A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.



A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters


by Hillary Kuzdeba, MPH


In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.


Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.


The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.


Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.


How does this strategy really play out?


  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”


  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.


  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.


Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

FFF: Furious Formula Feeders?

“The community of women who choose to formula feed, and the moms who have so many challenges with nursing that they formula feed, tend to feel that the lactation professionals are insensitive, pushy and overstate the amazing-ness of nursing a baby. And they are ANGRY!! Check out the Fearless Formula Feeder page and you will get a massive dose of angry. They seem to take so much personally and cannot seem to see the broader cultural ramifications of the formula companies’ marketing campaigns. They also do not seem to understand that successful nursing is time sensitive. It has to be initiated early after birth or there is really no going back.”


After seven years of working in the infant feeding space, I’ve become rather immune to criticism. There are people who will never understand why a site like this is needed; people who think what I do “promotes” formula feeding; people who don’t think there should be any sort of choice in how babies are fed. Recently, my Facebook readers were threatened by someone claiming they would be reporting them to social services for child endangerment, due to their feeding method. It happens. People suck, and all that.

But last night, I saw the above comment on the page of someone who claimed to be all about female empowerment, empowered choice, and sisterhood. This was someone I collaborated with – or, rather, allowed to use my image and words in a way that resulted in no financial compensation, favorable publicity, or support for my own cause (the exact opposite, actually – it was a film which portrayed formula as the devil and romanticized mostly white, upper class, celebrity women and their breastmilk). Someone I welcomed on the FFF page. Someone, I assumed, who respected that our opinions were different, but whose goals were ultimately the same: ensuring that mothers were informed, autonomous, and supported in their choices.

Seeing her comment did, indeed, make me “ANGRY!!”

Then, I started thinking… maybe she’s right. Maybe we really are ANGRY!!. For a moment, I felt self-conscious and defensive, wondering if I should post something sweet and positive to counteract this negative portrayal.

But then I stopped myself, because damn straight, I’m angry.

I’m angry that despite sharing hundreds of stories of what the “breast at all costs’ mentality does to women, the people who are responsible for perpetuating this culture refuse to listen.

I’m angry that these same people spend so much time and energy hating the formula companies, when the formula companies are not the ones mishandling women in the hospital, leaving IGT and other potential breastfeeding complications undiagnosed, ignoring the mental health needs of new parents, or forcing women to go back to work after a few short weeks in order to support their families.

I’m angry that they can’t see the difference between “anti-breastfeeding” and “anti-breastfeeding-extremism’. These are not the same things. quotescover-JPG-32

I’m angry that they continue to gaslight the women who come to me for help, sometimes suicidal, over their perceived “failure” to breastfeed.

I’m angry that they are allowed to be angry at anyone and everyone who doesn’t think the way they do, but insist on absolute complacency and infinite patience from us.

I’m angry that they think we are uninformed about breastfeeding, when the most common reason parents come to my page is that they were blindsided by formula feeding; they had read books and taken classes on breastfeeding, but never even thought of using formula. These women know more breastfeeding than most. They know about jaundice protocols, Thomas Hale, SNS feeding, galactogogues, tongue ties, lip ties, skin-to-skin, the magic hour, the breast crawl, good latches and bad latches, exclusive pumping, power pumping, and more. They know how important it is to breastfeed immediately after birth. There’s a reason nearly every FFF Friday starts with a scene in the delivery room.

I’m angry that some of the “new voices” in this debate are doing more harm than good, making claims that can’t be supported, confusing the issues, and making it harder for the rest of us.

I’m angry that my community members are told that they are victims when they don’t feel like victims. I’m angry that when they do feel victimized, they are dismissed, brushed off as unfortunate casualties in the War Against Big Bad Formula.

I’m angry that the formula companies continue to make stupid marketing moves, adding fuel to a fire that should’ve been extinguished back in the early 1980s.

I’m angry that “celebrating moms” always means “celebrating breastfeeding”. Moms should not be celebrated for feeding their babies. They should be celebrated for doing a job that is often hard and thankless, for bringing home the bacon, frying it up, and cleaning all the dishes afterwards before putting the kids to sleep and working on tomorrow’s quarterly reports. I’m angry that this myopic focus, this fetishizing of what should be a perfectly normal act, marginalizes adoptive parents, primary caregiving fathers, and anyone without working mammary glands.

