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Nicole Saphier, MD is a physician at Memorial Sloan Kettering Cancer Center, an assistant professor at Weill Cornell Medical College and bestselling author of ‘Panic Attack.’ Her opinions are her own and not reflective of her employers.
An uncomfortable truth has become obvious as anxiety over the worsening infant formula shortage grows.
For potentially millions of parents and children, it didn’t have to be this way.
At birth, 1 in 5 newborns receive formula within the first couple days. By three months, less than half are exclusively breastfed.
As the shortage worsens, some babies may go without food and risk becoming malnourished while parents struggle to find formula, are unwilling to change brands or unable to create homemade remedies (which pediatricians warn against because they may not meet the nutritional needs of infants).
Breastfeeding is physiologically more advantageous to mother and child, yet breastfeeding is underutilized in this country.
The formula shortage has highlighted our collective, self-induced frailty related to feeding our infants. And part of the problem is that we are discouraged from talking about it.
To be clear, I am not minimizing the struggles associated with breastfeeding.
I breastfed my three children for their first 12 months of life. I will be honest; it was not easy.
By three months, less than half of infants are exclusively breastfed. Breastfeeding is physiologically more advantageous to mother and child, yet breastfeeding is underutilized in this country. (Above) CDC statistics on percentage of U.S. children who were exclusively breastfed, by birth year
Basic challenges arise immediately at birth from encouraging an infant to latch, to proper positioning of the newborn, to delayed or poor milk production.
Women all over the country like myself will attest that breastfeeding can affect career goals and be psychologically and physically traumatic.
A 2020 Harvard Review of Psychiatry study found as many as 23% of employed mothers return to work within ten days of giving birth, because of financial pressure.
These new moms face the additional hurdles of breast-pumping in the workplace and properly storing milk.
Unsurprisingly, a 2018 UNICEF report found that wealthy developed countries, where women make up a significant percentage of the work force, have the world’s lowest breastfeeding rates.
In Ireland, 55% of mothers breastfed their infants at least once. In France, it was 63%, and in the U.S., 74%, according to this study.
Compare that to low-income developing countries like the Democratic Republic of Congo where 98% of mothers breastfed their children at least once.
All these challenges are legitimate, and all of this should be weighed in the decision of whether to breastfeed.
But there are two parties involved here, babies and mothers.
For the infant, the CDC, American Academy of Pediatrics and many other public health entities say breastfeeding is the best source of nutrition for most infants. Because of this, it should be strongly considered despite known challenges it may pose.
Over a decade ago, in an effort to lower infant mortality, U.S. public health officials started a campaign to urge more mothers to breastfeed their newborns.
Under President Obama, in 2011 the Surgeon General put forth a Call to Action. The Healthy People 2020 campaign’s primary objectives were to increase the percentage of infants who receive any breastmilk as well as those exclusively breastfed until 6 months and still breastfeeding at 12 months.
Over a 7-year span, according to the Centers for Disease Control and Prevention (CDC), the number of infants who received any breastfeeding slightly increased from 79.2% in 2011 to 83.9% in 2018. (Note: The CDC’s findings differ from the UNICEF report, but the statistics are useful to demonstrating societal dynamics and trends)
Similar incremental increases were seen in infants exclusively breastfed until 6 months (18.8% to 25.8%), however that is still well-short of The Healthy People campaign’s stated goal of 42.4%.
A small increase in infants breastfed through 1 year of life was also seen (26.7% to 35.0%). Again, that’s much lower than the 54.1% target.
Over a 7-year span, according to the Centers for Disease Control and Prevention (CDC), the number of infants who received any breastfeeding slightly increased from 79.2% in 2011 to 83.9% in 2018. (Above) CDC data on US breastfeeding
Collective research also establishes exclusive breastfeeding for 6 months and continued breastfeeding through 12 months as key to maintaining infant and maternal health.
Extended breastfeeding not only reduces acute illnesses in infants, it also decreases the risk of future conditions such as obesity, sudden infant death syndrome (SIDS), asthma, and low IQ. Breastfeeding additionally decreases the rate of high blood pressure, diabetes, and breast cancer in women.
The truth is, our nation is exacerbating this supply crisis because of an erosion of science at the hand of cancel culture.
Like being accused of ‘fat-shaming’ when discussing a person’s weight and the direct correlation with medical risk, the derogatory term ‘bottle-shame’ has evolved as many bottle-feed formula over breastmilk.
This attrition of science and good public health policy is nothing new of course, but it is a growing problem.
As Covid-19 illness spread like wildfire throughout our country, physicians and media pundits were paralyzed by the fear of retaliation and failed to state the obvious regarding the obesity epidemic rendering Americans vulnerable to SARS-CoV-2.
In April 2020, I wrote an editorial titled ‘Coronavirus – Deaths rising due to chronic illness, obesity should alarm us all.’
We have a formula scarcity because of supply chain issues but also from overutilization. Many mothers are choosing to use formula, and no one is allowed to question why.
The article detailed how advanced age and being overweight were directly linked with severity of illness and death from Covid-19. Yet, a digital comment left responded, ‘Oh look, fat-shaming and classism.’
We witnessed this repeatedly throughout the Covid pandemic – from the inability to discuss weight and its link to Covid mortality to the debate over controversial school closures, masks and vaccines.
This isn’t right. Political correctness has inserted itself between the medical community and public to the detriment of overall wellness.
Actress Bette Midler recently commented on the formula shortage in a tweet saying, ‘TRY BREASTFEEEDING! It’s free and available on demand.’
While the tweet is overly simplistic, the idea is worth considering. Instead, the public response was merciless.
One Twitter respondent tweeted ‘We need to stop shaming women. For having sex. For liking sex. For getting raped. For having babies. For not having babies. For breastfeeding. For not breastfeeding. For using daycare. For not using daycare. Please, can we just let women live? Can we please just let them be?’
Breastfeeding has become a hands-off topic considered too contentious to discuss because a small vocal extreme considers any suggestion that breastfeeding is superior to formula feeding to be insensitive to those unable to or who choose not to breastfeed.
Author, Dr. Nicole Saphier is a physician at Memorial Sloan Kettering Cancer Center, an assistant professor at Weill Cornell Medical College
While it is settled science that breastfeeding is linked to lower risk of illness in mother and child, not every mother can breastfeed. There must be suitable alternatives readily available.
Women who cannot breastfeed should not be ridiculed or made to feel as they are not prioritizing the wellness of their child. It is a physiological truth they are faced with. But one truth does not cancel the other.
The paucity of infants breastfed for their first year of life is a public health concern that should be carefully deliberated by parents and pediatricians.
The medical community must be allowed to be honest about the scientific advantages of breastfeeding and encourage more women to do it while also acknowledging and respecting those unable to.
The truth is, America is now rationing a limited supply of formula, and we are in denial if we believe there will be a quick fix.
We have a formula scarcity because of supply chain issues but also from overutilization. Many mothers are choosing to use formula, and no one is allowed to question why.
The Call to Action from the Surgeon General and the CDC remain; it is vital to increase breastfeeding rates across our nation. And we must talk about it.
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