Thanks for this post! Great work!

What about, "When he's old enough to ask for it, he's too old"?

Anonymous: Agreed. My boys have been asking for it from birth. Why does it matter whether they ask for it by crying, by signing or with words?

why do we have to waste energy being antagonistic toward each other like this. there are some instances when mothers might elect to use formula when the alternative becomes to difficult, particularly when there is little support (in many instances) to get through the difficulties of balancing work and childcare, not to mention that it's not the easiest thing to get the hang of. at least it wasn't for me.

i understand the reaction to the last two comments about weaning and public nursing, but the other comments seem just as disrespectful to mothers who choose formula. after all, most women (in the U.S. at least) start out wanting to nurse, according to the recent AAP report card; but it also states that many challenges still exist.

let's not make other women be another challenge to feeding our children. it took me six weeks before my child and i could work out the breastfeeding relationship, and comments like yours certainly wouldn't have been supportive during the times when i was already beating myself up for feeling like a failure (and having to supplement so he didn't keep losing weight). regardless of the truth of the information you present here, the way in which it's presented gives off an impression of elitism which is unlikely to bring anyone over to your side. we should be working to support each other, as moms, as women, rather than broadening the divide with the kind of rhetoric you claim to be combating.

I agree with mamasaysso. Using such aggressive sounding language and putting women down for using formula is in no way helpful or educational. My 6 month old is exclusively breastfed and I had a tough time getting started. Thank goodness I didn't come across your post then, I would have felt like a failure. Please rethink your style, you'll catch more flies with honey.

Thanks Amyables, Anonymous and Anna, much appreciate ladies.

And you too Mamasaysso, it's always good to get perspectives from all angles. I WISH I read this when I was first breastfeeding, I had no idea the importance of breastfeeding. I wrote this article and began this blog to help inform other women who were in my position - an uninformed choice is no choice. Help me understand what statements I've made that are elitist to you, I've tried to be as precise as possible. But I'm not about to pander to any "there's nothing wrong with formula" sensitivities.

Women deserve the truth for once, they get bombarded with enough formula marketing to last a lifetime.

Thanks again ladies :)

Sorry Erin, there's enough soft cushy "breast is best" articles out there, I'm not about to be one of them.

I don't find anything antagonistic about this article. As a matter of fact I appreciate that it lists arguments I have had to use over and over again myself. I know it will help mothers who see this who may be doubting themselves and it also reassures me as I fight a sometimes lonely battle.

The fact is that breast milk is perfect nutrition. This is marginalized severely by formula marketing campaigns and along with our baby unfriendly modern society and lack of information, women are misinformed that there really is an equal choice. There isn't. Babies are born with the right to breast feed and gain comfort and nutrition from their mothers. It's not a feminist issue, or an equal rights issue or an ego stroking issue. It is a fact. Look at nature and see what mammals need. This does not minimize dad's role or extended family's role. It is a statement of fact as true as to say that a baby is best carried in-utero full term. This is not about the adults being offended it is about speaking up for the baby who is literally helpless without us.

The position stated by Cherie is not original. It has been stated by many advocates before her. I applaud those who have the courage to set politics aside and speak the truth. We should really try and focus on the issue at hand.

Personally, I had many problems with my first child and though I managed to breast feed for over 2 years, it was always supplemented. Was it ideal? No. I did my best with what I had. I also had problems with my second child which I managed to overcome with perseverence over 10 weeks, a time frame that many told me they would not have lasted. I have had women stop me and ask me if it is easy and others applaud me for doing it in public, as they feed their own child with a bottle (contents sometimes formula sometimes breastmilk). I have had others stop playdates because my child could verbalize her need to nurse. I have been told by family I am spoiling my children because they breast fed on demand and through the night. I have also been told the infamous line :"look at me! I turned out fine on formula"

Our anti-breast feeding culture is overwhelmingly ubiquitous. We need to speak up for the children and set our own needs for ego stroking and politics aside. In doing so we are also 100% supporting those high numbers of mothers who start out intending to breast feed and for some reason end up failing. We may in the process convince the rest to at least give it a go, and ultimately help curtail some of the societal barriers. And for those who truly need supplementation, as I did, with support and trying, at least we know we gave it our best shot. Hopefully human milk donors will be able to bridge some of that gap for us in the future.

