Experiences of Formula Feeding: Results of a survey of 1,120 formula-feeding parents

We talk a lot in the Fearless Formula Feeder community about the negative experiences we’ve had with medical professionals, media outlets, and our peers. And this is good, and healthy – we need a place to chew on these bitter feelings, and hopefully digest them so we can move on with our lives. Still, I want to go a step further this year, and really think about (and act upon) what could be made better. I think the time for some positive, real change is now, don’t you?

Considering how much the infant feeding world likes research, I think some data is a good place to start. Mind you, what I’m about to talk about isn’t peer reviewed or even professional compiled data; it’s merely a Survey Monkey study, which any Joe Shmoe can do at any time. This one was written by me, and I am by no means an epidemiologist (although I like to pretend I am, and probably would have tried to be if I could wrap my mind around simple algebra, let alone statistics) or PhD or anything of the sort. So it’s important to take this data with a grain of salt; it’s simply anecdotal, self-reported data crunched by a website to give us some idea of what’s going on for a particular, self-selected group.

Let’s talk a little about what this all means. Basically, I posted this site on the FFF Facebook page. It was shared and spread around a fair amount, but it’s safe to say that the majority of the respondents were FFF members. Which means something, because as a group, we tend to be a few things: educated, interested in parenting, mostly white, mostly lower-middle to middle class, mostly English-speaking (although the respondents included people from the U.S., Canada, the UK, France, United Arab Emirates, Australia, New Zealand, the Netherlands, Bulgaria, South Africa, Russia, and Mexico), and people who read a lot and care a lot about formula feeding issues. Because of this, we can’t necessarily assume that our experiences are typical of ALL formula feeding parents, but considering we have a pool of 1120 people, from a variety of geographic areas who formula feed for a number of different reasons, we can infer some things from the data we have here.

That said, I think it’s interesting and helpful to at least collect our experiences in a way that can help us talk about them more clinically, to understand the experience of some formula feeders, who tend to be parents who think a lot about parenting. That’s important, I think, because it suggests that these answers are relevant for care providers who are trying to serve this market.

With no further qualifications and hemming and hawing, I’d like to present you with the results of the first ever Fearless Formula Feeder/I Support You Survey on Formula Feeding Experiences. 

 

Question 1: When did you begin formula feeding?

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The majority (32%) of respondents began using at least some formula shortly after birth, although breastfed at least once. But those who began using formula after one month were a close second, at 25%, and 19% formula fed from birth.

Real-world implications: If most of these respondents were formula feeding a one-month infant or younger, their responses on the degree of instruction they received carry particular relevance. In completely unscientific terms – we’re talking about tiny babies and brand new, very sleep deprived parents. If anyone needs explicit guidance on something which can, at times, resemble a junior high chemistry experiment, it’s these folks.

Question 2: What were your reasons for choosing formula?

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Respondents were able to select more than one answer here, so please note that there was often a combination of reasons that led an individual parent to formula feed. The most common answers were “I couldn’t produce enough milk” (44%); “My child wasn’t able to breastfeed successfully” (33%); and “Breastfeeding contributed to my postpartum depression” (22%). 17% of respondents chose “I did not want to breastfeed.” As respondents could elaborate on their reasons via a text box, some of the comments received were as follows:

“I am a survivor of childhood sexual abuse, and both childbirth and breastfeeding were intensely triggering.”

“I stopped because it was straining my mental health and I felt like I was missing my daughter’s life because I was so consumed with trying to make breastfeeding work.”

“When they tested my milk with my 2nd child (32 weeker preemie) it was as fatty and nutritious as tap water.”

“Doing all of the nightfeeds by myself was never a realistic option for our family because I earn most of our income, I can’t show up to work massively sleep deprived and I have no opportunity to pump during the workday. This little detail was glossed over in all our prenatal breastfeeding education. When I caught on to it in the first week postpartum my husband and I jointly decided that breastfeeding was not for us.”

“I had mastitis so severe I was hospitalized. It turned into an abscess that they tried 3 times to drain with a needle but it didn’t work. They eventually had to do surgery to remove it. I tried to breastfeed through all that up until the second time they tried to drain it with a needle when I finally decided to stop trying because it was killing me.”

“Child ended up hospitalized due to dehydration.”

“I had postpartum thyroiditis. Only ever… produce(d) 2 ounces of milk per day. It also triggered devastating insomnia that lasted for 12 days. I decided it was killing me, so i stopped.”

Real-world implications: The responses on this question are obviously all self-reported, and there’s no way to verify the validity of medical reasons such as an inability to produce milk. However, I’m in the business of believing moms when they tell me things, so I’m assuming that there was a valid reason each of these moms felt that breastfeeding did not work for them. The point of including this question, for my purposes, was to see the variety of reasons parents chose formula and to get an idea of what would be best discussed prenatally. For example, there are visual cues for Insufficient Glandular Tissue, which physicians could be trained to notice during prenatal exams. Or, for women with histories of depression or sexual trauma, it might be helpful to be more open about the effect breastfeeding may have on them in an individualized, sensitive way – because what is empowering and healing for one woman might be damaging and re-traumatizing to another.

Question 3: When you first began formula feeding, were you given instruction/guidance from medical/hospital staff?

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55% of respondents said that were not given any formal instruction or guidance on how to use formula. While 33% of the rest of the group did get some sort of verbal guidance from a medical professional, only 12% got a pamphlet or written material.

Real-world implications: This seems like a no-brainer – how hard is it, really, to give new parents a brief one-sheet on formula prep, with resources listed for further help?

This leads me to….

Question 4: Where did you receive most of your guidance on using formula?

