Is Breast Really Best? The Case for Infant Formula

Infant Formula

Woody Allen once joked of his emotional scarring as an infant, on account of being “breastfed from falsies”. That was in the 1960s and 70s, when infant formula was all the rage. Today, though, it’s formula that often gets accused of being fake food. How this happened is pretty clear. Breast milk, after all, is good for your child. It’s balanced nutritionally for the infant’s age and, conveniently, contains immunoglobulin A (IgA) and smaller amounts of other types of immunoglobulins, a class of protein that protects the child against infection until her immune system is up to speed. On top of this, there was a campaign in the 1980s against a food company that was pushing infant formula on young mothers around the globe. In some cases, the mothers could not afford the formula in adequate quantities, so they stretched it out. They diluted it too much with water, and this led to nutritional deficiency –a tragedy that could have been avoided had they simply nursed the children.

This did not help the reputation of baby formula from any company, and for a few decades there has been a cultural swing toward doing things the ‘natural way’. There is a great deal of marketing promoting this idea. When it comes to breast-feeding, that movement is so powerful that hospitals are earning reputations of being “baby-friendly” if they promote breast feeding by new mothers and limit the number of children who begin life on baby formula.

This is happening, despite the fact that infant formulas are getting more and more advanced, and it’s happening particularly among well-to-do families. Frequently, those who could pay for infant formula are taking the breastfeeding option. They do this, partly because of the fact that there’s protective IgA in their own milk –and yes, that is a fact; the baby can get IgA only from breast milk. But they also may be influenced by other factors that really just amount to a plethora of opinions and claims. There are claims floating around, for instance, that breastfed children are less likely to develop food allergies, that they perform better in school, or ultimately earn higher incomes compared with their formula-nourished peers. In such a culture, mothers –and fathers too– can be driven to think that they are not good parents if they choose formula –whether for medical reasons, or because the advantage of breastfeeding doesn’t weight up against the impact on the mother’s work, or career.

Don’t fall into this trap. Though you may see families breastfeeding all around you, though you may hear parents, and even doctors, say that there are scientific studies showing that “breast is best”, this is a distorted view of the science. Yes, breast milk contains immunoglobulins, and yes, there are some studies suggesting that breastfed infants are less prone to infections. But these are isolated studies, and when assessing a health issue we must consider the bulk of scientific studies taken together. When considering all studies together, results must be analyzed in terms of whether the outcome that you are measuring —for instance infections, school grades, job success— can be controlled with respect to the condition that you are hypothesizing to produce an effect, in this case breast-feeding. Controlling a study means that you account for possible confounding factors —situations that could be linked both to the condition being studied and to the supposed outcome being measured.

Doing this, it turns out that the scientific literature, taken as a whole, does not show a benefit, whether in health, education, or some other outcome, that cannot be attributed to some confounding factor. When it comes to breast-feeding, the chief confounding factor that you should keep in mind is socioeconomic status of the parents. Look around the fancy neighborhoods where virtually every new mother is breastfeeding and realize that there are numerous factors, apart from breastfeeding, that probably are contributing to better health, better school performance, higher SAT scores, and whatever outcome you want to throw in there, compared with other neighborhoods. I mean particularly neighborhoods in which parents are struggling with extra jobs, and where the mother is under extreme pressure to return to work –and not have an extra burden during work.

You may be rich or poor, but very likely you are somewhere in between. You might be teacher, or an office worker, with maternity leave, enabling you to nurse or pump. That’s wonderful, but mothers also may be small business owners, freelance workers, or something else that really makes formula look like the better option. Don’t sweat it, if that’s the case. Breastfeed, if you like that idea, and if you are prepared, but don’t do it based on a belief —that’s popular but also wrong— that the science is behind it.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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