I’m angry that moms can’t nurse in public without it being a fucking federal case. Literally.

I’m angry that moms don’t get sufficient support in the hospital for breastfeeding – especially if they are young and/or non-white.

I’m angry that parents get no support whatsoever about formula feeding, and that parents in the UK need to preemptively bring their own supplies if they think there’s even a chance they might need or want to supplement. (Has anyone else thought about how this might be more self-sabotaging than having formula available in the hospital? Not that I think either is actually self-sabotaging, but for those constantly making that argument… let’s use basic logic for a minute.)

I’m angry that my use of formula is somehow threatening to your efforts to encourage other women to breastfeed.


I’m angry that women insist on battling each other in these snarky ways, like life is just one big junior high school. Grow up. Grow. The. Hell. Up. There are so many problems in the world – you really want to spend time arguing about whether we feed babies breastmilk or a perfectly viable substitute? Is live and let live really that hard a concept? Do you really have nothing better to do than tell random women on the internet how they are Doing It All Wrong? And formula-feeding moms who hang out on breastfeeding sites to cause trouble – I’m talking to you, too. You’re part of the problem. Making shitty comments about breastfeeding moms, who have just as much right to community and support as you do, is hypocritical and mean. Mean girl behavior is not “venting”.

I’m angry that comments like the ones above leave my community no choice but to stay silent. If they respond, and say what they want to say, they sound ANGRY!! If they don’t respond, they are silenced. Neither is an attractive or empowering choice.

I’m angry that I still feel the need to write posts like this, when my kids are in elementary school. I am angry that I care. I am angry because it doesn’t change anything, and I’d probably be a much happier person if I never said the word “lactivism” again.

So yes, I am angry. In fact, I am ANGRY!! And I’m sure much of it is self-imposed, because I could be focusing my own efforts on something more important, like the Syrian refugee crisis, the poverty and inequality in my own city. I could be focusing this energy on my children – sometimes I think that formula feeding made me a better mom, but Fearless Formula Feeder made me a pretty crappy one.

As for the FFF community? Sure, I suppose they are ANGRY!!, too. But no more than they should be. And if they are talking and venting and crying and supporting each other on my page, they are handling that anger appropriately. They have a safe space to work through that anger – but there are many people who want to take that away from them. “Concern Trolls” who repeatedly post inflammatory pieces (and if you’re going to argue that “information” isn’t ever inflammatory, ask yourself: would you post a piece on how easy it was for you to get pregnant on an infertility support page? Or an article about a plane crash on a Fear of Flying support group?), “experts” who try to school them, people who don’t believe they have any right t feel bad because formula feeding is so prevalent. (So is obesity. Doesn’t make the kid who gets relentlessly teased in school for their weight feel any better.)

Most of my readers work through their anger, and move on. Many go on to breastfeed future kids, armed with the knowledge they now have that there’s no such thing as failure. They understand relative risk. They know how to spot problems, and what can and can’t be done about them. They aren’t trapped in the sticky spider web of dogma. They know they have a soft place to land, should things not go as planned.

ANGRY!! isn’t a bad thing. ANGRY!! is what makes us act up, speak out, and create change. ANGRY!! is a healthy, justified emotion when you’ve been shamed, mistreated, embarrassed, ignored, and insulted. ANGRY!! is empowering, as opposed to sad, depressed, lonely, ashamed.

So yes, you’re right. We are ANGRY!! We don’t enjoy it. We don’t want it. We want to move on and be HAPPY!! CONFIDENT!! ACCEPTED!!

Maybe if you could just let us be, you could let us be.


The following are some additional comments sent to me by FFF members, reacting to this piece.

