In honor of Breastfeeding Awareness Week (August 1-7, 2012), and myself as a breastfeeding mom, I am responding to a recent blog published by Amy Sullivan for The New Republic, The Unapologetic Case for Formula-Feeding.  As someone who is still enjoying a rewarding breastfeeding relationship with my 20 month old, I was curious in finding out what this case might be.

I was disappointed to finish reading the article only to find that no case for formula-feeding was made at all, and even more disheartened to see that  Amy Sullivan equated her own anecdotal positive formula-feeding experience with a valid argument to be made against a New York City program, Latch on NYC, that promotes breastfeeding.  Part of the program aims to: 1) stop hospitals from distributing free formula samples to new parents; 2) encourage hospitals to adopt policies that require parents to convince a nurse to sign-out formula by providing a medical reason for each bottle of formula; and 3) provide information and education to new parents at hospitals on the benefits of breastfeeding.

Amy Sullivan disagrees with the Latch on NYC program.  Her main arguments against the program include: 1) She has formula-fed from day one and finds it to be convenient for modern-day work and life for various reasons; 2) the expectation that women breastfeeding overly- stresses the lives of working women; 3) she apparently believes that the only way to have an equitable parenting partnership with a husband, or allow for bonding with a father, is if a baby is formula-fed; and 4) breastfed babies aren’t actually proven to have more positive outcomes.

Let’s first put opinion and personal experiences aside (I’ll move on to that later) and address the real heart of the matter: is there a case to be made in favor of formula-fed babies that invalidates the Latch on NYC program as the title of her blog and her introduction suggests?  Her title and introduction led me, as a reader, to believe that I would be offered some evidence or facts as to why the Latch on NYC program might have negative public health or economic outcomes that taxpayers are forced to absorb, or how their might be negative outcomes on the health of babies or mothers if they are encouraged to and educated about breastfeeding in hospitals.  She provides no such evidence, probably because someone would be pretty hard-up to offer evidence on the negative public health impacts of breastfeeding.

As someone with an economics background, I tend to contemplate policy decisions through that lens first and foremost.  Why would Mayor Bloomberg and the NYC Health Department be interested in having hospitals adopt pro-breastfeeding policies, I wonder?  The most obvious reasons include: 1) improving public health outcomes; and 2) decreasing public health expenditures.

These are the real issues, personal anecdotes or opinions aside, that any article criticizing or supporting the Latch on NYC program should address.  Relying on anecdotes and personal experience alone I find to be both irresponsible and dangerous, but not surprising since political discourse in this country often seems to re-shift the real debate away from intellectual argument and evidence towards self-referential myopic viewpoints.

The only allusion to facts about breastfeeding vs. formula-feeding that Amy Sullivan presents in her article is a new study that concludes that breastfed babies tend to have higher IQs than formula-fed babies not because they are breastfed, but because mothers who choose to breastfeed are more likely to have higher IQs themselves, are more educated, and less likely to smoke. Okay, so a study says that smart women choose breastfeeding.

Amy Sullivan takes this study and concludes that breastfeeding provides no advantages whatsoever to a baby and …”requires women to go weeks without getting more than two hours of sleep at a time…”  Whoa.  Hold on.  First of all, Ms. Sullivan- does one study about IQ and breastfeeding offer conclusive evidence that there are no other benefits to breastfeeding?  I can definitely buy that there is a correlation rather than cause with the IQ- it certainly makes sense.  But do you really believe there are no other benefits?  And where in the world did you get the idea that parents using formula get tons of sleep and breastfeeding parents don’t?  Most importantly, what does your conclusion offer us in terms of contemplating whether or not a city should adopt policies to encourage breastfeeding at hospitals or not?

Amy Sullivan basically concludes that breastfeeding is incompatible with the lives of modern day working women and presents the “case” for formula-feeding as a more ideal alternative, using only…her own experience.

The World Health Organization promotes exclusive breastfeeding for at least the first six months of life, although currently only 40% of infants under six months of age are exclusively breastfed for the first six months of life.  In most places in the world, exclusive breastfeeding can be life-saving- it provides the perfect nutrition, is safe, and most importantly contains antibodies that formula does not that helps protect infants from common childhood illnesses including diarrhea and pneumonia, the two primary causes of child mortality worldwide (Public health concern #1).  Breast milk is also readily available and affordable (Public economic concern #1).

