Deciding how best to nourish your baby is one of the most fundamentally important choices a parent will make. While there are many factors to consider when determining whether to breast or formula feed your baby, the unfortunate truth is that there are political influences that will attempt to sway your decision, and they come from all directions.
Breastfeeding a baby has unmatched advantages, for both mother and child. For the mother, the act reduces post-childbirth uterine bleeding, lowers the risk of breast and ovarian cancer. Breastfed babies receive antibodies that wed off bacteria and viruses, are less likely to have asthma or allergies, and those who are exclusively breastfeed for six months show fewer incidents of ear infections, respiratory illnesses, and bouts of diarrhea. Still, mothers worldwide have experienced pushback in their efforts to normalize breastfeeding. Breastfeeding in public is legal in all 50 states, yet there are countless incidents of women being shamed for doing just that.
One mother in Tulsa found herself chastised for feeding her baby while in the Municipal Courts Building. At the protest that followed this incident, a demonstrator told a local newspaper, “I feel like we sexualize women to a point where we can't even use our bodies for what they're meant for.”
Though laws to protect breastfeeding mothers exist, they’re vague and generally favor the property owner. For example, while women have the right to breastfeed in public, there is debate on whether or not they are required to cover up while doing so. Additionally, though a woman cannot be arrested for breastfeeding in public, nineteen states still do not exempt breast-feeding from public indecency laws, and in some states, a mother can be arrested for trespassing if she refuses to leave a location if a business owner asks her to leave due to to her breastfeeding. These loopholes have yet to be addressed legislatively.
Maternity leave also has highly political undertones related to breastfeeding which could be contributing to the problem. To begin with, women are often encouraged to return to work quickly, before they have the opportunity to establish a breast-feeding routine. In fact, about 25 percent of women in the US return to work within 10 days of having a baby. Once they are back at work, pumping milk for their baby comes with its own set of obstacles.
Despite the Affordable Care Act of 2010 requiring American companies with more than 50 employees to provide a private place for women to pump every few hours, women returning to work often find that ‘requiring’ the space is a far cry from encouraging the practice.
“It's already challenging enough to be pregnant or a new mother in the workforce,” explains one woman who found herself forced to pump in a dark, unlocked closet. “You don't want to be taking more time and—I don't know, compromising your work ethic. So, you just make do.” Perhaps what’s worse is that there are no penalties for non-enforcement of this federal law. Therefore, there is no effective protection for women who pump at work.
“I wasn’t breastfed myself but I did believe it would be best for my baby so with my first, Belle, I wanted to just try it. I was ready to give it my all but I was also prepared for the struggle. And a struggle it was. I started losing all of my energy and wasn’t able to enjoy my little baby girl anymore, so I decided to stop. Because I wanted her to receive my mothermilk, I became a full time pumping mom. I was really proud of myself for trying my best and even proud for making the call to stop, but I always felt a little pain, especially when I saw other moms breastfeeding their babies. That special bond, that beautiful and magical bond between a mother and a baby, physical as well as mental. I wanted that. I longed for that. So I knew that if there would ever come a second baby, I would try even harder. I knew it would be different because this time I would know what to expect, I would be more calm and more comfortable. And there she was. And there I was, the calm and powerful mom. Without all the questions and insecurities of the first time. I wasn’t planning on giving up this time, and I haven’t yet.” - breastfeeding mom Lois Kruidenier
Mothers who choose to formula feed aren’t much better off, and often find themselves the target of defamation and politicalization as well. A 2016 study showed that mothers who supplement with formula were made to feel “guilty, stigmatized, defensive, and dissatisfied over their decision.”
Formula feeding is a controversial issue, at least partly because of the mixed messages our social hierarchy sends. Though the US began an official Breast is Best campaign in the 1990s, the current administration has openly sought to discourage breastfeeding practices.