“Well yes I am angry. I am angry for being bullied into breastfeeding even though it was clearly not the right path for me. I’m angry my sons were left to go hungry and get sick because nobody would believe I wasn’t producing breast milk. I’m angry my midwives believed in breastfeeding at all costs. I’m angry there were entries in my post natal notes essentially calling me lazy and not trying hard enough to breastfeed. I’m angry that “normalise breastfeeding” has caused the vilification of formula feeding. I’m angry that I have been made to feel like a second rate mother who is poisoning her children and condemning them to a life time of low intelligence and obesity. That is, of course, if they survive child hood at all. I’m angry that I am supposed to laud and bend over backwards to accommodate breastfeeders but the courtesy is never returned. I’m angry that twaddle like “only 2% of women can’t actually breastfeed” is bandied around and taken as gospel, despite there being no respectable scientific research into such a claim. So yeah, I am angry. But as I usually say, if you kick the dog long and hard enough, sooner or later it will bite back.” – Emma

“What it comes down to is that unless you agree with the lactivist mentality that breastfeeding is a child’s “birthright” and that it’s the “end-all, be-all” of infant nutrition, then you wrong, misguided and angry. In reality, we are standing up for what we believe in just as much as they are standing up for their beliefs. However we believe in a women’s right to choose, to keep her bodily autonomy while still nurturing her children. And above all we lift one another up as mothers. I’m proud to be a part of the latter side.” – Deanna

“Being angry about having your body policed and having your parenting choices judged and shamed is a completely legitimate feeling/thing. Or are we as women only allowed to ever be happy or sad and anger is never ever appropriate?” – Nikki

“I wonder what the end game is if they actively alienate women who chose to, or had to, formula feed. I wonder, do they really care if we breastfeed? If so, do they think this kind of hurtful rhetoric will be a useful tool in convincing women to try breastfeeding again with the next child? Or are they just turning women off to their agenda through causing them pain? I for one have found the most support and kindness in caring for my child in the ff community, so I’d stick with what worked to keep myself and my family healthy and safe. It just seems so disingenuous that they are trying to “help” through hurting people. I don’t think they give a fig in the long run what I or any of you do, or for the health of our children. They just want to stare into their own reflections in solipsistic fantasy.” – Jessie

“I’m not angry that I couldn’t breastfeed. Not anymore, at least. You know what DOES make me angry though? A bunch of sanctimonious women (and men too, I guess) telling me how wrong I am for feeding my children formula. You know what? Formula saved BOTH of my kids’ lives. And it saved my sanity! My kids are happy, healthy, and thriving.” – Tasha

“I’m not angry or disappointed that BFing didn’t work out for us. I really don’t care anymore. Shit happens. I’m angry about the way moms are treated and babies put at risk for something that doesn’t really matter.” – Amy

“It’s funny because I’m not angry at all. Formula helped my son’s life from the beginning and formula helped me through PPD and other issues with my two girls. Not angry, grateful.” – Shannon

” I honestly think we are entitled to stand up for ourselves. All of us have at least one, if not many more, stories of being shamed for feeding our healthy and beautiful babies. The whole reason we’re here is to receive support from each other, that we are amazing mothers and parents, regardless of how we feed. We aren’t here to just bash breastfeeding, we are here for each other when everyone else is bashing us. were an amazing group of women who need support. We may come off as angry, but if these individuals who bash were in our shoes, they would see just how wrong their opinions of us are.” – Alexis

“They don’t even get *why* I’m angry. It’s not about me, I don’t give two shits I’m angry for two reasons. 1-All of the lovely ladies and GOOD MOMS who come here with broken hearts because of how the lactivist community has treated them and 2- Because their judgement doesn’t end with their side eye and snarky comments, they are changing public policy (think BFHI and all the horror stories from WIC offices) and that affects all of us. I don’t care if you sit there and comment about my bottles til the cows come home, but when you’re changing policies based on bad info that’s dangerous.” – Maria

“As someone who had no desire to BF whatsoever I have never gotten used to the opinion that we’re not allowed to decide what we want to do with their bodies and we’re not allowed to get angry when people tell us we’re not allowed to decide– or act as if we are stupid or misled when I KNOW we are some of the most informed women when it comes to this issue.” – Nicole


“How can they read the stories of what the mothers and babies went through to establish breastfeeding, and still blame women and claim everyone can Bf!!. DARN RIGHT I am angry!!!!!. I bought the “everyone can breastfeed” BS. None of those brilliant nurses (who were also licenses LCs) managed to help my baby latch. My baby had hypoglycemia, jaundice and lost 10% of her birth weight within two days, under their ‘watchful eye’.” -Bahan

“The justification for why why “should not be angry” is both condescending and misdirecting. Also, I’m pretty sure a lot of us are way more educated on formula and breastfeeding, and have given far more thought about the rhetoric surrounding it and it’s implications than most people.” – Bethanny

