I’ve noticed a burst of blogs and articles lately seeming to rubbish breastfeeding evidence, claiming equivalency of breast and formula milk, decrying any benefits of breastfeeding or risks of formula feeding, and defending formula as merely a choice, rather than a health dilemma.

I’ve been pondering the correct response to this for some time. I wondered if there was room for one more voice in the clanging melee of voices that have already put their point of view forward.
But I’m going to. It seems to me that this issue is far more complex than just critiquing the research articles that have been brought forward to either evidence the case for or against breastfeeding. It’s not as simple as that!

I’m not sure that anyone has understood the fundamental problem with all these pieces so far. Indeed, maybe I haven’t grasped it either, but here is my humble attempt.

First and foremost, breastfeeding advocates and lactation consultants are not against formula. Or formula-feeding mothers. Or bottles. They have a legitimate place in society. Women deserve correct information about bottle-feeding.  Formula needs to continue to be made safer, better, and more affordable. Bottle feeding mothers also have problems with feeding and they deserve compassionate, non-judgmental information and support.

Some women fall into formula feeding not by choice, but because they have been failed by a healthcare system that does not have the skill to adequately support breastfeeding when problems arise. Some women fall into formula feeding because of health problems, infant illness, birth difficulties, tragedy and poor breastfeeding management in the early days. Not everybody has access to good quality lactation support. If you’re one of those mothers – know that lactation consultants around the world think you’re doing a great job doing the best you can for your baby. If you were my client asking for help, you would get every ounce of support I could muster. I would laugh and cry with you. You are not a failure. You are a mother.

Other mothers either move on to formula feeding or choose it from the outset. You know – I don’t have an issue with your choices! I really don’t! And nor does any breastfeeding advocate worth their salt. The thing is, most women want to breastfeed, at least for a little while. It’s not my job to persuade you to breastfeed if you don’t want to. I respect you as a mother, and I have many good friends who cheerfully formula feed. I’m sure they would all tell you that I didn’t put any pressure on them, nor do I ‘make them feel guilty’ for their personal choice.

What I take issue with are these articles that claim equivalency of breast and formula milk in order to justify their use of formula. I would humbly suggest that if you don’t feel guilty about your feeding choices, then just bottle feed with a smile, and please do not cite literature that is 20 years old and has been superseded with far superior and more robust research! Women are confused enough!
I want to suggest that the right approach is as follows:

  1. Fundamentally, this is about supporting mothers to make the right choice for them. I have yet to meet any woman who wants to breastfeed purely for the health benefits to her baby. Honestly. Most women are aware of these pieces of research, but they want to breastfeed for a whole host of reasons. Nobody initiates breastfeeding just because their baby is 8 times less likely to be hospitalized with diarrhoea and vomiting. That actually does women a disservice – we are complicated creatures and often the women I meet want to breastfeed for reasons they frequently can’t put into words.
  2. All information should come from a robust evidence base. There is a lot of bad research out there. But lactation consultants are not fools! We haven’t somehow missed the point, or failed to critique the evidence for ourselves! Some of the most intelligent people I have ever met are lactation consultants. They can understand the most complex statistical analysis, summarise a meta-analysis of several randomized controlled trials, and spot flaws in longitudinal studies at a glance. We need to stop warring over research and concentrate on the mother and baby in the middle!
  3. All information should be tailored to the needs of the mother and baby in question. What is the use in explaining the risks of formula to a mother in tears because she has received bogus ‘advice’ which has sabotaged her efforts to breastfeed? Where is the compassion in lecturing about breastfeeding benefits to a mother who has struggled with low supply despite doing everything possible to increase it?

The bottom line, is that breastfeeding advocates are not trying to persuade women who do not want to breastfeed to breastfeed. They are doing their best to support the millions of women around the world who do want to breastfeed. Breastfeeding support needs to be clothed in understanding, compassion, and correct information. That’s all we’re trying to do!