The bottom-line is that formula is expensive- there is a higher cost to formula-feeding than to breastfeeding.  Would it not be more cost effective and save tax-payer money if more women relying on public aid for health and food were breastfeeding and not unnecessarily wasting money on formula?  Isn’t the hospital where they give birth a pretty good start to educate mothers on breastfeeding and how to do it successfully to save money for them and us?  That alone is reason enough to take a step back from opinions and personal experiences, whether a breastfeeding or formula-feeding parent, and think about the bigger picture.

Breast milk in developing and developed countries can be lifesaving for premature and low-weight babies at birth.  If the birth mother is unable to provide milk for the baby, then donor breast milk is the next best option, followed as a last resort by infant formula.  One of the biggest challenges premature and low birth-weight babies face is consuming enough calories- breast milk is unquestionably the best source for these calories and can make a difference in a baby living or dying.  Formula is made from cow’s milk, which human babies (particularly premature ones) have a difficult time digesting- it can cause problems with absorption of nutrition and digestion.

Even more compelling, especially in the developed world where potable water does not make us a concerned about safe water and diarrhea, “adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.”  Talk about a public health and public economic concern in a country with childhood obesity, heart disease, diabetes, etc. are costing us billions of dollars every year.

Might this also be a compelling reason for a city to adopt a cost-effective prevention measure to try and contribute to the solution for our growing health care expenditures, especially when considering that lower income people dependent on public health aid (E.g. our taxpayer money) are particularly at higher risk for these health problems?  Educating a mother about health and nutrition beginning with day one in the hospital can help to increase her awareness and concern about her child’s health over the long-run.  It certainly can’t hurt anyone, can it?

Breastfeeding also has health benefits for mothers.  It reduces risks of breast and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster, and lowers rates of obesity (Public health concern and economic concerns #2).  More cost savings here.

Let’s also not glaze over the fact that an international code to regulate the marketing of breast-milk substitutes was adopted in 1981 calling for, among other thing, no promotion of breast-milk substitutes, no free samples of substitutes to be given to pregnant women, mothers or their families; and no distribution of free or subsidized substitutes to health workers or facilities.  That was 30 years.  Latch on NYC is way beyond the times.  What they are doing is nothing new, modern, or even controversial- it’s following international best practice adopted three decades ago.  It’s amazing that more places, or the U.S. as a whole, has not adopted these practices because of the positive health and economic benefits that it would have for our nation.  It’s also international best practice to provide lactation consultants to help new mothers in learning and practicing breastfeeding, which has been proven to increase the practice of breastfeeding for a longer duration.

The bottom-line is that even if you personally do not care for breastfeeding, or even if you disagree that there are no positive benefits to breastfeeding, you can’t, with integrity, ignore the direct cost to taxpayers of footing the unnecessary bill of expensive formula for mothers depending on public aid.  Breast milk is free, and arguably no less nutritious or beneficial for babies.  So why wouldn’t we want to, as a matter of policy, want to educate, help, and promote breastfeeding in hospitals?

This is where the real debate should be framed.  There is certainly a place to discuss opinions and experiences about breastfeeding vs. formula-feeding, and parenting, motherhood, and fatherhood in general, but those should not be driving or shaping public policy- or the debates around them.  Amy Sullivan’s blog would be more aptly titled, Why I Liked Formula-Feeding My Baby, rather than The Unapologetic Case for Formula-Feeding.

Now let’s turn to what her blog was actually about- why Amy Sullivan liked formula-feeding- and step away from the very separate public policy issue of promoting breastfeeding in hospitals.  I will use my own personal experience and anecdotes to show how ridiculous it is to use personal anecdotes to make these arguments since each of us, whether breastfeeding or formula-feeding, have different experiences, positive or negative, and challenges as parents.  We’re really not all that different when it comes down to it.

