The Stigmatization of Formula Feeding
Any parent can tell you the messages they receive from the moment they pick up a parenting book, take a hospital parenting or breastfeeding class, or receive counseling from well-meaning friends, family, and health professionals. It is that “breast is best” and therefore, formula is “inferior.” However, not all parents are able to exclusively breastfeeding or there are other factors that make formula feeding necessary. The result is that some parents are labelled as “good parents” because they can and do feed their babies in the socially approved manner, and those who feed formula are, by comparison, less so.
Studies on the effects of formula feeding stigma have been published in peer-reviewed publications. A systematic review of 23 studies of over 13,000 participants entitled, “Mothers’ Experiences of Bottle-Feeding: A Systematic Review of Qualitative and Quantitative Studies,” found that:[1]
- Mothers who bottle-fed their babies experienced negative emotions such as guilt, anger, worry, uncertainty and a sense of failure.
- Mothers reported receiving little information on bottle-feeding and did not feel empowered to make decisions.
- Mistakes in preparation of bottle-feeds were common.
This study described negative experiences with health professionals leading them to not get the support and professional advice they needed regarding formula feeding. In one of the included studies, 32% of mothers reported a sense of failure, 23% worried about what professionals might say and 20% worried about the effect on their baby’s health.[1] A few quotes from different studies included the following:
“You’re such a failure because all you’ve got to do for this baby is feed it and if you can’t do that, or you’re having problems with that, you must be rubbish.”[2]
“..and you’re a horrible mother if you didn’t do it (breastfeeding).”[3]
“It felt like I was going to harm him or something by giving it to him (bottle feeds). (The feelings lasted) for a good four or five months definitely”[1]
“..every single thing says breast is best . . . the pressure is massive, this is what you must do and if you don’t do it you’re harming your child”[1]
“you don’t really get information from professionals about bottle-feeding, the do’s and don’ts, you just have to be self sufficient . . .”[1]
One of the barriers was that health professionals did not talk with them about formula unless specifically asked. They also described that their health professionals pushed “the breastfeeding line” and that they were judged negatively because they were formula feeding.
One participant described her experience with a maternal and child health nurse, “They do push ‘breast is best’ and to the point of making you feel really bad…they were too judgmental. So that’s why I’ve never really visited them this time around.”
The same stigma carried through to bottle feeding, not just from health professionals but also by members of their community. One mixed-feeding mother described, “I think there’s a stigma attached to formula use…So if you’re out there’s a lot of scrutiny if you pull a bottle out versus if you breastfeed your child.”
This systematic review provides evidence that not only does the stigma surrounding formula feeding result in negative experiences for the mothers, but that it directly puts infants at risk as mothers are less likely to receive education on correct formula preparation as a result.
Another study entitled, “Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed” found the following:[4]
- Formula feeding mothers were viewed “less positively than the identical breastfeeding and control mothers, who were typically not perceived differently than one another.”
- “Unintended formula feeders were viewed more positively than unintended breastfeeders.”
- “Women who formula fed were penalized when they did so intentionally, while those who breastfed were penalized when they did so unintentionally.”
The authors of this study warned that caregivers, health care providers, and policy makers may be creating a formula feeding stigma with potential health consequences to women and infants by promoting a pro-breastfeeding rhetoric. They suggested that there should be interventions to reduce the stigma surrounding formula feeding and to promote awareness of the safety and utility of proper formula use.
These findings are repeated in multiple other studies, and the authors of those studies have concluded that infant feeding advice should be more woman-centered,[5] empathetic, attentive, and inclusive.[6-9]
How do I navigate speaking to health professionals and hospital staff about my intention to formula feed?
Some mothers may make an informed decision to exclusively formula feed after careful consideration of hte many factors that affect their infant feeding choice such as a history of breastfeeding problems, physical and mental health problems, and/or life circumstances. While some decide that they will feed a combination of formula and breast milk.
Others decide they will feed their baby in whatever way that works depending on how things go after their babies are born. All of these are valid choices.
Given the current environment, research has shown that many mothers who choose to formula feed either exclusively or partially receive counseling by their health professionals about the benefits of breastfeeding and the potential harms of formula feeding.
Some hospitals require their health professionals to perform counseling about “the risks of formula feeding” even if it will contribute to negative patient interactions. It’s important to know that several medical and health professional organizations have come out with position statements stating that while they support breastfeeding, they also believe that the mother is uniquely qualified to decide what method of infant feeding is best for her and her infant.