I know some of you guys may find it a little strange a man replying to a breastfeeding site (A damn incredible service for all informed mothers - thank you Cherie and Natural Moma NZ).I am a stay at home daddy of 3 awesome new generation leaders! It is an absolute honor to be able to soak in every second of our babies lives isn't it!! "You only get this second in time once so enjoy every one of them and never stop appreciating"!
In relation to the formula companies (Effectively drug companies) we must all remember that they are big business - human wellbeing in reality is not in the forefront of their mission statements, Admittedly these companies do endeavor to budget copious amounts of profit in to their R&D Departments as the drug company age old ethos is to find the synthetic equivalent of substances that naturally occur - it is understandable that their aim is to create a sustained source so we don't continue to absolutely pillage this planets limited resources - however - breast milk is sustainable. Common sense then says Formula is primarily a marketed product for the simple outcome of profit so these companies can then continue to research and develop their "One Big Product" Imagine if you were the one that invented Ibuprofen - Need say anymore?? In short - live and let live - Mums out there that are unable to produce or simply just don't want to I respect you decision - A woman should never feel pressured to do any thing - too many woman are psychologically pulverized whether it be aggressively or more commonly passive (open your eyes it is every where) to be and do what you are socially supposed to do to be acceptable Stand tall all you beautiful human beings you are powerful you are you - you grew a life you are what keeps that life alive and most incredibly you can feed your baby and keep it alive! Without you Human beings cease to exist!- In my opinion you baby deserves a total Selfless Parent on both sides, It may be that in this the 21st century we don't have to rely on wet nurses anymore because of these synthetic designs - but in conclusion again common sense says Breast Milk is natural it is well tested since the birth of Human civilization - it is an amazing product only produced by you ladies and there is not a drug company that could ever or will ever replicate the sheer magic or beautiful complexity that is what a woman can do naturally - you are special - a most beautiful gift from the powers of the universe thank you for the amazing gift you give of being you every day!!

Massive

Thanks so much for your comments Anonymous and Massive, I'm honored to have such wise readers. I truly enjoyed reading your comments, you hit the nail on the head pointing out that the root of our "breastfeeding catastrophe" lies in formula marketing, and the skewed beliefs it has instilled in the minds of mothers.

All the best :)

Love your posts! It's about time someone has the guts to present the facts instead of your usual mamby pamby "Breastfeed if you can..but if you can't, your baby will turn out okay". Yeah..my kid could survive a whole year on hot dogs and french fries..doesn't mean he's healthy. I see babies whose mothers stopped breastfeeding. They bounce from formula to formula, trying to find one that doesn't make them vomit or have diarrhea, when they could have been breastfed. People laud that it's the mother's choice..but how is it a good "choice" if she's not truly informed on what she's giving up by formula-feeding? Plus, why do we have to make women choose between having a career and breastfeeding? It used to be that if women wanted a career, they had to give up the option to have a family. Now a woman can have both a career and a family. It's about time that employers cater to breastfeeding. Great article! Keep up the good work!

You know it would be fantastic to see creche's, private feeding rooms etc compulsory at all jobs. Mother's are doing the most important job of all - raising the next generation - and should be given the tools to do this effectively.

Also, breastfeeding mothers drastically lessen the load of sick children in the health system (as stated above, formula fed infants are 14 times more likely to be hospitalized in their first year), and should most definitely be rewarded for that.

Thanks for your comment ;)

I didnt get to breastfeed my daughter for long but was lucky enough to do so with my son. They are both wonderful kids only the one i breast fed has eczma and asthma at 3. I absolutely believe in the benefits of breastfeeding but it by no means is the be all and end all of child health, genetics plays a WAY bigger part. For example the stat that formula fed kids 14 times more likely to be hospitalised could well be skewed by genetics as some mothers who cant breastfeed because of illness may pass on the dodgy genes that go with it. As stated in a previous article on this site, there are studies and statistics to support any point opinion and at the end of the day breast or bottle does not define success as a mother.