I have numerous times written blogs about the benefits of breastfeeding for traveling mothers like myself (E.g. lighten the packing load, not worrying about packing/ finding formula at the destination, easier to get through TSA, quick and easy fix for calming baby in long lines, on airplanes, helping baby’s jet lag, etc., and most importantly providing baby with antibodies when traveling to developing countries we frequent and removing the risk of water-borne disease).

However, in all of my packing lists and advice I provide information and options for parents that may be exclusively breastfeeding, pumping, or bottle-feeding/ formula feeding.  Everyone makes different choices for different reasons, sometimes out of necessity and sometimes out of preference.  That’s okay, and I respect any decision a parent makes for whatever reason.  It doesn’t make us any less of a mother or parent, whatever we choose.  This is why I find Amy Sullivan’s “case” for formula-feeding extremely weak and clearly misinformed about the lives of breastfeeding mothers.  Again, like Amy, this is based on my personal experience alone.

1) Amy states she “made the decision to formula-feed for one reason: [she] wanted to have a fighting chance of setting up an equitable parenting arrangement.”  Seriously?  All of us that breastfeed don’t have a fighting chance of setting up an equitable parenting arrangement?  

My husband and I both work as free-lance consultants in international development.  I had the first consulting gig after our daughter was born, which included a three week work trip to Paraguay when my daughter was only six weeks old.  The three of us went to Paraguay, and most of the days I was gone for 12 hours + in rural farm areas- sometimes I would leave at 3AM and return at 1AM the next morning.  My husband was the sole care provider for our infant (feeding her my pumped breast milk and washing cloth diapers by hand).  A few days into the arrangement he sent me an email stating that he didn’t even have time to take a shower or catch up on the news- he was exhausted.

He was loving spending time with our daughter, but overwhelmed.  He is in every way an equitable parenting partner, and he has the empathy and understanding of how hard it is being a sole care provider because of that initial experience he had solo.  He often suggests I hire help when he is the one working and I am home with Veda (we frequently switch roles), just so I can “have time to myself.”  Breastfeeding my daughter in no way diminished my opportunity as a woman to be in an equitable parenting arrangement.  The idea that formula-feeding is the only way to have an equitable partner is bizarre to me- I always just assumed that since I made a decision to marry a great, equitable guy, he would continue to be that as a parent and it never occurred to me that I would have to force him to be an equitable partner in parenting via formula-feeding?

I also pumped on and off for the first 16 months or so so that my daughter had breast milk when I had to be away from her for work.  Usually that meant that I was working somewhere remote and rural, so I have pumped in the back of jeeps surrounded by male colleagues, behind trees, among circles of breastfeeding farm women with whom I was holding focus groups (did I mention I am also a gender equality specialist?), in unlit musty storage closets, and in stinky bathrooms.  Yes, pumping can be challenging- I will be the first one to say that.  For me it wasn’t a matter of “self-sacrifice” as Amy Sullivan makes it out to be- it was just part of it all, and I did it because I made the decision to breastfeed and give my daughter my breast milk, and still wanted to work.  I wasn’t a martyr about it- it just was what it was, just like the rest of parenting just is what it is with all the challenges and rewards (for me, at least).

I do have to say, though, that out of all the places I have pumped throughout the world (including Paraguay, Jordan, and India), finding a less worse place to pump in the U.S. kind of seems like a piece of cake.  The real argument about breastfeeding and pumping, though, shouldn’t be about women being forced not to pump in the U.S. because of work conditions and forced to choose formula-feeding as a better alternative that suits “modern-day life.”  The real argument should be about how we should change policies in our country to ensure women (and men, minus the pumping) have pro-baby, pro-family, pro-pumping work environments and arrangements.  If the work conditions suck, let’s change the work conditions- why do we have to adapt to crappy conditions?

2) Amy Sullivan asserts that “the choice to formula-feed gave [her and her husband] a precious gift in those first few exhausting months: sleep.”   She said she relished in sometimes getting eight hours of sleep, and that she “bets the La Leche women don’t mention that!”

I bet they don’t mention that, either, because as someone who has breastfed since day one, I was getting ten to twelve hours of fantastic sleep every single night.  I will caveat that by saying that we also co-slept, which means that when my daughter was hungry she would latch on- we both “roused” but never actually woke up.  Everyone’s first question the first few months of my daughter’s life was always, “You must be exhausted?  Are you getting any sleep?”  My husband and I thought this was hilarious.  We were more well-rested than we ever were before.  My baby’s breastfeeding helped me to fall asleep and stay asleep, and I slept…like a baby.