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53% – just over half- said that the main source of instruction was from the back of a formula can.

Parents are also getting help from other sources – nearly 30% did cite their pediatrician/other medical professional as a resource, so that’s promising. Another 33% said that websites were helpful, and 23% got assistance from friends or relatives.

Real-world implications: Considering pediatricians typically give verbal or written instructions on how to administer baby ibuprofen, and discuss things like television use, potty training, and sleep training with patients, I think it’s odd that we assume the instructions written on the back of a can are sufficient for safe formula prep. Not all parents are native English speakers or fully literate. Not all parents can read tiny print on the back of a can at 2am, when they are sleep deprived and worried about a newborn.

 

Question 5: Do you feel you received adequate information about formula feeding safety and use?

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While 40% said yes, 34% said “no” and another 22% said “I’m not sure”.

Real-world implications: This suggests more than half of parents using formula aren’t convinced that they were given enough information to feed their babies safely. Not acceptable.

Some additional responses:

“Too many people I spoke to IRL seemed to be compelled to remind me that breast was best. That shaming did not help me during a time when I was very vulnerable and wanted information”

“Eventually, after I did my own research. The nurse in the hospital almost yelled at us for leaving the half consumed bottle of ready-to-feed out at room temperature. We had no idea as new parents what we were supposed to do with formula, and no one had taken the time to explain it to us. So any information I got was from my own research.”

“I feel I had to ask too many questions to the pediatrician that should have just been told to me. For example, in the hospital they gave him 2oz every 4 hrs. When we went home no one told us to change that so he dropped a lot of weight…”

Question 6: If you could choose the way you received info on formula, how would you like it to be given?

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Respondents could choose more than one answer here, but there were two methods which received the vast majority of responses: “a nurse or doctor to talk to you about it” and “a pamphlet or written materials.”

Real world implications: Medical professionals need to be informed on formula feeding safety and practicalities, and be allowed to impart the information in a judgment-free manner. Written materials should also be created to be given to parents at discharge. Since 18% and 16% responded that they’d like to learn about formula via a peer support group or websites/books respectively, it also may be helpful to offer a resource list to all expectant mothers that is truly comprehensive, and not just helpful for those planning to breastfeed.

Question 7: What was the hardest thing you faced when you began using formula?

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This was one of the most interesting questions on the survey, in my opinion; 65% of parents responded that “my own feelings about formula use (guilt, shame, fear, etc.)” was the hardest aspect. The other two popular answers were “the lack of social/emotional support from fellow parents” and “the lack of information on safety, choosing a formula, bottle feeding, etc. (practical issues).”

Real-world implications: Formula feeding parents need a safe space where they can access peer support, work through feeling of guilt/shame/fear, and learn about practical issues of formula feeding. To me, the simplest answer is that we need peer support groups, our own version of La Leche League. Kim Simon and I have been developing a platform for these peer groups through the I Support You organization, and I am really excited that two FFF members have already started their own local chapters (Atlanta and Baltimore). I hope that we can grow this movement so that every major metropolitan area has a resource for formula feeding/combo feeding parents, because as these numbers show, it is desperately needed. Need more proof? Here are some of the open-ended responses to this question:

“I became very depressed and felt worthless as a mother and human being. Luckily, my husband caught me in the middle of writing a good bye letter to my daughter as I had planned to end my life.”

“felt like a failure for not giving the “liquid gold.” I really had to search for good evidence. I remember finding a paper by 3 biostatisticians who had all breastfed. They dug into the evidence. Reduced mortalitly? One study had one infant death in the formula fed group, but the baby fell off the counter!!! Finding unbiased, easily accessible info would have been great. “

“The NICU lacation consultants were relentless. My doctor told me that I most likely would not be able to successfully pump. The NICU nurses understood that it didn’t work out. My baby’s doctor made arrangements for donor milk. However, the lactation consultants hounded me and made me feel like it was my fault it wasn’t working. They added unnecessary stress to a situation that was already a nightmare.”

“I didn’t know any other formula feeders. It wasn’t that my fiends/peers were unsupportive… but they were all breastfeeding and could not relate to formula feeding.”

Question 8: Did you have any trouble with the technical aspects of formula feeding?

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43% of respondents said no, they hadn’t had any issues in this regard. Of the remaining respondents, the most commonly-faced issue was reflux/other GI issues, followed closely by “I had trouble finding a formula that worked for my child.” A small but significant amount (14%) “(were) confused about formula or supplementing and felt lost on where to go for help.”

Real-world implications: More than half of those surveyed endured some sort of struggle with the technical aspects of formula feeding, suggesting that using formula is not as simple as “add powder and water” for many parents. I hear this excuse a lot from those who deny the importance of formula feeding education and support – that it doesn’t have a learning curve, that doctors don’t need to know much about it because every formula is the same, etc., etc. And that is certainly true for some people, but not for all. Not for over half of us.

Question 9: Did you experience any emotional challenges due to your choice to formula feed?

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Only 18% of respondents said no, that they hadn’t experienced emotional challenges. The rest (who were allowed to choose more than one answer) mostly struggled with their choice or need to use formula (58%), and worried what others would think (55%). 35% felt “left out by other moms” and a quarter of respondents (26%) felt that the emotions around infant feeding contributed to postpartum depression and/or anxiety.

The open-ended responses included:

“I would have felt very comfortable in my decision to formula feed from the start if I had not been pushed into breastfeeding by the hospital, and also my mother and stepmother made me feel incredibly guilty. I had asked for info on bottle feeding while in the hospital and was snubbed. These issues contributed to my emotional challenges. It took almost 4 months for me to realize everything was okay.”

