Will Formula Feeding Harm My Baby?

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All risks, including those associated with breastfeeding and formula-feeding, have a subjective dimension. Risks are ubiquitous, but we only pay attention to some of them.

Some cars have better safety records than others. The air in congested cities and suburbs is more highly polluted and raises the risk of asthma and other illness. Yet parents are not the targets of concerted campaigns imploring them to trade their SUVs for safer minivans or to move to less populated areas for the sake of their developing babies. A sustained effort by interest groups, doctors, and the government to move every baby from urban areas in order to reduce the risk of asthma likely would be met with skepticism. Parents would discuss tradeoffs, or costs and benefits, and most probably would elect to stay in their relatively polluted neighborhoods. Riding in cars can be deadly. Although safety seats provide some protection, parents who drive with their babies and children routinely put them at risk. Yet, it is difficult to imagine a cultivated campaign to keep families out of cars. Should such an effort materialize, it is liable to be met with resistance because driving is culturally normative.

Mothers who leave employment temporarily – for example, to spend full-time with young children – are more likely to be poor in old age, and they are at greater risk for poverty in cases of divorce. Yet the perils for women of not sustaining employment are largely ignored while the putative risks of not breastfeeding (or of sending young children to daycare) are well publicized. This makes sense in a culture where mothers’ obligation to reduce any risks to their children, no matter the cost, is normative.

The point here is not that all families should stop driving and move to the country, or that no mother should take time from work to be with her babies or children. Rather, it is to demonstrate that we make risk decisions every day without knowing it, and that we pay comparatively more attention to risks that require short and long-term sacrifices from mothers. In a culture with an all-encompassing notion of what mothers can and should do to optimize life for their children, we often emphasize risks to babies and lose sight of risks to mothers.

Many women love breastfeeding, and some combine it with work with relative ease. But articles, books, blogs, and other media have made clear that many women, even among those who breastfeed successfully, do not like it; some find it unbearable. According to the PROBIT study, one in twenty-five bottle-fed babies will have an additional GI infection compared with breast-fed babies. Are the risks of GI distress great enough to offset the costs to mothers who prefer to bottle-feed? Every woman who breastfeeds will not become anxious or depressed or suffer catastrophic economic consequences; every bottle-fed baby will not experience serious GI illness. Risks do not exist in isolation. They only have meaning in relation to other risks.

Science is never perfect, and to expect that it be so is to create an impossible standard. That is why scientists have created rules about how to determine whether evidence is persuasive and under what circumstances citizens should be advised to change their behavior. Studies on breastfeeding and GI infection make clear that it is possible to produce compelling science despite the impossibility of controlling for all confounding variables. But in the research on other outcomes, many scientists and public health officials are not following their own rules, and this fuels the misrepresentation of breastfeeding by advocacy groups and the media.