I always tell people I am the laziest mother in the world because I breastfeed and co-sleep.  I can’t imagine having to get up out of bed in the middle of the night to fetch my baby and go to the kitchen to prepare a bottle, figuring out how warm it should be, etc.  I am amazed that moms and dads do this every night.  My husband and I both have slept so well with our arrangement, and all of the women I know how breastfeed and co-sleep (which is advocated also by La Leche League) giggle at the thought of being sleep deprived.  I agree with Amy Sullivan that a happy baby requires a happy mom, which requires rest.  And as a breastfeeding mom, I have gotten more rest than I ever dreamed of since my daughter’s birth.

3) Amy Sullivan asserts that “bottle-feeding allowed both [her] and [her] husband to bond with [their] new daughter.”  She goes on to say that because breastfeeding creates an amazing bond between mother and child, “it also guarantees that fathers have that much less time to develop a bond.” She cites that she can’t imagine denying her husband the special time he had with her of giving her bottles and stories every night.  This seems to be her most defensive argument that she makes, and also goes on to state that her bond with her daughter didn’t suffer as a result of formula-feeding.

There certainly is a completely out-of-this world bonding experience that comes with a breastfeeding relationship that I could never understand until I was in it.  But I certainly would never say that mothers or fathers that do not breastfeed are denied a chance to develop a bond with their child.  That would be ridiculous.  Just as mothers who do not breastfeed can have just as close and bonded a relationship with their baby and child as a breastfeeding mother, so can a father have a close and bonded relationship with his baby, whether his partner breastfeeds or not.

Fathers bond with their babies in amazing ways, too.  Fathers of breastfed babies can read their children stories, too. They can also give them pumped milk through bottles.  My husband bonded with baby by wearing her in a baby carrier/ sling much of the time.  Whenever he went anywhere he was eager to jump at the chance to have her tied tightly to his chest, and many of her photos early on were of her sleeping on his chest, her head against his heart.

Might we agree that any loving parent, whether breastfeeding, formula-feeding, or partner of a breastfeeder or formula-feeder, can develop and nourish a lasting healthy bond with their child?  Do you honestly believe that fathers of breastfed babies are less bonded than fathers of formula-fed babies?  Why the need for divisive unsubstantiated suggestions about any parent’s ability to love and bond with their child?

4) Lastly, Amy Sullivan asserts that it is a “shameless promise that breastfeeding will help women lose weight faster after giving birth.”  She says this is a shameless promise because she was active and lost all her weight quickly (because she was so well-rested and was able to “walk for miles around the city in gorgeous autumn weather).  I’m not entirely sure how logic follows that breastfeeding is a shameless promise to help lose weight, just because one formula-feeding mom also lost weight by walking a lot.  Yes, it is logical to say that women who do not breastfeed are also able to lose weight through exercise (and presumably diet), but how do you make the logical leap that breastfeeding won’t help?

I ran a 5K and did yoga every single day of my pregnancy, including the day I went into labor.  I’m pretty sure that helped me stay in shape, have a speedy recovery from birth, and bounce back to health.  But my daughter was born in the dead of Chicago winter in the month of December- no lovely autumnal outings for us.  It was blizzard conditions, so I was happy to hibernate in my warm home with my newborn.  Then I was off to work 12-18 hours a day in Paraguay- no time for exercise there.  I got zero exercise the first few months.  And all the weight was shed off completely by the end of the third month (actually I lost a few extra pounds, too, and had a completely flat belly)- with zero effort at all on my part.

Both breastfeeding moms and formula-fed moms can shed weight.  I think the point is that breastfeeding moms, whether because they had to have an emergency C-section and are limited physically, are living in extreme weather conditions (E.g. blizzards in Chicago), they are a single parent working two jobs without time to exercise, or quite frankly are not prone to exercising, might not be able to stroll about on lovely autumnal days and “walk off” their pregnancy weight.  I’m all for exercise and think that moms will greatly benefit pre-natal and post-natal from exercise, but let’s not dismiss all of the scientific evidence (and my personal anecdotal evidence- hooray!) that breastfeeding can indeed help shed weight faster, sans any working out.