“They’re silencing us, undermining our autonomy. ‘They make X choice because they’re angry and stupid so X isn’t valid'” – Stephanie

Begging for Balance Before Banning the Bags

Last month, Maryland became the fourth state to eliminate the practice of handing out formula samples at hospitals. This was heralded as an important move in ensuring the health and welfare of the state’s newborns, as these sorts of initiatives always are. Reporters quoted breastfeeding advocates and nurses talking about how hospitals should be “marketing health”:

“This move allows Maryland hospitals to put their smallest patients’ health first,” said Dr. Dana Silver, pediatrician at Sinai Hospital and vice president of the (Maryland Breastfeeding Coalition), said in a statement.

From The Baltimore Sun

While the ban was officially a voluntary decision from the state’s 32 birthing hospitals and not a ruling from the state government, there were an awful lot of comments coming from state officials about the new policy:

“With changes like ‘banning the bags,’ we expect to see more mothers to try to exclusively feed their infants through breast feeding,” said Dr. Howard Haft, deputy secretary of public health services, in a statement. “This provides better overall health outcomes for Marylanders and brings us closer to achieving national goals in this area.”

The move was proposed three years ago by state health officials as part of a package of steps hospitals could voluntarily take to support breast feeding, which studies show may provide health benefits to the infants and mothers

The Baltimore Sun

Supporters of the “Ban the Bags” movement claim that mothers who get the formula samples are less likely to exclusively breast feed and stop breast feeding before mothers who don’t get the formula.. They are absolutely correct. There are many studies showing this result, and I am in absolute agreement with them that the bags should NEVER be indiscriminately handed out upon hospital discharge.

Further, I agree that there’s no need for any marketing to be allowed in the maternity ward. As long as we all agree that this really means NO MARKETING. That includes free samples of Medela breast pads. I would also argue that posters ‘advertising’ the benefits of breastfeeding – often with slogans that are inherently shame and anxiety-producing – have no place in the maternity ward.

And lastly, there’s a valid argument that allowing formula companies to provide samples drives up the cost of commercial formula. But this is a bit of a straw man, because the marketing budgets of large pharmaceutical corporations are built in well-thought-out, specific ways; I suspect that Enfamil will find a way to use whatever money was going into the hospital discharge packs and spend it elsewhere. The cost of brand-name formula isn’t going down anytime soon, which is why it’s a wonderful thing that we have high-quality generic options on the market.

All of these arguments in favor of the Ban the Bags movement are valid. But there are other, equally valid arguments opposing it, that are being uniformly ignored by those in power:

What if mothers actually want the samples?

What if these samples allow parents to feed their babies the safer but far more expensive ready-to-feed nursettes, which reduce the risk of bacterial infections and exhausted, new-parent errors in preparing powdered formula?

What if the formula-sponsored discharge bags are the only real source of formula “education” parents are receiving?

Granted, these three questions all have other solutions than “give everyone formula samples”. For example,

– Formula samples could be on hand but only given upon parental request.

-These samples could be generic RTF newborn nursettes, pre-measured into small amounts that would prevent overfeeding (since everyone is so concerned about formula-using parents force-feeding their babies until their thimble-sized tummies expand, cursing them to a lifetime of morbid obesity)

-Samples could be outlawed, but all parents could instead receive a pre-discharge tutorial on safe formula feeding, what to look for in terms of insufficient breastfeeding and/or jaundice, and also a pamphlet or book with unbiased, easy to understand instructions for all safe feeding methods (breastfeeding, pumping, donor milk, formula feeding), as well as a local resource list for breastfeeding, formula feeding and postpartum mental health support.

Advocates for Ban the Bags can claim that these policies are put in place to protect babies, rather than to shame mothers or take away their options, but they need to understand that this is indeed the perception. I conducted a simple survey, composed primarily of the Fearless Formula Feeder audience, to explore what formula-using mothers thought of these initiatives. Of course, this is a biased group – most started out breastfeeding and switched to formula within the first 3 months, and some formula fed from the beginning (although I did open the survey up to anyone, and we did have 17% who exclusively breastfed, and 15% who breastfed and switched to formula between 3-12 months). But I’d posit that their bias is what makes their opinions so powerful. These are the moms who didn’t end up exclusively breastfeeding. If they felt that formula samples were at fault for this result, we would see that on the survey. Instead, this is what the survey found:


Hurt your breastfeeding efforts= 2.26%

Help you in some way = 22.56%

Neither= 32.83%

Some of the open-ended responses included:

“I was offered a bag but refused it.”

