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Why breastfeeding isn't a solution to the formula shortage

The popular conception that parents can simply rely on breastmilk is misguided and dangerous.
Babies drink from bottles circa 1945.
Babies drink from bottles circa 1945.Harold M. Lambert / Getty Images file

The infant formula shortage is an ongoing nightmare for American families with young babies as parents find themselves without the basic food and fluids to keep their infants alive and healthy. As a pediatrician and mother, it’s horrifying to see that, rather than unifying the country in a concerted effort to address this emergency, the shortage is being used by many people to further the stigma against infant formula — and the shaming of parents who use it and the babies who need it. 

I’m here to set the record straight. The popular conception that parents can simply rely on breastmilk — and that breastfeeding is the only way mothers should be feeding their babies in the first place — is misguided and dangerous. Many, if not most, infants will need at least some amount of formula supplementation to reach their optimal health, and even to reach a parent’s breastfeeding goals.

Even as a pediatrician, a part of me had been convinced that formula was the enemy. As a result, these pressures worsened my own postpartum depression and anxiety.

In some instances, maternal or infant biology means that providing an infant exclusively with breastmilk from the first days of life isn’t an option for mom or baby. Not all parents are biological parents, and even some biological mothers are unable to safely provide breast milk — a variety of infections, medications and genetic conditions can take breastfeeding off the table entirely. 

Even more common is low milk supply. Potential obstacles to being physiologically able to produce enough milk to nourish an infant include having had a C-section, infertility issues and dozens of maternal health conditions (like thyroid disease, postpartum bleeding, polycystic ovarian syndrome — the list goes on) that interfere with the intricate biological ballet that matches a postpartum body’s milk supply with an infant’s demands. 

Babies themselves are sometimes not able to tolerate breast milk or to survive on it alone, with common conditions like jaundice and low blood sugar frequently making formula use a medical necessity. In these cases, using a safe, regulated breast-milk substitute that has been designed to contain the exact amount of micro- and macronutrients, salts, sugar and water that a delicate newborn body needs — i.e., commercial infant formula — is the only way to prevent starvation, dehydration and death.

Providing formula can even be important in allowing mothers to rely on breastmilk as the primary or almost exclusive source of nutrition. Savvy breastfeeding supporters — lactation consultants and pediatricians — know that, for many, formula can actually be an essential tool in establishing breastfeeding in the first place. 

More often than not, introducing some amount of formula is the only way to keep infants healthy and happy enough that they can actually learn how to breastfeed. And there are times when a breastfeeding mother’s own postpartum needs — troubleshooting why it’s painful when the baby latches on to her breast, or getting enough rest to help with physical and emotional postpartum healing — make bottle feeding a breast-milk-promoting intervention. 

Yet too many moms equate using formula with failure. I remember one mother I worked with whose daughter was born premature and couldn’t get the hang of latching even after weeks of work with a skilled lactation consultant. She pumped every three hours (even setting an alarm overnight), causing prolonged exhaustion that made it impossible to bond with her newborn, let alone engage in the treatment she urgently needed for her emerging postpartum depression and anxiety. When I recommended using formula supplementation as the only way to optimize both maternal and infant well-being, she immediately began to cry. 

The stigma against formula is so deep-seated that I felt it myself when I gave birth, despite all the information to the contrary at my disposal. I was completely committed to exclusive breastfeeding, but a variety of factors — my daughter’s jaundice and low sugars, my relatively low milk supply, her prematurity and her struggle with latching — took exclusive breastfeeding off the table. 

Like so many mothers, I cried needlessly when combined breast and formula feeding became our necessary reality. Even as a pediatrician, a part of me had been convinced that formula was the enemy. As a result, these pressures worsened my own postpartum depression and anxiety. This is common, as the pressure of breastfeeding and the negative experiences with it are associated with a higher risk of postpartum mental health issues.

Amid the present formula shortage, I’ve seen little understanding of these nuances and more doubling down on exclusive breastfeeding promotion. Disturbingly, many justify this approach with the erroneous claim that in the past there was only breastfeeding and people managed fine. But those were not the good old days: It was a time of more infant deaths.

On top of everyday breastfeeding struggles back then, mothers frequently died or became critically ill during childbirth. If other lactating community members didn’t step in (the use of “wet nurses” was a common, widespread and frequently coercive practice throughout history) infants died without a safe, alternative source of nutrition. Some people made their own formula to fill the gap, which sometimes worked but was overwhelmingly unsafe, often leading to serious disability or death. 

When I see TikTok videos providing recipes for homemade formula as the supply chain crisis persists, I feel transported back to this darker time. I have personally treated cases of hospitalized infants who have suffered from near-fatal complications of unregulated formula use — emergent electrolyte imbalances, serious bacterial infections and malnutrition that can lead to permanent bodily damage. 

More often than not, introducing some amount of formula is the only way to keep infants healthy and happy enough that they can actually learn how to breastfeed.

It’s no wonder that the invention of infant formula in the last century saved lives. But as formula companies pushed their product on parents — as well as doctors — it became the norm for infants to receive manufactured formula instead of breast milk. The response was a “breast is best” movement that, while based on the correct assertion that breast milk has health benefits, became extreme in and of itself. The tragic result was that in the early 2000s some babies, including in the United States, were denied the additional food and fluid they needed in a misguided attempt to promote breastfeeding and died from dehydration

There are additional hardships imposed by our modern world that make it hard for even the most determined parents to exclusively breastfeed. Infants need formula or breast milk for a full year. Providing all of a baby’s needs through breast milk is nearly impossible over this stretch in this day and age — and not always in the best interest of a baby or lactating parent. The barriers to sustained breastfeeding are real and challenging: workplaces that don’t support pumping, inadequate parental leave, insufficient long-term breastfeeding support from expert lactation consultants and, of course, lack of supply.  

As a society we can — and should — promote breastfeeding as a way to support infant health without taking a simplistic and dangerous black-and-white stance. When I observe parents stigmatized for using formula, mom-shaming on social media or just a generalized misconception that formula is the enemy of breastfeeding, I see these as the biggest obstacles to helping parents meet breastfeeding goals and optimize infant health.