Despite this less than subtle nod towards the use of formula, significant barriers remain to mothers who choose to formula feed. The cost of the formula itself is often prohibitive, and no federal law requires medical insurance to cover this product, even in cases where specialty formulas (such as for reflux or digestive issues) are deemed medically necessary. A basic formula for the first year of life is estimated to cost about $1500. The equipment required for formula is no less expensive, and increases every year as manufacturers create new formula mixers, sterilizers, bottle warmers, etc., hawking them to exhausted parents with the promise of convenience and ease. Some women feel pressured to formula feed in order to return to their jobs, and consequently find themselves obliged to bear the financial burden that comes with formula feeding. And cost does weigh heavily into this decision; a 2013 study revealed that mothers with more income and education were less likely to formula feed, primarily because it is those mothers who have the access to the expensive infrastructure that supports breastfeeding: “longer maternity leaves, jobs that allow for pumping breaks, the ability to hire outside help to support a new mother, and—perhaps most importantly—immersion in a culture that unconsciously views breastfeeding as a desirable status symbol.” Mothers that cannot afford this kind of advocacy find themselves forced to assume the substantial costs of formula feeding as well as the stigma of being a working-class mom.
So who is responsible?
It’s important to look at both the administrations, future and past, and the formula industry as a whole to get a better understanding of why food, especially for babies, has become so polarizing.
What was expected to be an uncontroversial measure put forth by the World Health Organization in 2018 encouraging mothers to breastfeed their babies quickly devolved when the United States delegation championed the interests of infant formula companies by insisting that the resolution remove specific language that asked governments to “protect, promote and support breast-feeding” as well as other passages that looked to restrict promotions of food products that might negatively affect younger children. When that tactic failed, American delegates were quick to threaten the first country with plans to move forward on this initiative, Ecuador, with “punishing trade measures and the the withdraw[al] of crucial military aid.”According to Lucy Sullivan, the director of 1,000 Days, an advocacy group that works on nutrition for mothers and children, “What this battle in Geneva showed us is that we have a U.S. government that is strongly aligned with the interests of the infant-formula industry and dairy industry, and are willing to play hardball.”
While the Trump Administration has made no secret of its interest in lobbying for infant formula manufacturers, the truth is that the United States has a history of siding with business at the expense of breast-feeding advocacy.
- In 1981, the WHO voted 118 to 1 to adopt a non-binding code that advocated for ending public infant formula promotion. The US was the one holdout, ostensibly, as explained by Elliott Abrams, then the Assistant Secretary of State for International Organization Affairs, because the restrictions on formula advertisements “run counter to our constitutional guarantees of free speech and freedom of information.”
- In 2004, the US Department of Health and Human Services attempted to promote breastfeeding through a series of advertisements that featured the medical paraphernalia they claimed non-breast fed babies are more likely to need - syringes and inhalers, specifically - but lobbyists from the infant formula industry persuaded the department to tone down the ads with pictures of flowers and ice cream. Unsurprisingly, this campaign did not improve breastfeeding rates.
- In 2006, Massachusetts banned gift bags filled with infant formula from being passed out in maternity wards, but then governor Mitt Romney reversed that decision and the following month Bristol Myers Squibb, a formula manufacturer, announced the building of a new plant in Massachusetts. Their official position is that the two incidents are not related.
But similarly to the maternity policies for employers, having the legislation in place is a far outcry from actually enforcing it in an industry known for blatant lobbying. “A new report by WHO, UNICEF, and the International Baby Food Action Network (IBFAN) reveals that despite efforts to stop the harmful promotion of breastmilk substitutes, countries are still falling short in protecting parents from misleading information.”
- Only 31 countries have legal measures preventing the harmful marketing of breast milk products targeted for use up to at least 36 months of age.
- While most countries prohibit the use of pictures on labels that may idealize the use of infant formula, far fewer prohibit the inclusion of nutrition and health claims on labels.
- Many countries have prohibitions on advertising or the use of promotional devices at points of sale, but only a few prohibit the distribution of information or educational materials from manufacturers or distributors.