Breastmilk has shown to be EXTREMELY beneficial to babies health, as shown in studies. Often in studies they they take into account genetics and other factors that would influence results and then adjust the result accordingly.
When talking about "success" it's really an individual who decides on their own success. No one will ever know what it's like to be in another person's shoes, we all have unique situations.
What we do know, is that breastmilk is immensely more beneficial than formula, period. What a person does with that information is up to the individual.

Natural Mama NZ, could you please give your source for the claim that formula-fed babies are 14x more likely to be hospitalised? That in no way matches the figures I've read, and I can't see anything backing it up in either of the references you gave. (The closest I found was the Cesar et al article showing 16.7x risk of hospitalisation specifically for pneumonia - but that was in Brazil, and there are doubts over whether the living standards would be comparable to those of women in the majority of countries reading your blog.)

Risks I've seen from studies in the developed world have been much lower. Yes, there are certainly risks associated with formula feeding, but I'm concerned about getting the figures right. If you have a reference for that figure that I've missed, I'd be happy to see it.

Hi Sarah,
This figure ('formula fed babies are 14 times more likely to be hospitalized') has been mentioned in a lot of articles about breastfeeding:
http://www.infantfeeding.info/RisksofAF.htm
http://www.lactivist.com/
http://milkshare.birthingforlife.com/healthbenefits
http://www.007b.com/wonders_breastmilk.php

The figure comes from the study 'Hospitalization patterns of a homogeneous, middle class, white population' by Allan Cunningham.

Here is a HUGE list of studies on breastfeeding you might find useful too:
http://www.breastfeedingonline.com/RisksofArtificialFeeding.pdf
And another great cited article on the benefits of breastfeeding:
http://www.naturalchild.org/guest/leslie_burby.html

Thanks so much for replying! Unfortunately, none of those links give a reference for the study (the first says it does, but the link they give for references goes to an empty page). The first link did say the study was done in 1981, but I can't find anything relevant for that author in that year on Pubmed, and I couldn't find anything searching on the title terms you gave, either (I doubt that's the actual study title). However, I did find a study by that author published in 1979 ('Morbidity in breast-fed and artificially fed infants. II. Journal of Pediatrics 95(5) 685 – 9) which gave a 15x risk of hospitalisation in the first 4 months of life for formula-fed infants as compared to breastfed. So that could be where the data originally comes from.

Anyway, when I looked at that study, the problem with that figure was that it doesn't seem to have been adjusted for any possibly confounding factors such as smoking, socioeconomic class, or siblings in the house. Those could be related to a mother's likelihood of breastfeeding but could also affect the likelihood of hospitalisation themselves, so, if those factors aren't allowed for in the final calculation, it could lead to a major overestimate of the beneficial effect of breastfeeding.

I do know of a couple of studies into hospital admissions in breastfed/formula-fed babies that do allow for confounders, so those would give more accurate results. One, which was carried out in Spain in the 1990s, is available online at http://pediatrics.aappublications.org/content/118/1/e92.full – this only looked at admissions for infection, so it would give something of an underestimate, but since infections account for such a big proportion of hospital admissions in babies of this age group this would probably still have picked up most of the admissions. They found the risk of hospital admission in formula-fed babies slightly less than 5x the risk for babies breastfed for over four months. Another study was (I'm guessing from your blog title!) from your country, back in the '70s – Fergusson et al, 'Infant Health and Breast-Feeding During the First 16 Weeks of Life', Aust. Paediatr. J. 1978: 14: 254 – 8. That one would also give something of an underestimate as it only looked at admissions for respiratory and gastrointestinal causes, but, again, that would cover a large proportion of the admissions. They didn't find *any* increase in risk of admission for reasons in either of those two categories.

So, based on those, I think the best estimate we can give women of increased risk of admission with formula feeding compared to breastfeeding would be 5x or less. Obviously that's still a figure worth knowing and a good reason to breastfeed – but it suggests the 14x risk is very exaggerated. I'd be very wary of using that figure.