“It was an absolute blessing- i needed to supplement while my breast milk came in, and it meant that i didn’t have to run to the store while recovering from 2 c-sections.”

“It did not influence my decision to switch to formula after 4 weeks, but it was so helpful to have the formula sample to try and see if it helped before buying expensive formula at the store.”

“Gave it away or threw it out.”

“It helped tremendously. I could only produce enough breastmilk for one baby, but I had two. Formula is expensive (as are babies, and we had two!), so the formula that the hospital sent us home with was invaluable. We wouldn’t have bought the nursettes on our own (we’re too cheap), so the ones that the hospital gave us made the first few weeks of parenthood a little bit easier. We weren’t having to mix formula after not sleeping.”

“I had a stack of breast feeding information given to me, a breast feeding class to attend, and a formula bag with some info and a small can of formula. The bag was just a nice gesture to formula being a choice for me and my babies.”

“I wasn’t as stressed about breast feeding bc I knew I had some formula to use if needed.”

There were some responses suggesting that the formula samples were detrimental to breastfeeding success, supporting my assertion that these should be clearly called Formula Bags, and only given upon request:

“It made me feel like the only option was failure… Here are samples and coupons so you can hand your life over to the formula companies.”

“… I forgot about it and when I found it the formula was expired. It was wasteful.”

“I felt like thenurses had no confidence in my ability to breastfeed. When I was given the bag I felt like I was destined to fail and everyone knew it except for me. My sister helped me to overcome the initial obstacles and I was successful meeting my breastfeeding goals, but without her I’m not sure I would have continued past two weeks.”

For those respondents opposing Ban the Bags, the most common impression was that it shamed formula feeding parents:

Chart_Q5_15110467% of respondents felt that the initiative “shames parents who choose formula”; 60% didn’t like banning the bags because the samples came in handy; 31% said that the bags were “the only source of formula education I received.”

Open-ended responses included:

“Because it’s paternalistic and undermines a parent’s right to choose how to feed her baby”

“I don’t think it should be banned altogether, samples should be available to women who choose to formula feed or combo feed, but I don’t think formula companies should be targetting women who intend to breastfeed exclusively any more than Lansinoh or Medela should target women who intend to formula feed.”

“Because it should not be the government’s business to create a culture of shame around a product that many new parents need. I think it would be fair to educate new parents that supplementing may interfere with their milk supply if they express a desire to breastfeed exclusively. Beyond that, they should leave it up to the parents if they wish to receive them or not. If a company wishes to provide a sample, their client base should be allowed to receive it…the samples are helpful as parents make decisions around what is best to feed their child.”

“Because it implies a qualitative judgement on formula use. Parents have a right to choose their feeding method and the hospital does not have a right to attempt to manipulate that choice. With both of my children, I was offered only pampers brand diapers in the hospital. Why does pampers get the opportunity to push their brand name but not a formula company?”

“Because it is completely, 100% disingenuous and insulting to insinuate that a promotional bag has more power over me than my own well-reasoned decision-making processes.”

“It implies parents aren’t capable of making a choice. That we women are so weak willed that if we see a formula sample we’ll throw our breastfeeding goals away for a few samples. It laughs in the face of informed consent. If one is going to make a choice human milk or formula then they should be given ALL of the information. The only information parents are given at appointments and from the hospital is about breastfeeding. Yet if a formula company gives formula information it’s decided it’s only for marketing. Sure formula makes formula companies money but if the hospital offered unbias formula information about it instead of 10 risk of formula feeding lists we wouldn’t be seeking it from the formula companies.”

“Much like banning condoms & birth control doesn’t prevent sex, banning formula samples & literature doesn’t prevent parents from using formula. It’s dangerous – parents need ALL the info about infant feeding. “Ban the Bags” initiatives are tantamount to sticking your fingers in your ears, closing your eyes, and saying “na na na I can’t hear you it’s not happening.” Childish and completely ineffective.”