- Many manufacturers and distributors of baby food products offer financial support for international or national scientific meetings and meetings of health professional associations, despite the clear conflict of interest this presents.
- To date, only 19 countries prohibit the sponsorship of scientific and health professional association meetings by manufacturers and distributors.
Aside from the legislation prohibiting formula marketing for the conglomerates, the breastfeeding policies actually pose a significant barrier to trade. In its continuing support of the formula industry, the Trump administration via the United States Trade Office has released a list of “significant trade barriers” it would like to see eliminated. What these suggestions reveal is that this administration is invested in campaigning for the infant formula manufacturers the world over.
- Hong Kong draft code designed to “protect breastfeeding and contribute to the provision of safe and adequate nutrition for infants and young children.” This, according to USTR, could reduce sales of food products for infants and young children.
- Indonesia: USTR wants to get rid of a draft regulation to ban advertising or promotion of milk products for children up to two years of age.
- Malaysia: USTR doesn’t like its code restricting corporate marketing practices aimed at toddlers and young children.
- Thailand: USTR wants to eliminate penalties for corporations that violate laws restricting the promotional, and marketing activities for modified milk for infants, follow-up formula for infants and young children, and supplemental foods for infants.
Though profoundly unethical, the government's response to these laws make sense when you look at the market size and their potential for economic profit. Infant formula is expected to reach a $103 billion worldwide market size by 2026. When we look at why it is growing and who owns the industry, we see that marketing is the number one driver. Marketing is expected to come from both the corporation's manufacturing and selling infant formula, as well as the people parent’s often trust most - their doctors.
Health professionals are often targeted and influenced by manufacturers and distributors of breast-milk substitutes through promotion, relationships and incentives, which can result in the loss of their independence, integrity and public credibility leading to additional legislation being put in place to stop the spread of misinformation and industry profit.
There are now 136 countries with legal measures in place but less than half have prohibitions on the donation of free or low-cost supplies of products, donation of product samples, or product information other than what is scientific and factual, and only five countries completely prohibit the donation of equipment or services by manufacturers or distributors. The United States currently has no federal laws that require hospitals or health officials to follow The Code’s directives, and it’s extremely common for new mothers to be sent home with a healthy supply of formula products. Unsurprisingly, the two brands most likely to be the suppliers of these samples are Enfamil and Similac; these two corporate behemoths are also the two companies that most forcefully promote their products via government subsidy, as we will discuss in just a bit.
The aggressive marketing tactics go beyond just politicians and doctors, reaching our public, and influencing their decision making at home. For decades, infant formula manufacturers have been accused of aggressive marketing campaigns in developing countries to discourage breastfeeding and instead, to push new mothers into purchasing formula.
The famous boycott of Nestlé in the 1970s led to the development and adoption by nations worldwide of the UNICEF/World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes (The Code) in 1981. The Code sets guidelines and restrictions on the marketing of breastmilk substitutes, and reaffirms governments’ sovereign rights to take the actions necessary to implement and monitor these guidelines.
The Code states:
- No promotion to the public
- No gifts to mothers or health workers
- No promotion in healthcare facilities or to healthcare workers
- No free samples or supplies to pregnant women or mothers of infants and young children, their families or health workers
- No promotion of complementary foods before they are needed
- No sponsorship of meetings of health professionals or scientific meetings by companies
- Adequate labels
- Companies must comply with the Code, independent of other measures taken for the implementation of the Code
“By March 2016, 135 out of 194 WHO Member States have had at least some parts of the Code in place in national legislation, but of these, only 39 countries have comprehensive legislation that reflects all or most provisions of the Code. Another 31 countries incorporate many but not all provisions of the Code in law, while 65 only have a few provisions enshrined in law. To this day, 49 countries have made no provision for the Code in their statute books.”
Women from lower income households are still being targeted by aggressive marketing campaigns that claim infant formula is more beneficial to their baby than breast milk. Nestle, Abbott, Mead Johnson, and Wyeth (now owned by Nestle) are accused of defying The Code and engaging in covert and often illegal advertising techniques, the effects of which can be seen worldwide.