Oh – found two more!

http://www.bmj.com/content/300/6716/11.full.pdf – found the risk of admission with gastrointestinal illness in the first year to be 5.64 x higher in never-breastfed babies than in those breastfed for more than three months, and the risk of admission with respiratory illness in the first year to be 2.16x higher for those same groups. Since those two groups accounted for almost the same number of admissions, that would give an overall risk of about 3.9x for the formula-fed babies of being admitted for one of those two reasons (which, again, might plausibly mean a slightly higher overall risk of being admitted because some babies would be admitted for other reasons and formula-feeding might increase the risk of those reasons as well).

http://www.ajmc.com/media/pdf/AJMCJun1997Hoey861-865.pdf (you have to register, but it's free) didn't find any significant difference in rates of hospitalisation between a group of babies exclusively breastfed for six months and a group exclusively formula-fed from birth. That study was quite a bit smaller, so it might have missed a small difference.

That makes four studies giving results that are vastly lower than that 14x risk. I do think it's fair to say that, although there's good evidence that there *is* an increased risk of hospitalisation with formula feeding, it's actually a great deal lower than 14x. I wouldn't recommend using that figure, as all the other available evidence suggests it really isn't accurate.

Sarah, thanks for the links! The 'Full Breastfeeding and Hospitalization as a Result of Infections in the First Year of Life' was an excellent article.

After going through the studies you provided and many more, and because we can not view the full text of Cunninghams study, nor can we find one replicating his results, it's best to bring the figure down to 5 (being very conservative), because there are a number of studies that back up this figure.

If you go by the above figures however...
Formula fed infants are 8 times more likely to suffer from Necrotizing Enterocolitis (severe intestinal inflammatory disorder).
Formula fed infants are 2.5 times more likely to suffer from Diarrhea.
Formula fed infants are 2-4 times more likely to suffer from Respiratory Illness.
Formula fed infants are 2 times more likely to suffer from Cancer.
Formula fed infants are 4 times more likely to suffer from Respiratory Distress and Infections.
Formula fed infants are 3 times more likely to suffer from Meningitis.

...it certainly does make you wonder whether a risk of 5x is enough.It would be great to see a more substantial meta-analysis of all relevant data, to get a clear figure on hospitalization.

Thank you for your reply, and I appreciate the discussion, as this is very interesting! I know I focused on the hospitalisation figure (I'd just been reading the Spanish study from Pediatrics, as it happens, so that was the one that particularly leaped out at me) but I would actually question some of the other figures as well. I've been comparing them with the figures from the AHRQ report on breastfeeding - this is a particularly good source as the compilers look for all the decent-quality evidence in each area and compile it into a meta-analysis, so I try to use this as a data source whenever I can. (It's available in full at http://www.ncbi.nlm.nih.gov/books/NBK38337/.) Obviously, this is going to give more accurate figures than just picking out a few studies without looking at the quality.

The AHRQ report gives the figures as decreased risk with breastfeeding rather than as increased risk with formula-feeding, so I've had to invert the figures to get equivalents, but, if my arithmetic's right... it found the increase in SIDS risk with formula-feeding to be around 1.5x and the risk of necrotising enterocolitis to be around 2.5x. The risk of acute lymphocytic leukaemia was around 1.25x, and the risk of acute myelogenous leukaemia was around 1.18x. The report doesn't give overall figures for reduction in cancer incidence, but it looks as though it's pretty doubtful whether the reduction in leukaemia risk can be extrapolated across all cancers (http://www.ncbi.nlm.nih.gov/pubmed/15986434), so the overall reduction in cancer incidence would be quite a lot lower.

Also – wasn't sure why you have a category for 'respiratory distress and infections' separately from the 'respiratory illness' category?

With regard to the differences in admission rates, I wouldn't say that 5x looks too low a figure. (If anything, I'd say that the admission rates for formula feeders in those studies sounded rather high – I'm a GP, and I wouldn't say I was admitting as high a proportion of formula-feeding babies as that.) Bear in mind that necrotising enterocolitis affects only premature babies at an immature enough stage that they wouldn 't yet have been discharged home, so an increased risk of that wouldn't affect admission rates; meningitis is fortunately not that common; and childhood leukaemia is rare (I once worked out that that level of increase in risk for formula-fed children actually worked out at an extra 1 in 100 000 risk of leukaemia as a result of being formula-fed). So those figures would actually have minimal to negligible effect on admission rates.