“I felt guilty for not feeling more guilty. Also felt like I didn’t try hard enough and that subconsciously maybe I was using PPD risk as an excuse. Oh, and I ended up with PPD anyway.”

“I was worried that all the negative health outcomes would come true- it’s pretty dirty to scare a mom into thinking that one choice could make her child overweight, less intelligent, and generally unhealthy. Happily, none of these things have come true in 3 years!”

“Despite knowing better, I felt guilty that I wasn’t giving my baby “the best.” That I hadn’t “tried hard enough” for her. The pediatrician at the hospital compared bottle feeding to “taking your baby to the drive through.” Thankfully her actual pediatricians were wonderful and told me it absolutely makes no difference either way.”

“I did feel some guilt about not breastfeeding, though I got over it rather quickly. What resonates more with me, though, is the fact that I didn’t want to breastfeed in the first place, but felt pressured friends, my community, the hospital, etc. to do it. And while it’s true that my kid had serious reflux, allergies, etc., and I had production problems, I also just HATED breastfeeding. And even sites like FFF sometimes make it sound like it’s only ok to FF if you tried to breastfeed and couldn’t. I’d love for women to have permission to just chose not to breastfeed in the first place.”

“I knew that there was no way that I could carry on attempting to BF and pump while still taking care of myself and my child (literally I would feed, attempt to pump, and he would be ready to eat again). But I could not relay that kind of feeling of desperation and failure to other moms who had no problems BF. I thought I was doing something wrong.”

“…I was confident in my decision about FF from birth, well educated and versed BUT still got side-eyed and looks from some people. No matter how confident you are when there are people who truly believe formula is poison and if you don’t BF you don’t deserve to have children (even when you fought with infertility to get said child) it’s disheartening. The lack of correct info on FF and the slew of misinformation on the benefits BF make it difficult to even the playing field.”

Real-world implications: Mothers are hurting. When over 80% of formula feeding parents are talking about the emotional ramifications of their feeding method, we need to sit up and listen. We have a large body of breastfeeding research now, but an abysmally small body of research on the effect of postpartum depression and adjustment difficulties on both mother and baby (not to mention other children, partners, employment, future relationships, etc.). If the way we approach infant feeding is contributing to emotional duress in a generation of parents, it seems worthwhile to reassess the risk/benefit of promoting breastfeeding in the way we currently do.

If we insist on continuing down the same path, then we need to also make sure that the negative experiences of formula feeding parents are tempered by appropriate measures. This means ensuring that they are treated with respect and with regard to personal autonomy; setting up social support systems like peer groups or pre/post-natal classes which address other methods of infant feeding; and perhaps providing sensitivity training for those dealing with newly postpartum or expectant parents so that they learn to impart the benefits of breastfeeding in a manner devoid of shame, guilt, or fear-mongering. It is possible, and it is well worth it.

Question 10: What country do you live in?

Most respondents were from English-speaking countries: the United States, Canada, the UK, Australia, and New Zealand.

Real-world implications: Not sure we can take much away from this, except that the reach of FFF (which is how respondents were recruited) is mostly in the English-speaking world. But while we’re on the subject… let’s address the need for culturally-specific infant feeding recommendations and policies. Even within the countries we’re discussing here – which on the surface have many similarities – there are demographic, socioeconomic, religions, cultural, and political differences. People cite the World Health Organization as a good source for formula feeding best practices, but it’s rather simplistic to try and make this issue universal. Mixing formula in a place with unsafe water and hygiene issues is quite different than doing so in a Lysol-happy kitchen using filtered, purified, boiled water and a dishwasher with a “sterilize” cycle. And that’s not even mentioning the impracticality of assuming that genetic, lifestyle, and dietary factors do not affect biological processes; to say IGT only affects 1% of the Swedish population, for example, means nothing to a demographic of Eastern European Jewish women in Manhattan. There are higher rates of breast cancer and Crohn’s disease in some ethnicities; higher rates of genetic diseases in others. Why should breast tissue be immune to these same factors?

I know I’m going off into tangents here, but the point is: it is time to think of infant feeding with more nuance, even in seemingly homogeneous populations. At the same time, we need to recognize that feelings of guilt, shame and fear are common in Western, relatively privileged demographics, regardless of breastfeeding rates and months of paid maternity leave. This is complicated stuff, and requires far more complex analysis than we’ve been given it. It’s time to step it up.

Question 11: What would have helped your experience with formula be more positive?

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The highest amount of responses went to the following (again, respondents could choose multiple answers): more support and guidance from medical professionals (50%), more support and guidance from peers (45%), prenatal preparation for formula feeding (50%) and a peer support group for bottle feeding or combo-feeding parents (44%).

Real-world implications: All of this would be so simple to accomplish. If medical professionals were not scared to discuss formula, lest it be considered giving women “permission” to not breastfeed; if formula could be discussed in prenatal classes in an honest, clear, factual way; if we could stop making it “breast vs. bottle” and just make it two different, sometimes compatible, ways to feed a baby…. just imagine what could happen.

When La Leche League began, it was due to the inadequate support for breastfeeding mothers from society and physicians. While there are still battles to be fought, we are seeing more and more support for breastfeeding (as long as its done within the parameters of what is deemed “socially acceptable” – ie, for no more/no less than a year or two – which is most definitely a problem we need to address), if not from society as a whole, at least from the medical establishment, the government (at least in lip-service and funding for Baby Friendly and corporate lactation programs) and the parenting community. Now may be the time for a formula-feeding equivalent of LLL to do the same noble work – ensuring that moms (and dads – formula feeding is not gender-specific, and dads need to be included more in this conversation, especially those that are primary caregivers) are getting the support they need, when the powers that be cannot provide it themselves.