- In Mexico, just 31% of infants are exclusively breastfed for the first six months, and half of mothers said their doctors had recommended formula.
- In Chile, 75% of doctors, nurses, and midwives reported visits to their hospitals by formula representatives.
- In the Philippines, only 34% of babies are breastfed for the first six months, even though the expense of formula both requires some mothers to lower the product’s concentration - resulting in malnutrition for the child - and also demands the mother go without food herself, to afford a product not every mother requires.
To promote and protect the practice of breastfeeding, many countries have implemented policies that restrict corporate marketing strategies targeting these mothers. The policies have led to increased breastfeeding in many countries even though greater progress is still needed, leading the WHO to provide further recommendations to improve breastfeeding rates in 2020.
- Legislators and policy-makers should recognize their obligations to promote and protect breastfeeding, and to eliminate inappropriate marketing practices.
- Countries should analyze and address weaknesses or gaps in their existing legislation and act accordingly.
- Legislation must be supported by allocation of adequate budgets and human resources.
- Governments should establish robust and sustainable monitoring and enforcement mechanisms.
- Governments should apply deterrent sanctions in the case of violations of national Code legislation.
- Health care workers should be educated on their responsibilities under the Code and national legislation to avoid conflicts of interest and fully protect, promote and support breastfeeding.
The Psychology Around Parent Shaming and Why Corporations Support It
Social media has never been more popular. Media outlets like Facebook, Instagram, Snapchat, and TikTok allow people to instantly publish small fragments of their life to the public at large, seemingly for the innocent purposes of entertainment and sharing our lives with friends and loved ones. The escalating popularity of these social media programs, however, has had a nasty side effect; the more we see of other people’s lives, the greater the temptation we feel to pass judgement on what we’re seeing. This has proven to be especially true for parents, who now find some of their most difficult or traumatic moments with their children recorded by complete strangers and then shared with a hypercritical community, eager to condemn. Clinical psychologist and author Dr. Shefali Tsabary explains this alarming trend:
“It comes from this good place but quickly becomes toxic, because in order to feel good about oneself, one should really just feel an inner deep sense of worth. Unfortunately, because we're lacking that, we can only feel good about ourselves when we prey on the well-being of others. When a situation like this arises ... [people react] because: 'Finally, there's really another parent out there who has done something, in my eyes, that is more clueless, more egregious than me! So let me jump on that wagon and allay and assuage all my incompetencies by projecting my insecurities on this parent, and for once I can claim to be better than — so I'm going to go for it.’ It really comes from a deep longing to be seen as good, to know that we are competent and worthy, because it's a deep longing that never gets checked or healed. It becomes toxic and it's rampant and it's a sickness of our society which needs to be checked.”
Corporations have been quick to harness the power of that toxic criticism and use it to shame parents into purchasing products they may not need in order to assuage their feelings of guilt or fear. This marketing tactic unethically taps into a parent’s vulnerabilities and creates insecurities that did not exist beforehand, and should not exist at all.
Ads don’t have to be overtly negative in order to channel the purchasing power of guilt, as writer and mother Rebecca Schuman observes about a recent Similac commercial.
"In the ad, sling-wielding yoginis, working moms, lactivists, lesbians, and even a few dads converge in a single park—and they’re about to throw down. Until, in their zeal, everyone loses sight of the very thing they want to protect—the babies!—and an unmanned stroller goes careening down a hill. Spoiler alert: The child lives and they all overcome their differences. (Similac™!)”
“By simultaneously absolving modern parents of shame and shaming them for shaming one another, Similac has jackhammered straight into today’s frantic parenting Zeitgeist. It turns out, however, that “The Mother ’Hood” is just the latest in a long history of American formula ads that recognize and then prey upon maternal insecurities.”
