 2015 BBC. The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.