I will be following up with another survey soon, which will examine if there truly is a need for more “education” about formula feeding, or if it really is simple enough to merit the lack of focus given to it in prenatal and postnatal settings. But until then, I want to leave you with a few more of the comments left in the open-ended sections of this survey. My hope is that this will inspire those with the money and resources to conduct actual, peer-reviewed research on these topics to do so. At the very least, I hope it gets us thinking. Because we need to be thinking, and not just shouting at each other, endlessly, about who knows best.

 

“I just wish that they would give better instruction at the hospital to moms who choose to formula feed about mixing, feedings and choosing the right formula for your child. They send lactation consultants for breastfeeding moms. Why can’t they teach formula feeding moms a few pointers about formula feeding? We are all feeding babies. Why give one method so much attention and neglect another entirely? All that matters is babies get fed. Is that not the most important objective?”

“If there was more support (from) medical practitioners perhaps breastfeeding mums would be less critical.”

“I took a breastfeeding class, but looking back I wish it would have been a general baby feeding class. To learn about pros and cons of breastfeeding, formula feeding, using bottles, and starting solids. Because although not everyone will breastfeed, everyone will at least need to learn about several of these options.”

“I  had no idea what I was doing and didn’t even know where I should look to find the information. It’s hard to find good formula info online and I didn’t know what to trust, especially when I was emotionally and physically exhausted and felt judged by others as well as by myself.”

“Can you fix the world and let everyone know that formula feeding isn’t bad? As long as you feed with love. This is such a touchy topic and I just wish everyone would let it go bc they only make it worse for moms. I also hate the attitude that formula feeding is okay IF you tried to breastfeed or IF you have low supply. I really want the attitude to be that there is nothing wrong with a mom who chooses to formula feed from the get go. Essentially if you could fix the whole attitude about how we feed our babies that would be great.”

 

All new parents deserve a place at the consumer protection table, not just breastfeeding ones: A response to the “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities”

Public Citizen is known for its advocacy for ordinary citizens who have been harmed by large entities–and rightly so.  Much good has been done by this organization in the name of everyday citizens who otherwise have little power to lobby our government for stronger laws and regulations to protect our society.  However, Public Citizen’s recent event, “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities,” does not accomplish the goal of protecting consumers.  A consumer protection advocacy organization has an obligation to women to support their right to bodily autonomy, as well as support their and their children’s health care needs—issues that are sometimes incompatible with breastfeeding and do not currently receive sufficient support in our breastfeeding-centric post-partum health care model.

The Day of Action fails to address many of the true issues that affect women’s and children’s ability to breastfeed.  A complete lack of formula advertising is not going to enable women with insufficient glandular tissue (IGT) to make sufficient milk, or change the fact that many women have to take necessary medications that are incompatible with breastfeeding.  It is not going to prevent complicated births or medical conditions in babies that sometimes make it exceedingly difficult – or impossible –for moms to breastfeed.  It does not reduce adoptive or foster families’ need for formula.  And a lack of advertising is not going to change the fact that some women do not want to breastfeed, and have a right to their bodily autonomy.  While we agree that it would be best for parents to receive information about formula from a non-profit source, currently, there is no such source that provides accurate, unbiased formula information, even to families for whom breastfeeding is not an option at all.

The Day of Action implies that information about formula is plentiful and accurate.  Nothing could be further from the truth.  Information about formula is typically riddled with fear mongering about not breastfeeding and uses value-laden language that assumes women who use formula lack perseverance or are selfish, lazy, uneducated, immoral, or ambivalent about their children’s health, despite ample evidence to the contrary. Formula supplies in hospitals are hidden in drawers or even locked up.  Lactation consultants are held to the WHO Code and urged not to discuss formula unless under special circumstances (lest it send a message that formula is “just as good as breastfeeding,” even though it is a medically appropriate option, and sometimes the only option).  Doctors are not taught about formula preparation and are frequently scared off of even talking about formula for fear of being labeled anti-breastfeeding.  Where are formula-feeding families supposed to get the accurate, unbiased, judgment-free information they need?

Perhaps Public Citizen is unaware of the extent to which breastfeeding marketing relies on shaky claims.  Maternity wards are typically papered over with literature that claims breastfeeding improving babies’ IQ and helps new moms lose weight—claims that some assert are based on poorly-done research that frequently confuses correlation with causation, and that have not been borne out in more powerful, well-designed studies.  Recent research on breastfed and formula fed siblings (three well-regarded published studies[1]) showed little to no long-term effect of breastfeeding for a number of oft-mentioned issues.  These studies are powerful because, unlike many other studies on breastfeeding, variables such as parental IQ, educational status, and socio-economic status are much better controlled.  Several large metastudies (including those conducted by WHO[2] itself and the United States’ Agency for Healthcare Research and Quality[3]) have found that the evidence in favor of breastfeeding is marred by confounding factors.

A consumer protection advocacy organization has the responsibility to ensure that advertising claims are based on sound science, but the “absolutes” plastered on maternity ward walls, city buses, and doctor’s offices (“Breastfeeding prevents asthma[4]”, “breastfeeding makes babies smarter[5]”, “Breastfed babies grow up stronger, healthier and smarter[6]”) and liberally sprinkled in literature distributed to new parents do not fulfill this criteria. Public service messages cannot be immune to the regulations that restrict other advertising.