Advertisers were not always this congenial about weaponizing a parent’s feelings of inadequacy. A Nestle formula ad from 1915 morbidly capitalized on a parents fear that their baby would not live past infancy (a problem in that time period, for many reasons) by reminding them that “millions of babies have come to their teeth easily and naturally with the help of NESTLÉ’S FOOD.” A large number of infants in that era did not live to see their teeth come in; this ad engaged that fear and then eased it.
These kinds of ads became ubiquitous and between 1900 and 1950, breastfeeding rates dropped from 70% to 25%.
The 1950s were no less discouraging for breast-feeding mothers. “Most young mothers wonder whether or not they should nurse their babies,” explained one Carnation sponsored pamphlet passed out in maternity wards. “You do not have to nurse your child. Scientific evidence today indicates that children who have never been nursed are just as healthy, sometimes more healthy, both physically and emotionally, as children who are nursed. If you are reluctant to nurse your child, if it makes you feel tense or uncomfortable, do not attempt it.”
Recognizing industrys’ attempts to exploit you is your best defense against their manipulations. Knowledge is power.
Why Breastfeeding Isn’t Really Free
Though we’ve discussed the price of formula feeding being a factor for working moms and directly impacting lower income communities, it’s important to acknowledge that breastfeeding isn’t free, either. We’ve discussed this before in our Formula 101 blog post, but its importance bears repeating: whatever you put into your body while pregnant or breastfeeding will ultimately make its way into your baby. This includes not only obvious toxins such as alcohol and drugs - which most women know to avoid during periods of pregnancy and breast feeding - but also more insidious harmful substances such as the chemicals and pesticides found in conventional and fast foods. Marilee Nelson, co-founder of clean product line Branch Basics, urges breastfeeding and pregnant women to consider their diet an integral part of their baby’s health. “I would rather a mother feed her baby a solid healthy formula than breastfeed eating the standard American diet. The neurological damage done to our babies today because of our diet is criminal. It is a false security to say ‘I am breastfeeding’ if you are downloading all the pesticide and chemicals into your baby.”
Her concern is not without reason.
A 2014 study from the Organic Consumers Association revealed that American women’s breast milk contained shockingly high levels of glyphosate, the pervasive Monsanto-owned pesticide known more commonly as Roundup.
This news is especially unsettling because the levels detected, while 760 to 1600 times greater than what is currently allowed by the European Water Directive, is still less than the 700 ug/l maximum contaminant level (MCL) that the Environmental Protection Agency has deemed safe based on the hotly debated assumption that glyphosate is secreted easily by the human body and does not accumulate.
And this isn’t an exclusively American problem. A recent study found that over 80% of breast milk samples examined in Urucui, Brazil were found to contain agro-toxins. According Inacio Pereira Lima, a master's student in Women's Health at the Federal University of Piaui's (UFPI) Center of Health and Sciences, 83.4 percent of the breast milk samples were found to contain glyphosate or aminomethylphosphonic acid (AMPA) or both substances.
These kinds of results are not unfounded. Toxicity in breast milk has been acknowledged for decades.
“In 1951 DDT became the first environmental pollutant found in human milk. Since then, DDT and its metabolites have been reported in essentially all human milk tested worldwide. In recent years, additional chemicals have been detected in human milk, among them bisphenol A, polybrominated diphenyl ethers (PBDEs), hexachlorobenzene, and the cyclodiene pesticides, which include dieldrin, heptachlor, and chlordane. Residues of many banned POPs persist in women’s milk.”
To further complicate matters, Trump’s administration has made deregulating the Department of Agriculture a priority. Records show that the administrators in charge of this process not only have been meeting with lobbyists whose sole interest is in furthering the agenda of corporate agricultural companies, but also have professional ties themselves to the pesticide industry’s main trade group, CropLife America and its members.
This information can feel scary and overwhelming, but there are alternatives to accepting the burden of toxicity as collateral damage. A clean, organic diet will go a long way in keeping you and your baby healthy. If for any reason that isn’t possible, there are options available.