“Families should receive noncommercial, accurate, and unbiased information so that they can make informed decisions about their health care. Obstetric care providers should be aware that personal experiences with infant feeding may affect their counseling. In addition, pervasive direct-to-consumer marketing of infant formula adversely affects patient and health care provider perception of the risks and benefits of breastfeeding… Obstetrician–gynecologists and other obstetric care providers should support each woman’s informed decision about whether to initiate or continue breastfeeding, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant.”[10]
— American College of Obstetricians and Gynecologists
The best way to ensure that you have a positive experience during your pregnancy and around the time of your delivery is to discuss your infant feeding choices with your obstetrician or certified nurse midwife before you deliver at your prenatal appointments. We also recommend that you write down your infant feeding intentions to bring to the hospital or birthing center to be placed in your hospital record.
Some parents, most notably a few mothers with a history of breast cancer and mastectomy, have even posted large signs in their rooms stating that it would be a “no breastfeeding zone,” to prevent negative interactions with health professionals.[11] Different hospitals will have different policies on how to respond to parents who come into the hospital choosing to formula feed.
For example, know that if you choose to combo feed and want to provide colostrum while intending to formula feed after the newborn period, you may be discouraged to supplement with formula while providing colostrum.
Ultimately, you are in charge of your baby’s feeding and a written document can protect your right to feed in a way that reflects your personal goals.
To learn more about this topic, read the Fed Is Best book available on paperback, e-book, and audiobook.
References
- Lakshman, R. et al, “Mothers’ Experiences of Bottle-Feeding: A Systematic Review of Qualitative and Quantitative Studies,” Archives of Disease in Childhood 94, no. 8 (August 2009): 596–601, https://doi.org/10.1136/adc.2008.151910.
- Lee, Ellie “Health, Morality, and Infant Feeding: British Mothers’ Experiences of Formula Milk Use in the Early Weeks,” Sociology of Health & Illness 29, no. 7 (November 2007): 1075–90, https://doi.org/10.1111/j.1467-9566.2007.01020.x.
- Earle, S. “Why Some Women Do Not Breast Feed: Bottle Feeding and Fathers’ Role,” Midwifery 16, no. 4 (December 2000): 323–30, https://doi.org/10.1054/midw.2000.0222.
- Moss-Racusin CA, et al. “Breast Is (Viewed as) Best: Demonstrating Formula Feeding Stigma. Psychology of Women Quarterly,” 2020;44(4):503–520. doi:10.1177/0361684320947647
- Fallon, Victoria et al., “The Emotional and Practical Experiences of Formula-Feeding Mothers,” Maternal & Child Nutrition 13, no. 4 (October 2017), https://doi.org/10.1111/mcn.12392.
- Nihlén Fahlquist, Jessica “Experience of Non-Breastfeeding Mothers: Norms and Ethically Responsible Risk Communication,” Nursing Ethics 23, no. 2 (March 2016): 231–41, https://doi.org/10.1177/0969733014561913.
- Wirihana, Lisa A. and Barnard, Alan, “Women’s Perceptions of Their Healthcare Experience When They Choose Not to Breastfeed,” Women and Birth: Journal of the Australian College of Midwives 25, no. 3 (September 2012): 135–41, https://doi.org/10.1016/j.wombi.2011.08.005.
- Tarrant, Roslyn C., et al. “Mothers Who Formula Feed: Their Practices, Support Needs and Factors Influencing Their Infant Feeding Decision.” Child Care in Practice 19, no. 1 (January 2013): 78–94. https://doi.org/10.1080/13575279.2012.737764.
- Hoddinott, Pat, Leone C. A. Craig, Jane Britten, and Rhona M. McInnes. “A Serial Qualitative Interview Study of Infant Feeding Experiences: Idealism Meets Realism.” BMJ Open 2, no. 2 (2012): e000504. https://doi.org/10.1136/bmjopen-2011-000504.
- ACOG Breastfeeding Work Group, “Optimizing Support for Breastfeeding as Part of Obstetric Practice,” October 2018, https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice.
- “Cancer Survivor Posts ‘No Breastfeeding Zone’ in Hospital Room to Prevent Criticism | Parents,” accessed August 15, 2021, https://www.parents.com/news/cancer-survivor-posts-no-breastfeeding-zone-in-hospital-room-to-prevent-criticism/.