Breastfeeding has many benefits to both mother and child, benefits that have been well studied and consistently shown for decades. Babies who are breastfed have lower rates of respiratory illnesses, gastrointestinal and ear infections, as well as lower rates of allergies, SIDS, diabetes and many other illnesses that can impact their life-long health. Breastfeeding mothers also experience health benefits, from decreased postpartum bleeding and depression to long term decreases in diabetes and breast cancer.

While infant formula has been improved over the years and offers an alternative for women who are unable or choose not to breastfeed, even in the best circumstances it has disadvantages. Formula is expensive and can cost families several thousand dollars a year in direct costs. Increased illnesses in formula fed babies also result in higher healthcare costs and loss of wages for parents who have to miss work to take care of their child. By increasing breastfeeding to optimal rates in the US, up to $13 billion a year could be saved on these indirect costs, according to analyses by the U.S. Department of Agriculture, Food Assistance and Nutrition Research. As a result of the importance of health and economic benefits, the American Academy of Pediatrics urges that breastfeeding be viewed as “a public health issue and not only a lifestyle choice”.

The impact of formula feeding on poor and developing countries can be even more profound than what is seen in the United States. Many women in these countries are malnourished and falsely believe they would be unable to produce milk with adequate nutrition for their children. Aggressive marketing by the formula industry, a multi-billion dollar industry, often focuses on poor areas and promotes this and other inaccurate information about the benefits of formula. This misinformation can be particularly dangerous as many of these women do not have access to clean water to mix with the formula, resulting in higher rates of water-borne illnesses in these areas. Due to the high cost, many women end up diluting the formula to extend its use, which also results in higher rates of illness and even death. A 2016 series in The Lancet journal estimated that worldwide 800,000 formula-fed infants a year could be saved by breastfeeding, mostly due to reducing rates of diarrhea, respiratory infections and malnutrition from formula dilution.

In 1981, the World Health Organization voted 118 to 1 adopt a non-binding resolution promoting the dissemination of accurate information on breastfeeding worldwide, as well as restrictions on inaccurate formula advertising and direct marketing and kickbacks to health providers. 130 countries have adopted the ban on the promotion of formula, and in countries where these laws are enforced, such as Brazil, the rates of breastfeeding are typically higher than those that do not. During the World Health Assembly (WHA) each year, this resolution has been reaffirmed and in 2016, the United States, under Obama, supported strengthening the resolution. Despite these efforts, in the past year alone, more than 800 violations of these practices have been noted by formula companies around the world. Funding for formula industry lobbyists has also remained high, with one company, Abbott Pharmaceuticals (makers of Similac and other formulas), spending more than $790,000 on lobbying efforts, including contributions to President Trump’s inauguration ceremonies. In the most recent WHA, our president sided with the formula industry in trying to oppose the existing regulations that would limit the negative effects of inaccurate formula advertising and direct marketing to healthcare providers. The US administration went as far as threatening the US contribution to funding for WHO to oppose this resolution.

Whether or not to breastfeed is a decision that each woman needs to make for herself and her family. Providing accurate information on options, as well as support for the challenges that new mothers will experience is the best way to optimize the health of future generations.