Further, perhaps Public Citizen is unaware of how much of the advertising for breastfeeding actually benefits corporate entities.  New moms in hospitals are given sample tubes of Lansinoh nipple cream, Medela breast pads, and coupons or ads for local boutiques that sell breastfeeding products such as Boppy nursing pillows and covers.  It is common for new mothers to receive sample magazines, which exist both to promote themselves as well as the advertisers within. It seems counter to Public Citizen’s goals to protest one form of advertising and not others.

Women deserve to know the full range of medically viable options for feeding their children, in an unbiased, accurate, and judgment-free manner, and we feel a consumer protection organization should be at the forefront of that fight.  Formula feeding parents need help, advice, and support just as much as breastfeeding parents. Unless Public Citizen is willing to help establish a non-profit center to train “infant feeding consultants”, not just “lactation consultants,” whose job is to support all medically viable methods of feeding a baby, this Day of Action seems just another way to deny formula-feeding families what little information they can still get about their health care options for their children.  It seems to contradict the stated goals of Public Citizen to protect consumers.

We encourage Public Citizen to speak with actual formula feeding parents, many of who feel marginalized in our healthcare system for the choice or necessity of formula.  Breastfeeding—and products and service providers who support it—is so heavily promoted in hospitals that formula feeding families are left without the kind of education or support that breastfeeding families receive. As there are no non-profit sources of education for formula, other than a few websites run by mothers who have taken up the charge, companies are the only remaining source. This is not ideal, but it is currently all we have. We encourage Public Citizen and all who support this Day of Action to read the stories of actual formula-feeding parents, the vast majority of whom report seeing no advertising prior to using formula, at FearlessFormulaFeeder.com, and consider how they may equitably represent the needs of pregnant, birthing, and post-partum mothers and their babies at the consumer protection advocacy table.

Signed,

Concerned Members of the FearlessFormulaFeeder.com Community

 

 


[1] Evenhouse, Eirick and Reilly, Siobhan. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res. Dec 2005; 40(6 Pt 1): 1781–1802; Geoff Der, G David Batty and Ian J Deary. Effect of breast feeding on intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis. BMJ 2006;333;945-; originally published online 4 Oct 2006; Colen, Cynthia G. and Ramey, David M. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, Volume 109, May 2014, Pages 55–65.

 

[2] Horta, BL and Victora, CG Long-term effects of breastfeeding: A systematic review. World Health Organization, 2013.

[3] NIH Agency for Healthcare Research and Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/Technology Assessments, No. 153, April 2007.

 

 

Breastfeeding pressure doesn’t care about privilege

I am privileged.

I’m not rich, but I have never gone hungry; never been without a roof over my head; never wanted for anything (well, nothing more pressing than a better body and maybe a date with Ewan MacGregor circa Trainspotting). I don’t know how it feels to be judged by the color of my skin. I’ve been discriminated against, as a Jew and a woman; called names like kyke and jewbeggar and bitch, but I’ve never been racially profiled or held back by a language barrier, or assumed to be suspicious or uneducated because of the way I look.  I have a great husband and amazing friends and ridiculously supportive parents and in laws.

I realize that in the United States, this means I am incredibly lucky. I also realize that this means I have no business assuming things about anyone else’s lived experience. It doesn’t matter how many academic texts I read or people I speak with in a clinical setting – I can’t know how it feels to be dependent on welfare, or in an abusive relationship, or at a dead-end job with a sexually harassing boss.

I often hear that the pressure to breastfeed is a problem plaguing a specific socioeconomic and geographical subset of women; that my assumption that women are being harmed by overzealous breastfeeding promotion is dripping with “privilege-laden assumptions”. The people making these claims insist that poor, minority women think formula is superior (because they’ve all been victims of unscrupulous marketing and social pressure), and do not know the benefits of breastfeeding, and that if anything they feel ostracized if they breastfeed. Formula feeding, they say, is the unfortunate norm – my concerns have no place in these communities.

I don’t deny that I am coming from a certain perspective, and I always acknowledge that things are different depending on where you live, and what your social circles are doing. I also don’t deny that these social and marketing influences are real. But I think it’s just as privileged to assume that all women in lower socioeconomic areas need to be “educated”, and to ignore the fact that the lower a woman’s status in society, the easier it is for her bodily autonomy or emotional well-being to be violated. Ensuring that the rights of these women are protected is more important than raising breastfeeding rates – and the same policies which are worrisome for a privileged white woman are even more deleterious for someone whose voice is already struggling to be heard.

Yesterday morning, I met with two women who work at an organization serving a lower income neighborhood of Manhattan, helping teenage mothers from a variety of cultural backgrounds. These women told me that in some of the ethnic groups they serve, breastfeeding is very much the norm; in others, it is not as culturally accepted. Their organization is extremely pro-breastfeeding – there is no formula available at their office to give to girls in need, and they encourage breastfeeding throughout the prenatal period and beyond. But when I brought up the idea that the girls these women work with are not being affected by the “breastfeeding makes good mothers” philosophy, I was met with disbelief. “The ivory tower ideal is even more of an ideal for someone who is already struggling to fit the definition of a good mother,” one of them explained. They expressed a need for better messaging – encouraging at-risk women to focus on mothering rather than just feeding. Things like promoting skin-to-skin, reading to your baby, eye contact… not putting the emphasis on breastfeeding as the be-all end-all of parenting.

I also learned that the breastfeeding education these girls are given mostly consists of comparisons between formula and breastmilk, and information on how breastfeeding leads to better bonding and healthier kids. There is little instruction on the actual mechanics of breastfeeding, or how to manage the lifestyle barriers that could make exclusive nursing difficult. So while these young women may go into labor wanting very badly to give their babies the best (and they are well aware its the best, as their prenatal education features lectures on the differences between formula fed and breastfed babies), once they leave the maternity ward and have to return to work or school within a few weeks, without successfully establishing breastfeeding, or knowing how to pump, or how to advocate for their right to express in the workplace (if their workplace even falls under the parameters of the latest breastfeeding laws, many end up on formula- without any advice on how to do so safely.