It’s Possible to Give Your Children Proper Nutrition Regardless of Circumstances
Regardless of the politics we face as parents, it’s important to know that it is possible to give your child proper nutrition, circumstances aside.
Lactation consultants: The United States Lactation Consultant Association and the International Lactation Consultant Association are both great resources for finding a lactation consultant and understanding the benefits these experts provide. Both associations are founded on the principle that children’s health is improved through breast feeding, and that consultants exist to provide support and education to those embarking on a breastfeeding journey. Lactation consultants can help with issues such as over or under milk production, latching, mastitis, and a host of other concerns breastfeeding moms might have. Even if you’ve had breastfeeding problems in the past, a certified lactation consultant may be able to rectify any complications you’ve experienced and help you feel comfortable and confident as a breast-feeding mother.
Breast Milk Banks: These institutions collect, process, test, and provide donor milk to parents without access to clean breast milk or to mothers simply waiting for their milk to come in. While most of these banks do charge either for the product or a processing fee, many of them offer financial aid programs that can help to offset the cost. Prescriptions might be required, but can be obtained from your doctor. These banks are an excellent way to provide your baby with the benefits of breast milk if your milk is unavailable. The Human Milk Banking Association of North America can help you find a local breast milk bank, should you find yourself in need. Your local LaLeche League can also point you in the right direction, and if you used a doula or midwife, they might be able to find a more casual mother-to-mother breasts milk exchange.
Formula covered by food stamps: The short answer is that yes, formula is covered by government subsidy programs, but admittedly the options aren’t great and the process that decides those options, too, is shrouded in industry influence and policy. There are two major programs that list to support formula feeding mothers.
- WIC - Women Infants and Children does allow for the purchase of formula, but you may be limited in the type of formula and the amount you purchase. Contact your community health department to find out which baby formulas are covered in your state. WIC benefits for formula do not extend beyond 12 months, so if you choose to supplement past that age, you will need to find another source of subsidization. It’s important to note that WIC depends on the government rebates offered by their infant formula suppliers, and consequently the brand of formula many mothers will have access to will not be decided by health factors, but by financial factors instead.
“Infant formula manufacturers provide substantial discounts, in the form of rebates, to state WIC programs in return for the exclusive right to provide their products to the state’s WIC participants. These rebates mean that WIC obtains infant formula at a large discount, generating $1.3 billion to $2 billion a year in savings that allows WIC to serve 2 million more participants each year with its federal funding. In the absence of the savings from competitive bidding, WIC either would need a substantially larger appropriation or would serve substantially fewer women, infants, and young children at nutritional risk.”
- SNAP - The Supplemental Assistance Nutrition Program has no limits on the type of formula you purchase or the length of time for which you choose to supplement; the only limit that comes attached to SNAP is the amount of benefit you receive each month. Though SNAP will allow you to purchase as much formula as you want up to your benefits limit, combining the benefits with WIC is optimal, particularly if you would prefer an infant formula that WIC does not allow.
As parenthood and all it entails becomes more prevalent on the political playing field, it’s important to remember that ultimately, you are your baby’s best advocate and the shield between them and outside influences that seek to profit from your desire to provide your child with the healthiest life possible. Do your research. Ask questions. Don’t be afraid to think outside the box and require that those caring for you and your child do the same. Sources of education and support are available to those in need. Be kind to yourself on this journey. It’s a long road, and no chosen path will look exactly like another.
Written by Quintanna Kessler-McGrath
THE STATEMENTS MADE IN THIS ARTICLE HAVE NOT BEEN REVIEWED OR APPROVED BY THE FDA OR EUROPEAN COMMISSION. THE STATEMENTS MADE IN THIS ARTICLE ARE NOT MEANT AS MEDICAL ADVICE AND SHOULD NOT BE TAKEN AS SUCH. CONSULT YOUR PHYSICIAN BEFORE MAKING DECISIONS REGARDING YOUR FAMILY'S HEALTH.