It’s Not as Simple as Telling Women to “Just Breastfeed”
In February, Abbott Laboratories, makers of Similac, closed its plant in Michigan after four babies became ill from bacterial infections after drinking their formula. Despite claims that there was no link between its formula and the infections, Abbott initiated a voluntary, nationwide recall. When combined with the existing supply chain problems, bureaucracy, the U.S.’s systemic lack of support for infant and child care, and the fact that the baby formula industry is an oligopoly controlled by just three companies, the result of the recall has been a nationwide shortage. As much as 43% of formula is out of stock at stores around the country.
In the face of this national baby formula crisis, President Biden announced a plan to address the shortage, including the invocation of the Defense Production Act. Over the weekend, the U.S. military airlifted a shipment of baby formula from Europe. According to Agriculture Secretary Tom Vilsack who greeted the delivery, the 78,000 of pounds of formula delivered is enough to feed 9,000 babies and 18,000 toddlers for one week. But what are the rest of the 75% of American babies and toddlers who receive at least some formula, according to the latest CDC Breastfeeding Report Card, to do? “Try breastfeeding,” many — including celebrity Bette Middler — have said.
If only it were that simple.
Most of us, mothers or not, have heard the saying “breast is best.” That comes largely from the group of seven housewives in a Chicago suburb who, in 1956, founded what would later become La Leche League. La Leche pooled their collective knowledge into a book called The Womanly Art of Breastfeeding, which became one of the first breastfeeding guides for mothers. La Leche went on to found the International Board of Lactation Consultant Examiners and train lactation consultants to provide hands-on support to moms. In 1990, the American Academy of Pediatrics also stepped in, producing a statement opposing formula advertising. The WHO and UNICEF created the Baby Friendly Program in 2017 to promote breastfeeding in hospitals. The CDC developed programs to further support the Baby Friendly Program. But this still hasn’t changed America’s long-standing demand for baby formula.
Babies have been getting milk from sources other than their mother for as far back as 2000 BC. Babies who couldn’t get breastmilk were fed milk from animals ranging from the traditional (cows, goats, and sheep) to the unexpected (horses, pigs, and donkeys). Until the rubber nipple was invented by Elijah Pratt in 1845, babies were fed via spoons, a cow’s horn with a chamois faux “nipple,” or even directly from the source if there was no other way to contain or deliver milk.
Wet nurses were also popular in colonial America into the early 20th century. Wet nurses were mothers, usually from a poor social class, who either had an abundance of milk from a recent pregnancy or lost child and, in some cases, were forced to abandon feeding their own children, with terrible consequences.
Before food preservation was developed in the early 1800s, there was no way to store milk. Once the technique of sterilizing and canning was invented in 1810, the invention of evaporated milk followed in 1835. Around the same time, scientists began studying the composition of human milk. A German scientist, Johann Franz Simon, published the first chemical analysis comparing human and cow’s milk in 1838. He found that cow’s milk had lower carbohydrate and higher protein content than human milk, making cow’s milk less digestible. Doctors began recommending additives — sugar, water, and cream — for cow’s milk to make it more human-like. Vitamin supplements, including cod liver oil and orange juice, were later added when babies started developing scurvy and rickets.
By 1865, Justus von Leibig, a German chemist, invented and patented the first commercially available infant formula in the U.S. Leibig’s Soluble Infant Food was a powder made from wheat flour, malt flour, cow’s milk, and potassium bicarbonate that was added to cow’s milk and fed as a liquid. By 1897, there were eight commercial brands of formula. Alfred Bosworth invented Similac (which stands for “similar to lactation”) in the 1920s. Until the early 1900s, although formula and its derivatives were readily available, the majority of babies in the U.S. were breastfed.
Doctors initially had strong negative opinions about commercial formula. During the 1950s, formula manufacturers shifted gears and began advertising directly to doctors. When the American Medical Association stepped in to regulate commercially available formula, manufacturers were forced to seek its “Seal of Acceptance.” During the 1960s, doctors increasingly became more formula-friendly, helping commercial formula grow in popularity. Commercial formula was fed to newborns in hospitals, presented to mothers as an easier alternative to breastfeeding. By the mid-1970s, commercial formula replaced evaporated milk as the new standard.
Along the same timeline, women’s roles in the U.S. were changing. The 1920s brought about women’s suffrage. During World War II, American women join the workforce, leading to a steep decline in breastfeeding rates. When the war was over, they didn’t go back to breastfeeding. By 1975, 75% of babies were fed exclusively with commercially made formula. Today, baby formula is a $55 billion industry.
Our dependence on baby formula is complex. While it’s easy to point fingers and place blame, there are many factors in play. But there is one part of the story that is rarely addressed. For many women, breastfeeding can be extremely difficult, incredibly painful, and sometimes impossible. I’m not talking about the obvious challenges of having the time and resources to do it. (Breastmilk may be free, but breastfeeding gear is not. Furthermore, many work situations, such as hourly jobs, make nursing or pumping impossible. And even when breastfeeding happens easily, it still takes a lot of time and effort.) I’m talking about the fact that there are very real anatomical reasons that prevent breastfeeding from being an option, no matter how hard moms and babies try or how much support they get.
Although we are led to believe that every woman can breastfeed if she wants to, that is simply not true. Breastfeeding takes two people and has a lot of moving parts. In the mother, there are breast tissue and anatomy, nipple shape, milk production variability, and hormones. In the baby, there are anatomical configurations that affect gape, suck, and swallow reflexes and mechanics. Mother and baby must work independently and as a unit. Adding to the complexity, the dynamics of breastfeeding change over time, from the first latch through weaning. So what may have worked at first may no longer work successfully just a few weeks down the line.
The U.S. has one of the lowest breastfeeding initiation rates in industrialized countries. In 2017, the CDC found that even though 84% of mothers initiated breastfeeding, only 47% were exclusively breastfeeding at 3 months and 26% did so at 6 months. These rates aren’t simply because mothers won’t breastfeed. It’s because many of them can’t without some kind of intervention. And yet when women can’t breastfeed, they are quietly blamed for the failure. What’s more, the negative impact of trying and failing is entirely ignored. Failed breastfeeding can increase a mom’s chance of developing postpartum depression and make it harder for her to bond with her baby.
We are fortunate to live in a time when there are so many options for feeding our babies. No one can argue that baby formula is necessary. While breastfeeding is ideal, it isn’t always possible — for a whole host of reasons. But if we want to curb our dependence on baby formula, mothers need more than encouragement, convincing, and shaming. Breastfeeding mothers deserve financial support, time, and real medical guidance.