After that meeting, I had lunch with an FFF who lives in Brooklyn. Her story was all too familiar – wanting to breastfeed, finding herself faced with low supply, getting conflicting advice from healthcare providers, balancing her own health and sanity with her (incredibly nuanced) understanding of breastfeeding’s benefits. The same sort of story we often see on this blog, from an educated mom with a supportive partner who had the ability to hire lactation consultants, and knew how to read scientific literature well enough to suss out her own risk/benefit analysis.

Obviously, this woman came from a very different situation than the women represented in the day’s earlier conversation.  But there was a remarkable similarity in what was expressed by everyone I spoke to. There was consensus on what we need: a more balanced, less hysterical, more individualized approach to infant feeding. All agreed that an honest discussion of the challenges of breastfeeding would be helpful, and that education on formula feeding safely and knowledgeably would go a long way in protecting the physical health of babies and the emotional health of mothers, regardless of their socioeconomic or ethnic background.

The stories these women are telling are not about white or black, native or immigrant, poor or rich. This isn’t about politics. It’s about what will be the best choice for an individual woman in her individual circumstances. These are stories with one moral: that we can – we must – support a woman’s right to breastfeed as well as her right to choose not to breastfeed.  This isn’t about doing away with Baby Friendly, because we need to ensure that women are getting a good start to breastfeeding and every opportunity to make it work (and that means switching the focus from vilifying formula to actually helping women initiate and sustain breastfeeding in practical ways). But we need to speak up and insist that there is a way to do this without loading more pressure onto new mothers.

I have a feeling breastfeeding guilt is seen as a problem of the privileged, because we are the ones with the time, resources, and autonomy to speak up about it. That doesn’t mean women of other backgrounds aren’t feeling the same pressure, perhaps manifesting in even more damaging ways. Still, it’s not my place to pretend to understand them, or to put words in their mouths. There’s no way I could, because these women aren’t an aggregate. They are individuals. To speak for the “disenfranchised” or “minority communities” as a sole entity is asinine. My experience is extremely different from other moms in middle-class Los Angeles – that doesn’t make it any less real, or valid.

One-size-fits-all infant feeding policies do not work, because women are not one-size-fits-all. In fact, in both fashion and life, one size usually just fits a lucky few. To label breastfeeding guilt as solely an experience of one type of woman, and paternalistic “education” as necessary for another, is just plain wrong.  It would be nice, instead of arguing about who has the most altruistic motives to help certain groups of moms feel empowered, we just focused on empowering all women to make choices that feel right for them, and to decide how their bodies are utilized.  Because while I would never attempt to speak for anyone, I don’t think it’s a privileged assumption that most of us would appreciate the ability to speak for ourselves.

 

 

Formula feeding education, or lack thereof

Reading through my Google alerts, I almost squealed with excitement when I saw a link entitled “Health Tip: Preparing Baby Formula” from none other than U.S. News and World Report. A major news outlet! Formula feeding education! Squee!

Well, turns out the article was less “squee” and more “eh”.

According to the esteemed publication, the formula-related health tip that was so vital that it necessitated being “called out” (publishing world lingo for highlighting a fact or quote) was the following:

Wash Your Hands.

The rest of the tips have to do with general hygiene- cleaning surfaces, sterilizing bottles, etc. I’m probably being unnecessarily snarky, because this is important information; it is important to keep things as clean and sterile as possible when making up an infant’s bottle. They also throw in one useful tip about keeping boiled water covered while cooling (great advice). But most of this is certainly not new information, and in many ways, I think it’s a waste of newsprint.

Why? First, I expect most parents know they are supposed to wash their hands and clean their bottles. What they may not know is why. There is no mention of the risk of bacterial infection here, so it just comes of sounding like vague, somewhat stodgy advice, like something your mother-in-law tells you in that tone. (You know the one.) The kind of advice that gets filed in the “I know I should do it, but come on, what’s the harm” portion of your conscience, alongside “floss twice a day” and “never jaywalk” (unless you are in Los Angeles. Then you probably take the jaywalking thing seriously, as the LAPD will ticket your ass for crossing where you shouldn’t). I think an acknowledgement that these precautions will help you avoid potentially deadly bacterial infections would make the advice seem a tad more topical.

But also, this is standard food prep protocol. There are other intricacies to formula feeding that may not be as intuitive- safety precautions like mixing the proper amounts of water to formula; not diluting the formula; using the right type of water; discarding formula after specific amounts of time; opting for ready-to-feed for newborns. Or what about other tips which might help avoid other formula-related health problems? Like a run down of the different types of formulas so that parents can choose the right type for their babies. Advice for understanding hunger cues. A bit of education on growth spurts; what’s normal when it comes to formula-fed babies and spit-up and elimination (both pee and poop); a quick description of how to feed a baby holding the bottle at a good angle?

I get that this was merely a half-column filler, not an 800-word feature. I understand that U.S. News & World Report isn’t in the business of imparting feeding advice to parents (and in fact, the article in question was syndicated, from Health Day) . And I seriously do appreciate the effort to give a bit of valuable info to formula feeding parents. Yet, I can’t help but wish that this half-column was put to better use. A short paragraph on when (and just as importantly, why) formula should be discarded would have been infinitely more interesting and useful.