Ms. Sullivan also reminds us that breastfeeding mothers have to consume more calories, too.  We have to, she says, as if that’s a bad or unwanted thing.  Right now I’m pregnant and breastfeeding, which means I get to consume an extra 800 calories a day (300 for the pregnancy, 500 for the breastfeeding toddler).  I never saw it as having to- I get to chow down on a whole extra delicious meal. I feel freaking lucky!  I’m certainly gong to enjoy this now in my reproductive years.  I will admit that it has been a challenge to eat that much more each day (while making healthy choices), but certainly not an unwelcome challenge.

So, there you have it.  Amy Sullivan’s case against breastfeeding in favor of formula-feeding.  According to her “case” since I breastfeed, I should be a sleep-deprived 1950’s homemaker (although I think being a homemaker is incredibly worthwhile and respectable, and I often find myself inclined to leave my career and become a cookie-baking domestic goddess) with a husband who has relegated all parenting duties to me and has been deprived of any chance of bonding with our daughter.  On the contrary, I am a working pregnant breastfeeding mama of a 20 month toddler with the most indulgent husband whom I respect infinitely for how much he continues to show how worthy he is of being my partner in the way he equally (and often more) shares the parenting load.  And my daughter adores him- after one month being separated from him and arriving in India, she spotted him through a sea of people on the other side of the glass while I was grabbing our bags from the carousel.  She ran smiling to the glass, pressing her hands and face against the glass and yelling “Daddy!” grinning from ear-to-ear.  I’m pretty sure their bond has not suffered as a result of my -continued- breastfeeding.

If this is the strongest “case” someone can make for formula-feeding, it seems incredibly far from intelligibly informing a policy debate or decision about promoting breastfeeding in hospitals.  By providing my own anecdotal evidence of my personal experience with breastfeeding, I hope to show that it sort of doesn’t matter.  Amy loves formula-feeding and I love breastfeeding.  Both of us have seen the benefits of how we feed our babies, both of us have had conveniences in the way we have fed our babies.  So the point is- so what?  I’m sure we are both great, loving moms with happy babies.  So where does this get us in making sound policy decisions for NYC?  And where does it get someone on the fence, unsure of whether they will breastfeed or not?

In the end, like most decisions we make for parents, we choose what works best for us and our kids- which can be different feeding, sleeping, or childcare arrangements, development and discipline approaches, and the list goes on.  Let’s have a conversation about what works for our individual families to help others make informed choices, but let’s not make ill-informed claims about the effects of what some parents choose (E.g. fathers of breastfed babies don’t get to bond with their babies).  That doesn’t help policy debates, nor does it assist parents choosing what is best for them in gathering reliable and accurate information in helping them form their decisions.

Amy Sullivan concludes by stating that she has “become a smug formula-feeding mama.”  I think it is incredibly sad that we continue to live in such a decisive society with so much smugness on every side of the aisle of every single debate.  As parents we have a wonderful opportunity to teach our children empathy, love, and cooperation.  We can teach our children how to hold-fast to opinions but be respectful and kind, to work toward a better world and future with others that hold different opinions.

Being smug, whether about breastfeeding or formula-feeding, isn’t helpful- in politics, in society, and especially as parents that are raising the next generation of leaders and policy-makers.  Let us bridge the divide by coming together and sharing our challenges, triumphs, and frustrations as parents all united in the hardest job of raising a human being in this world.  Let us challenge one another and ourselves in a respectful way with integrity and reason.  Let us put aside our personal experiences and judgments when making policy decisions and look outside ourselves and how those decisions might impact all of us as a community across income divides- not just whether we like something or not relative to ourselves and our personal decisions.

Read more about facts on breastfeeding at the World Health Organization

Related Pages

Six Reasons to Choose Breastfeeding on the Go

Five Tips to Make and International Flight More Comfortable with Baby

Breakfast at 3am: How to Help Baby Adjust to Jet Lag

Five Tips to Practice Water Health Safety with Baby