Breast- and bottle-feeding: Is ‘better’ always best?

Have you ever wondered what the phrase ‘informed choice’ means? Get pregnant, and you’ll soon find out.

One of the many leaflets that I was given at the antenatal clinic, around this time last year, deals with the question: ‘Feeding your baby – breast or bottle?’ ‘This leaflet is based on research to help you make your own choice’, it states at the top of page one. Further down, it clarifies: ‘This is one of a series of leaflets designed to help you make the right choices for you and your baby.’ (1)

But what is the choice? ‘Breast milk is the best food for babies. For a long time people thought bottle feeding was a safe alternative. But now there’s evidence that some babies who don’t receive breast milk get very ill’, states the leaflet on page two. What follows is an exhaustive list of the advantages breast-feeding (including, bizarrely, the claim that children breast-fed for eight months or more have higher IQ scores and do better at school), and the disadvantages of bottle-feeding. There is also a frightening box titled ‘Is bottle feeding safe?’ which tells you how much more likely a bottle-fed infant is to suffer a number of terrible diseases than breast-fed babies, and handy hints for the would-be quitter (for example, a reminder that 99 per cent of women can breast-feed).

Each of the leaflet’s six pages carries the moniker ‘Informed choice for women’. It ends with a statement headlined ‘Your choice’, and the claim that ‘Whatever you decide, the midwives are there to help you’. But what pregnant woman, after reading this leaflet, can happily go away ‘choosing’ not to breast-feed – having been ‘informed’ that bottle-feeding poses a serious threat to her child? The leaflet’s message is not that you have a choice, but rather that you have a duty to your baby to make the right decision – and if you decide to make the wrong decision, you must be in some way a bad person, too selfish or lazy to do the best by your baby. Is this the best kind of advice to issue to new mums?

When it comes to feeding your newborn baby, the concept of ‘choice’ has become loaded out of existence. It is for this reason that spiked has organised a discussion on the subject at its London conference ‘Whose choice is it anyway? Questioning the new conformism’. The purpose of this discussion is not to debate the merits of breast- versus bottle-feeding. Scientific evidence indicates that breast-milk is generally better for the health of new babies than formula milk, giving some protective effect against some illnesses; and it can also help new mothers regain their figures. This is something that everybody from health professionals to formula companies recognises.

But the promotion of breast-feeding has gone way beyond a recognition of the relative health benefits of breast-milk. If this were all it was, the health authorities would provide gentle encouragement in the direction of breast-feeding while having a relaxed approach to the way that many women combine breast-feeding with bottle-feeding. Instead, the idea that women should breast-feed exclusively has become a moral orthodoxy, with any bottle-feeding viewed as a real problem. The issue at stake in our discussion about choice is whether women, knowing that ‘breast is best’, should be cajoled and guilt-tripped into making the ‘right’ decision about how to feed their new baby, given all the other factors that impact upon whatever decisions they make.

The session at our conference has already proved controversial, largely because it is sponsored by Inform – a group supported by UK infant formula companies which describes itself as ