Human mothers have been breastfeeding their babies for nearly half a million years. It’s only in the last 60 years that we have begun using baby formulas as a substitute for breast milk.
Prior to this, for centuries, when a woman could not breastfeed her baby herself, another lactating woman, or ‘wet nurse’, took over the job.
Although wet nurses are now uncommon in western cultures, premature babies or babies who are born very ill have access to donor breast milk from a human milk banking association (in certain areas). There has been a rise in awareness of informal donor breast milk sharing communities, with social media making them more easily accessible.
Unfortunately, there is a stigma attached to informal milk sharing communities. This is due to a bottle feeding culture, which not only encourages formula feeding from birth, but also makes mothers believe that breast milk substitutes are as good as, if not better than, the real thing.
The marketing of infant formula
The unethical marketing of baby formula has greatly contributed to the belief that artificial milk is superior to breast milk.
Although there are now stricter advertising limitations, for years infant formula manufacturers were able influence health professionals through their marketing tactics. As the subject of human nutrition became more ‘scientific’ among health professionals in general, breast milk substitutes were marketed as a technological improvement on breast milk.
Manufacturers also ply their influence through contact with health professionals, to whom they provide free samples for research and ‘educational purposes’ and who act as middlemen. Free gifts, educational trips to exotic locations and funding for research are just some of the ways in which the medical profession becomes ‘educated’ about the benefits of formula.
Baby formula manufacturers spend countless millions devising marketing strategies to keep their products at the forefront of public consciousness. In the UK, formula companies spend at least £12 million per year on booklets, leaflets and other promotions, often in the guise of ‘educational materials’. This works out at approximately £20 per baby born. In contrast, the UK government spends about 14 pence per newborn each year to promote breastfeeding.
It’s a pattern of inequity that is repeated throughout the world – and not just in the arena of infant-feeding. The food industry’s global advertising budget is $40 billion – a figure greater than the gross domestic product (GDP) of 70% of the world’s nations. For every $1 spent by the World Health Organization (WHO) on preventing the diseases caused by Western diets, more than $500 is spent by the food industry to promote such diets.
Since they can no longer advertise infant formulas directly to women (for instance, in mother and baby magazines or through direct leafleting) or hand out free samples in hospitals or clinics, manufacturers have started to exploit other outlets, such as mother and baby clubs, and Internet sites that purport to help busy mothers get all the information they need about infant feeding. Manufacturers are allowed to advertise follow-on milks, suitable for babies over six months, to parents. Sometimes, though,these ads feature a picture of a much younger baby, implying the product’s suitability for infants.
The impact of these types of promotion should not be underestimated. A 2005 NCT/UNICEF study in the UK determined that one third of British mothers who admitted to seeing formula advertisements in the previous six months believed that infant formula was as good or better than breast milk. This revelation is all the more surprising since advertising of infant formula to mothers has been banned for many years in several countries, including the UK.
The regulation of infant formula marketing
When it became clear that declining breastfeeding rates were affecting infant health and that the advertising of infant formula had a direct effect on a woman’s decision not to breastfeed, the International Code of Marketing of Breast-Milk Substitutes was drafted and eventually adopted by the World Health Assembly (WHA) in 1981. The vote was near-unanimous, with 118 member nations voting in favor, three abstaining and one – the US – voting against. In 1994, after years of opposition, the US eventually joined every other developed nation in the world as a signatory to the Code.
The Code is a unique instrument that promotes safe and adequate nutrition for infants on a global scale by trying to protect breastfeeding and ensuring the appropriate marketing of breast milk substitutes. It applies to all products marketed as partial or total replacements for breast milk, including infant formula, follow-on formula, special formulas, cereals, juices, vegetable mixes and baby teas, and also applies to feeding bottles and teats. In addition, it maintains that no infant food may be marketed in ways that undermine breastfeeding.
Specifically, the Code:
- Bans all advertising or promotion of these products to the general public
- Bans samples and gifts to mothers and health workers
- Requires information materials to advocate for breastfeeding and to warn against bottle feeding; materials must not contain pictures of babies, or text that idealises the use of breast milk substitutes
- Bans the use of the healthcare system to promote breast milk substitutes
- Bans free or low-cost supplies of breast milk substitutes
- Allows health professionals to receive samples, but only for research purposes
- Demands that product information be factual and scientific
- Bans sales incentives for breast milk substitutes and direct contact with mothers
- Requires that labels inform fully on the correct use of infant formula and the risks of misuse
- Requires labels not to discourage breastfeeding.
Problems with baby formula
Most baby formula products are derived from cow’s milk. Before a baby can drink cow’s milk in the form of infant formula, the milk needs to be severely modified. The protein and mineral content in cow’s milk formula must be reduced and the carbohydrate content increased, usually by adding sugar. Milk fat, which is not easily absorbed by the human body (particularly one with an immature digestive system) is removed and substituted with vegetable, animal or mineral fats.
Vitamins and trace elements are added, but not always in their most easily digestible form. This means the claims that formula is ‘nutritionally complete’ are true, but only in the sense that the full complement of vitamins and minerals have been added to a nutritionally inferior product. This applies to regular formula and specialty formulas.
Many formulas are also highly sweetened. Although most infant formulas do not contain sugar in the form of sucrose, they can contain high levels of other types of sugar, such as lactose (milk sugar), fructose (fruit sugar), glucose (also known as dextrose – a simple sugar found in plants) and maltodextrose (malt sugar).
Does infant formula put a baby’s health at risk?
For years, it was believed that the risk of illness and death from bottle feeding was largely confined to children in developing countries. In countries where there is no access to clean drinking water, babies have fallen ill and died as a result of drinking baby formula made with contaminated water.
In poverty stricken countries, mothers have over diluted formula preparations to make it stretch further, resulting in severe malnutrition in their babies.
Baby formula shortage
In more recent history, infant formula shortages in the US led to some parents turning to online recipes for homemade infant formula. Homemade baby formula, however, is not a safe solution to a baby formula shortage. There are significant safety concerns about nutritional imbalances resulting from homemade formulas.
Formula might also contain unintentional contaminants introduced during the manufacturing process. In the US, in 2022, a popular infant formula was recalled by the food and drug administration after 4 babies were infected with cronobacter, a bacteria deadly to infants.
In developed countries, there are also risks associated with not breastfeeding. Formula fed babies have an overall increased risk of morbidity and mortality compared with breastfed babies, as well as an increased risk of other serious health problems.
Some of these are:
- An increased risk of SIDS
- An increased risk of gastroenteritis
- An increased risk of ear infections
- An increased risk of developing childhood cancers
- An increased risk of developing type I and type II diabetes
Which infant formula is closest to breast milk?
If somebody were to ask which is the best infant formula, or which infant formula is most like breast milk, the answer would be ‘nobody knows’. Formula makers use marketing tactics to advertise their brand of infant formula as superior, giving parents who are trying to decide what is best for their baby a seemingly endless variety of formulations.
Although we might assume that the manufacture of infant formula is heavily regulated, no transparency is actually required of manufacturers. For example, they do not have to log the specific constituents of any batch or brand with any authority.
Breast milk is a ‘live’ food that contains living cells, hormones, active enzymes, antibodies and at least 400 other unique components. It is a dynamic substance, the composition of which changes from the beginning to the end of the feed and according to the age and needs of the baby. Because it also provides active immunity, every time a baby breastfeeds it also receives protection from disease.
Let’s look at the differences between the ingredients in breast milk and those in infant formula:
Breast milk – fats
- Rich in brain-building omega-3s – namely, DHA and AA
- Automatically adjusts to infant’s needs; levels decline as baby gets older
- Rich in cholesterol; nearly completely absorbed
- Contains the fat-digesting enzyme lipase.
Formula – fats
- No DHA
- Doesn’t adjust to infant’s needs
- No cholesterol
- Not completely absorbed
- No lipase.
Protein – breast milk
- Soft, easily digestible whey
- More completely absorbed; higher in the milk of mothers who deliver preterm
- Lactoferrin for intestinal health
- Lysozyme, an antimicrobial
- Rich in brain and body-building protein components
- Rich in growth factors
- Contains sleep-inducing proteins.
Protein – formula
- Harder-to-digest casein curds
- Not completely absorbed, so more waste, therefore harder on kidneys
- Little or no lactoferrin
- No lysozyme
- Deficient or low in some brain and body-building proteins
- Deficient in growth factors
- Contains fewer sleep-inducing proteins.
Carbohydrates – breast milk
- Rich in oligosaccharides, which promote intestinal health.
Carbohydrates – formula
- No lactose in some formulas
- Deficient in oligosaccharides.
Immune boosters – breast milk
- Millions of living white blood cells, in every feeding
- Rich in immunoglobulins.
Immune boosters – formula
- No live white blood cells or any other cells
- Has no immune benefit.
Vitamins & minerals – breast milk
- More easily absorbed
- Iron is 50-75% absorbed
- Contains more selenium (an antioxidant).
Vitamins & minerals – formula
- Less easily absorbed
- Iron is 5-10% absorbed
- Contains less selenium (an antioxidant).
Enzymes & hormones – breast milk
- Rich in digestive enzymes, such as lipase and amylase
- Rich in many hormones, such as thyroid, prolactin and oxytocin. Taste varies with mother’s diet, thus helping the child acclimatise to the cultural diet.
Enzymes & hormones – formula
- Processing kills digestive enzymes
- Processing kills hormones, which are not human to begin with
- Always tastes the same.
For further reading, you can refer to BellyBelly’s article What’s In Breast Milk and What’s In Formula?
Why aren’t women breastfeeding?
Before bottles became the norm, breastfeeding was an activity of daily living, based on mimicry and learning within the family and the community. Women became their own experts through the trial and error of the experience itself. Today, though, what should come more or less naturally has become extraordinarily complicated and is the focus of global marketing strategies and politics, lawmaking, lobbying support groups, activists and the interference of a well-intentioned, but occasionally ineffective, cult of experts.
Breastfeeding rates also began to decline as a consequence of women’s changed circumstances after World War I, as more women left their children behind to go into the workplace. This was a consequence of women’s emancipation and the loss of so many men in the ‘killing fields’. It happened to an even larger extent with the advent of World War II, when even more women entered into employment outside the home.
‘There was also the first wave of feminism’, says British midwife and academic, Mary Renfrew, ‘which stamped into everyone’s consciousness in the 60s, and encouraged women get away from their babies and start living their lives. So the one thing that might have helped – women supporting each other – actually created a situation where even the intellectual, engaged, consciously aware women who might have questioned this got lost for a while. As a consequence, we ended up with a widespread and declining confidence in breastfeeding, a declining understanding of its importance and a declining ability of health professionals to support it. And, of course, all this ran along the same timeline as the technological development of artificial milk and the free availability of formula’.
In more recent history, the global pandemic has contributed to the absence of community amongst women to talk to each other about pregnancy, birthing and mothering; this has resulted in women’s choices being more directly influenced by commercial advertising.
The breastfeeding drop-off rates are alarming: 90% of women who give up in the first six weeks say they would have liked to continue. It also seems likely that long-term exclusive breastfeeding rates could be improved if consistent support were available and if approval within the family and the wider community for breastfeeding, both at home and in public, were more obvious and widespread. Clearly, this important social support is missing.
The bigger picture of breastfeeding vs bottle feeding suggests there is, in addition, a confluence of complex factors – medical, socioeconomic, cultural and political – that regularly undermine women’s confidence. They also reinforce the notion that women feeding their children artificially is about lifestyle rather than health and that the modern woman’s body is simply not up to the task of producing enough milk for her offspring.
Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed. Without support, many women will give up when they encounter even small difficulties.
Even so, according to Mary Renfrew, ‘Giving up breastfeeding is not something that women do lightly. They don’t just stop breastfeeding and walk away from it. Many of them fight very hard to continue it and they fight with no support. These women are fighting society – a society that is not just bottle-friendly, but is deeply breastfeeding-unfriendly’.