The most attractive solutions for most respondents were to hand out the sample bags only upon request (73%), or to give an unbiased book/pamphlet talking about all infant feeding options (62%)  as an alternative:

Chart_Q7_151104(Interestingly, 19% chose “parents could receive sample bags of breastfeeding-related products”. I find this interesting, as it does negate the more palatable argument (at least in terms of feminism and bodily autonomy) that the reason to ban the bags is to take corporate interests/marketing out of healthcare settings. Apparently, predatory marketing on postpartum women is perfectly okay, provided it comes from Lansinoh rather than Similac.)

Many respondents mentioned feeling like the gift bags “normalized” formula, saying that it was the only time formula was mentioned or seen during their hospital stay. For those choosing to formula feed or combo-feed from the start, this can be disheartening. If formula were discussed as an option, without the scare tactics or patronizing language used in most healthcare settings, perhaps getting rid of the bags would meet with less outrage. In a space left for respondent comments, a sense of feeling marginalized and that there was only one “right” choice for infant feeding was clear:

“I had zero information about the right way to formula feed. I had no idea how good formula was good for, how to properly store it, the right amount to give, etc– I only learned from formula containers. Information about this in a pamphlet would have been very helpful.” 

“The lack of free formula is not my concern. I am concerned that regulating this shames formula feeders (i.e., the message is that formula is so awful it should not be given out by a hospital). I am also concerned about the total lack of education in hospitals about when and how to supplement or EFF.”

” These are often the first times mom and dad are presented with formula, and the only “education” and information they may receive about it. Yet breastfeeding info and help is available in quite a widespread manner. Again to take this away would do a great deal of harm for parents who may exclusively formula feed, as they could certainly use whatever educational info they can get about formula feeding.”

“Parents should be given accurate, and unbiased info about ALL feeding options. Denying info about a healthy, and nutritional feeding choice merely due to zealotry does nothing to help women, or children.”

“Formula information and samples should always be available on request – no questions asked. Also safe and clear information for both feeding methods needs to be made to all parents. Breastfeeding, pumping, bottle feeding, sterilising equipment, post partum depression, maternal health, and safe practice for storing formula and breastmilk.”

Although there’s been a recent backlash against breastfeeding pressure, this is not an issue of questioning breastfeeding’s benefits. Of course hospitals should be protecting and supporting breastfeeding, provided it is something a woman is not opposed to doing, but we also have to be realistic: formula is here to stay. It is going to be used, and the way we’re going about things now, it is going to be used incorrectly, with shame and guilt and fear. Of course direct marketing to patients has no place in the healthcare setting, but in a climate where formula is being kept under lock and key and treated like tobacco or alcohol, we need to be aware that the formula companies are often the only ones discussing their product with new parents. If we truly care about “putting the health of our smallest patients first”, then do exactly that, because leaving their parents without proper info on formula use is putting their heath in danger. Making their mothers feel marginalized simply because their breasts don’t work how they are supposed to, or because they have personal, valid reasons for not wanting to feed a child from a culturally, emotionally-loaded part of the female anatomy, puts the mothers’ health in danger, which can obviously affect infant health as well.

These are not simple issues, so let’s not oversimplify them by insisting that taking away a bag – a bag that can be taken or left, like the jello on the hospital tray – is going to make a huge impact on breastfeeding rates, while ignoring the impact it may have on the experiences of formula-using parents.

Balance before bans. That’s all we ask.






It’s Not About the Brelfie

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

But as the day wore on, red flags started popping up. First, a fellow blogger alerted me to the fact that the survey conducted by the Bressure movement alluded to breastfeeding selfies as “sexualized”. Then, every single article I read focused on how these (apparently sexualized) “brelfies” were directly causing pain and suffering to bottle feeders. Instead of talking about the systemic issues that create a cycle of guilt, fear, and competition, we were once again dragging the conversation down into the mommy-war gutter, pitting woman against woman, and continuing the seemingly endless divide between breastfeeding and formula feeding moms.

This is not progress.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the  “#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.


We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?


The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.


Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.


Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.


While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.


This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.


You don’t need to know why I don’t breastfeed, because it shouldn’t matter.