There are a few reasons why formula feeding education is as hard to come by as a good house under half a million in the greater Los Angeles area (I’m bitter about real estate at the moment). Many people think it’s unnecessary; formula feeding is seen as the “easy way out”, and assumed to be as simple as scoop and shake. Some breastfeeding advocates believe that prenatal formula education/preparation is counterproductive to breastfeeding promotion – the theory being that if you discuss it, it will be taken as an endorsement, when formula should only be used in an all-else-has-failed scenario. (The World Health Organization’s “WHO Code” basically forbids health workers from even uttering the words “infant formula” until it becomes clear that there is no other option.)

What is puzzling to me about this situation is that breastfeeding, while definitely a lost art in our bottle-heavy society, does have an intuitive aspect to it. Or at least it is portrayed that way – something so natural, so instinctual, shouldn’t require training. Assistance, yes. Support, most definitely. Protection, you bet your bottom dollar. But instruction/education? That seems rather – well, quite literally, counterintuitive.

Formula feeding, on the other hand, is something which has always been a man-made, lab created, medically-approved (at least up until recent events) form of infant feeding. It does require instruction; you don’t see our primate cousins giving birth and popping open a can of Similac (although I am quite sure they could be trained to do so, considering how smart they are. I’ve seen Rise of the Planet of the Apes. Scared the bejesus out of me). Yet parents leave their prenatal classes and hospital stays with plenty of info on birthing and baby care and breastfeeding, but little to no instruction on how to make a damn bottle.

The vast majority of babies will have some formula in their first year. Heck, by the time they are 6 months old, it’s a safe bet to assume most of them are partially, if not exclusively, formula fed. We can’t sell infant feeding as the number one predictor of infant health and development and simultaneously ignore the primary way our nation’s babies are being fed.  It’s bogus, and irresponsible.

This is not to imply that parents are putting their babies in dire jeopardy because they leave a bottle out too long, or forget to scrub their hands like Lady MacBeth before mixing formula. Heck, I committed almost every formula feeding sin and my kids are pretty normal. (Except for Fearlette’s suspicious fear of police helicopters, but I blame that on her past life.) But until we ensure that parents are properly educated on formula feeding – something that could be done with one quality, AAP-endorsed pamphlet, or a few minutes of discussion in a hospital baby care class – we can’t possibly get a clear idea of the real risks of formula feeding (I bet we’d see an even smaller difference in breastfed versus formula fed if all formula feeding parents were doing it correctly), or feel confident that all of our babies are getting the best version of whatever feeding method their parents have chosen.

For now, I’d suggest checking out Bottle Babies – a great non-profit organization run by some friends of mine. They’ve put together some excellent, research-based information on a myriad of bottle-related issues. Or feel free to click on the link to the FFF Quick-and-Dirty Guide. And I hate to say it, but for the moment, the formula companies are probably the best resource for formula feeding parents. At least they give a crap about their customer base, even if this is rooted in a desire for customer loyalty and a fear of litigation.

And, ya know, remember to wash your hands.

Nothing changes…

Lately I’ve been frustrated. Like, mind-numbingly frustrated. It seems that every week there’s a new article on the infant feeding wars, rehashing the same points over and over, with the same battle being waged in the comments section: You’re judgmental. Yeah, well, you’re anti-breastfeeding! No I’m not, and I’m a better parent than you! Oh, really, well, I’m am MD/RN/LC/PhD and I KNOW I’m right, so shut up! You’re a lactofanatic! You’re selfish and misinformed and a threat to breastfeeding moms everywhere! Bloomberg! Hannah Rosin! Bottle! Breast! Bottle! Breast!

Shall I go on?

I’ve been blogging for nearly 3.5 years now, and I’m so damn tired. I’m incredibly grateful and proud of the community which has formed around FFF, but I don’t see anything changing. I want to do more than whine about how unfair the current atmosphere is; I want to change it. I want to make this blog unnecessary, because I’m truly sick of talking this subject to death. And I’m sure you guys are sick of hearing about it. How many times can I pick apart studies which fail to thoroughly consider the most basic notions of correlation and causation? How many ranty essays can I vomit out about the pressure to breastfeed? None of it seems to matter, because nothing changes.

I mean, nothing changes.

I wrote a book, one that took nearly three years of heavy research, interviews, and soul-sucking rewrites, hoping that it would help me reach a larger audience, and get people talking on a more nuanced level about this debate. But no one wants nuance.

And nothing changes.

I sit here at my computer, hiding behind the safety of our little community, preaching to the choir, holding myself up as fearless while I wallow in fear; the fear that people will judge me, criticize me; the fear that I will disappoint you.

And nothing changes.

Recently, an opportunity came up that might allow me to effect change in one tiny arena of this circus of insanity. It would allow me to meet with some other people who are uneasy with the way formula is being vilified. It would give me the ability to spread the message that we need better education and guidance for bottle-feeders. It might give me access to people willing to listen to ideas about tempering the Baby Friendly Hospital Initiative to be a little more palatable to those of us who must, or choose to, formula feed.

The problem is that this opportunity necessitates my associating with a formula company. They are the ones with the means to bring me to the table, to have these conversations. It makes sense that they contacted me; they have a vested interest in protecting infant feeding “choice”, and so do I. But theirs is financial, and mine is personal. I’m not naive; I know they aren’t doing this out of the kindness of their hearts.

