Breastfeeding seminars

The Breastfeeding Divide and Global Demand for Infant Formula | Science | In-depth science and technology reporting | DW

This is the first article in a two-part series on some of the reasons why some mothers opt for formula milk instead of breastfeeding. We have attempted to cover as many of the deciding factors in these two articles, but it is ultimately a very personal and individual decision for each new mother. The second part of the series is linked here at the bottom.

Most women worldwide start breastfeeding after giving birth, but only 44% breastfeed exclusively until the sixth month, according to the World Health Organization.

Infants cannot eat solid foods during the first half of their life, which leaves them dependent on breast milk or formula. This fact makes the current formula shortage in the United States, where only one in four babies are exclusively breastfed until six months, dire.

The infant formula shortage was caused by production and supply chain issues and an investigation by the U.S. Food and Drug Administration into a factory run by major infant formula producer Abbott Nutrition. . The company is one of four that together produce approximately 90% of infant formula in the US market. Although production was back on track, Abbott Nutrition had to halt production again at the plant when a storm hit the Michigan site on June 13.

Women in wealthy, developed countries are least likely to exclusively breastfeed their children up to six months

Research suggests that exclusive breastfeeding is a healthy and natural way for women to feed their newborns. It’s good for the mother-child relationship and cheaper than formula milk. So why do so few women stick to it?

In this two-part series, we want to explain some of the structural and medical reasons why some women use formula and how the importance of breastfeeding may be different depending on where you live. In part one, we ask why so many women use formula instead of breast milk.

It starts in the hospital

There are various reasons why women choose not to breastfeed. But many experts say a woman’s experience in hospital after childbirth plays a decisive role.

For decades, the WHO has been pushing hospitals to put in place “baby-friendly” measures to promote breastfeeding at birth. These first 24 hours are crucial for a baby to learn to feed directly from its mother.

Most hospitals in the United States and Europe are “baby-friendly”. But in other parts of the world, this is not always the case.

Antonina Mutoro, researcher on maternal and child well-being for the African Center for Population and Health Research in Nairobi, Kenya, helped carry out a survey in Nairobi’s informal settlements, which a recent UN report called “some of the most dense, unsanitary neighborhoods and precarious slums in the world.

Among the new mothers surveyed, only 2% breastfed their babies exclusively and not bottle-fed.

This is despite the fact that many of the women Mutoro met could not afford a regular supply of infant formula. They used cow’s milk or foods like porridge to feed their babies before they were six months old, she said.

Mutoro said the lack of breastfeeding in the settlements was partly due to the fact that women were probably not taught about breastfeeding in the hospital after giving birth.

The baby's arm is measured in Madagascar

In many developing countries where clean water is scarce, lack of breastfeeding education can lead to child malnutrition

“If it’s not a baby-friendly facility, sometimes health workers offer to take the child and give him formula. That sets a precedent,” Mutoro said.

Other times, women were told by doctors that they didn’t have enough milk. Mutoro said a woman’s ability to produce breast milk generally depends on demand. Shortly after birth, this demand is created by placing the baby on the mother’s breasts, which helps stimulate milk production.

“But you find the narrative is usually, ‘Oh, I don’t have enough milk.’ So the solution is to look for other options and the formula is usually the fastest option,” Mutoro said.

It’s not due to ignorance, Mutoro said — most staff who work in pediatrics or gynecology know that breastfeeding is good for the baby, she said. But the structures aren’t in place to promote it, and when the workload becomes overwhelming, some doctors and nurses don’t take the time to train new mothers if they can offer formula instead.

Impact of formula producers

Then there is the formula industry.

In 1981, the World Health Assembly, the decision-making body of the WHO, adopted an international code of marketing of breast-milk substitutes. The code prohibits the marketing of infant formula, in an effort to prevent women from being discouraged from breastfeeding.

But one WHO report published in February shows that companies have continued to aggressively market their products online through methods that did not exist when the code was adopted, such as ad algorithms tailored to reach new moms and parenting apps.

The report says that while breastfeeding rates have largely stagnated in the four decades since the code’s implementation, infant formula sales have doubled.

Uyghur baby Xinjiang China

In China, only about 1 in 5 babies are exclusively breastfed until 6 months

Lack of practical training

Rafael Perez Escamilla, one of the authors of the WHO report, said even in baby-friendly hospitals, women don’t always get the support they need to figure out how to breastfeed once they go home.

Perez Escamilla said there were two reasons for this. In most medical nursing schools, students can only receive a few hours of breastfeeding training throughout their training.

“I’m in a big institution, Yale University, and I’m in charge of [teaching] breastfeeding, a component of medical student training, and that’s like two hours,” Perez Escamilla said.

Without sufficient hands-on training, health care providers lack the skills to teach women how to breastfeed their own babies. This work is often passed on to lactation peer counselors or lactation consultants, Perez Escamilla said.

But in many countries, lactation consultants are not paid by public health systems, making their services accessible only to women who can pay for them privately.

And sometimes providers can understand the benefits of breastfeeding but not promote it because they’re courted by the formula industry, Perez Escamilla said.

“A lot of them get invited to dinners, they get paid for their lectures, they get books, some of them can even get a bribe if they prescribe a minimum of X products,” said he declared.

A nurse helps a woman to breastfeed in the hospital

Not all women receive adequate training on how to breastfeed in hospital

Breastfeeding is a full time job

If a woman is breastfeeding, her breasts will fill with milk every few hours. This milk must leave his body somehow – either by feeding a baby or by pumping – or it will cause him pain.

In Germany and many other European countries, women are allowed to take up to a year of paid leave after childbirth, which makes the question of expression less problematic.

In other countries, including the United States, this is not always the case, or the duration of maternity leave differs.

If a woman cannot afford to leave her job for six months, she will have to pump at work. This is possible in the United States and protected by law – women must be given a place where they can express their breast milk at work.

For women who work in the knowledge industry and have their own office, this may be fine, said Kailey Snyder, a professor at the Creighton University School of Pharmacy and Health Professions in Omaha, Nebraska. But not all women have access to a personal office.

Maternity leave infographic

Some countries lack legal protections for mothers, making it difficult to breastfeed when they have to return to work

“It’s a completely different story if you ask a young woman who works in a fast food industry to ask her manager to give her space to pump, and maybe the only space that’s enough is her office,” Snyder said. “It’s not doable and doesn’t happen often even though it’s legally protected to pump.”

In such situations, formula milk may present itself as the only possible option, even though the woman might theoretically be more interested in exclusive breastfeeding.

The reasons why some women use formula milk are not only structural: some women want to breastfeed their babies, but cannot. We explore some of the reasons in part two of this series here.

Edited by: Zulfikar Abbany, Carla Bleiker

Correction, June 27, 2022: A previous version of this article suggested there was no legal provision for paid maternity leave in Kenya. This has now been corrected. We apologize for the error.