This past week, Emily Wax-Thibodeux’s excellent essay, “Why I don’t breastfeed, if you must know”, went viral. As it should have. It’s a cutting, heartfelt expose of just how ridiculous the pressure to breastfeed has become, made all the more powerful by the author’s recounting of her double mastectomy.

Unfortunately, even breast cancer didn’t stop the haters from hating.

“95% of the time people don’t breastfeed for reasons other than terminal illness. This is a red herring argument. She shouldn’t feel bad for having a legitimate reason for not breastfeeding and if she does then its really a personal problem,” said one comment on a Today.com thread.

“We all understand should and can are different. A mother who cannot breast feed is different than a mother who can but chooses not to…Breast milk is better for an infant than formula, I don’t think there is a doctor, nurse or midwife who would say that formula is better…Shame people would criticize this mother who CANNOT breastfeed like it was her choice,” wrote another (who happened to be male).

And then there was the woman who insisted that “(t)here is absolutely zero systematic or general judgment against infant formula or bottle feeding. It is the absolute expected norm by the majority of adults and parents in our culture. No one cares if you feed your baby infant formula or use a bottle…Most children start on the breast. Most children are weaned. Most children are given formula and fed with bottles. There is no public backlash against infant formula or bottle feeding. But here’s an article that pretends “infant formula shaming” is some actual thing. No. It isn’t. Not in the real world of critical thought and evidence. The data doesn’t support this notion at all.”

In the FFF community, there was tremendous support for Wax-Gibodeux’s piece, but an underlying concern about the title – because why must we know why she isn’t breastfeeding? Is shaming more acceptable for some mothers than others? What is the litmus test that rewards us with a breastfeeding “pass”? If a double mastectomy doesn’t quite cut it, I don’t know what will.

So maybe we should stop giving reasons altogether.

For those who fear formula as a product, no reason in the world is sufficient for a baby to be given anything other human milk. It doesn’t matter if the baby has to be wet nursed by someone with an unknown medical history – that is still better than formula.

For those who like to shame mothers – because that’s what it really is about, enjoying the act of shaming, of making yourself feel superior, or feel better about your choices by questioning those of others – no reason in the world will make a mother above reproach. She could always have done more – after all, breastfeeding is 90% determination and only 10% milk production, as a recent meme proudly stated. Best case scenario, she might get pity – but pity carries its own heavy scent, similar to the sour stench of shame.

Giving a reason for why you didn’t breastfeed is pointless.

That doesn’t mean telling your story isn’t important, because our narratives matter; they help those floundering in their own messy journeys make sense of what’s happening and find community with those who’ve been there. But there’s a difference between telling your story and owning it, and telling it to defend yourself. One gives you power, the other takes it away. 

We are at a turning point, I hope. Jessica Martin-Weber of The Leaky Boob has taken a stand against romanticizing the reality of breastfeeding, and is helping those in the breastfeeding community feel comfortable with bottle (and formula) use. When one of the leading voices in breastfeeding advocacy speaks out against a culture of fear and rigidity, that means something. Wax-Thibodeux’s piece has brought many powerful voices out of the woodwork, allowing women who’ve swallowed their shame to regurgitate it, and make the uninitiated understand just how sour it tastes.

Now is the time to draw a line in the sand. This conversation has moved beyond breastfeeding and formula feeding and whether one party is more marginalized than the other, or how superior one product is nutritionally to the other. We’ve been there, done that, and nothing has really changed. We’re all still hurting. We’re all still feeling unsupported, unseen, and resentful, like a 3-year-old with a colicky new sibling. Now, we need to stand up, collectively, and say it doesn’t matter why I am feeding the way I am. It is not up to anyone else to deem my reason appropriate or “understandable”. I’m going to stand up for anyone who has felt shamed about how she’s feeding, instead of just people who’ve had identical experiences to me, or those who I feel tried hard enough. 

A breastfeeding advocate shouldn’t be afraid to admit she questions aspects of the WHO Code. A breast cancer survivor shouldn’t have to have awkward conversations about why she’s bottle feeding. A woman who chooses not to breastfeed for her own personal reasons should not have to lay those reasons out in front of a jury of her peers.

This Tower of (breastfeeding) Babble has reached a fever pitch. It’s time for it to come down. Pick up your axe and start chopping. And next time someone asks, simply tell them, “You don’t need to know why I don’t breastfeed. Because it shouldn’t matter.”


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