Formula companies- like all major corporations- are out to make money. Some of the ways they go about this do not bother me – for example, I see no harm in them advertising their product. I view formula as a healthy substitute for breastmilk – certainly not perfect, not without room for improvement (because I always suspect manufactured substances always have room for improvement – that’s just the capitalist in me), and as I explain in Bottled Up, not a competitor to breastmilk. Just another option. Considering the only industry that has major restrictions on advertising is Big Tobacco, to say formula companies shouldn’t be allowed to advertise is to compare them with the manufacturers of cigarettes- a completely unfounded, ridiculous, and irresponsible comparison, in my opinion. I don’t like when they bring breastmilk into the marketing message – lines like “closest to breastmilk” should be left on the cutting room floor- but at the same time, how can we really blame them? If we are spending so much time and effort convincing society that breastmilk is the gold standard, why wouldn’t specific formulas want to be seen as coming closer to matching this liquid gold than their competitors?

But there are other ways that formula companies handle themselves that provoke a disturbing, fundamental mistrust in my gut. They want to increase their sales; therefore, it’s in their best interest if women do not breastfeed. This is a fact that’s impossible to ignore, when we see them sponsoring breastfeeding “help” hotlines and guides. I can’t help siding with breastfeeding advocates on this one: the LAST people who should be giving breastfeeding advice are the folks with a vested interest in having women turn to the alternative.

This is the point in my ongoing internal debate where I start getting all angst-ridden. Formula marketing execs need to take a long, hard look at how they are handling their accounts. They have an incredibly smart, media-savvy audience in this country-not all moms are Little Red Riding Hoods; many of us know there’s a wolf hiding behind that grandmotherly lactation consultant. Even if the breastfeeding information they are doling out is 100% useful, encouraging, and evidence-based, it is not going to be received as such.

What I find so frustrating is that formula companies are so busy trying to market to breastfeeding moms, when they have a willing and ready market base just sitting here, waving our arms to get their attention. Ban The Bags doesn’t want them hawking their wares to mothers attempting to breastfeed? Fine. More for us. Why not urge hospitals to keep the bags on hand, to be distributed only to parents who request them? Or even better, give parents the option of signing up on a website to receive the samples in the mail. Seems like a no-brainer that most moderate people could accept as a compromise.

Likewise, why should formula companies distribute pamphlets on breastfeeding when formula advice is so needed? If you’re going to spend money sending formula samples in the mail, the literature accompanying it should be about formula feeding. Not breastfeeding. Leave that to Medela or Lansinoh.

I have plenty of ideas on how formula companies could better serve us, their true customer base, and perhaps shift the cultural opinion of formula feeding away from a “competitor” to breastmilk and towards a more moderate point of view, where it is merely seen as an option for women who cannot or choose not to breastfeed. Tough distinction, but worth making. And there’s a hopeful part of me which thinks that maybe, just maybe, the formula companies also want to protect their customer base – even if it is for entirely selfish reasons.The formula companies don’t want their customers feeling ashamed to buy their products; they want us to be proudly bragging about how great our kids did on Enfasimistart. They don’t want us improperly using the stuff and then suing them later.

If I’ve learned anything in the past few years, it’s this: breastfeeding moms have a tough time in this world. But they also have a lot of respected, smart, noble individuals fighting their fight. No one believes that formula feeders need defending, so we are left to our own devices. The only folks who have a vested interested in our well-being is the formula companies, and they haven’t really done us many favors.

I’ve been thinking that maybe I can change that, though. If I can’t make headway with the breastfeeding organizations, maybe I can at least provoke some change in the companies who are making and marketing the products that feed our babies. Maybe if they hear from us – their customers – they can put some of their considerable resources and influences to good use, rather than simply pissing off breastfeeding advocates and giving them more fodder to hate on formula, formula makers, and by association, formula feeders.

This is something I want to do; something that I think could actually provoke change in a positive way for both formula feeding parents and breastfeeding moms – because we don’t have to be at cross purposes. I support infant feeding choice – that means ensuring that breastfeeding and formula feeding are equally protected, and parents are appropriately educated about whatever feeding method is right for them. I don’t see any education or protection for formula feeding parents, and no one is willing to change this. It would be great if UNICEF or the Academy of Breastfeeding Medicine wanted to listen to what I have to say, but I’m not waiting by the phone for them to call. I don’t get the impression they’re very interested in what I have to say.

While all of this sounds good in my head, these thoughts are giving me a migraine. I’m well aware that associating with the formula companies opens me up to major criticism. And yet I can’t help think that there is a major difference between being influenced by a formula company, and influencing a formula company. Being influenced by a formula company would mean having them sponsor this blog, or pay me a salary, because then my content would be soiled by bias- whether it be of the financial or subliminal persuasion. We’ve all seen how having ads or sponsors can soil the editorial style of some of our favorite bloggers; I certainly don’t blame them for it, since this blogging thing takes time and a girl’s got to eat. In my case, though, if I don’t have my neutrality, I don’t have sh-t.

But I’m not talking about being influenced – I’m talking about influencing. I’m talking about having them interface with me on MY terms, helping them move in a better direction, and walking away if I feel things are shady. I’m not sure how this is more suspect than a representative of Planned Parenthood meeting with Trojan. The former wants to advocate for safer sex, and knows abstinence is unrealistic; the latter makes condoms; if Trojan can help promote safer sex and sell more condoms due to a halo effect, it’s a win-win for both parties.

I’m opening this up to the community, because your opinions are the only ones I care about. People have been accusing me of being in the pockets of the formula industry since day one; I don’t know if it even matters to them whether I throw molotov cocktails into the lobby of Nestle headquarters, or bathe naked in a vat of Good Start. But I take my responsibility to this community very seriously, and I wouldn’t make a decision like this without your input.  Please think about this, and let me know: is it okay to associate with the formula companies on an advocacy level? Or will this destroy my neutrality, even if I vow not to let it?

Because seriously…. something has to change.

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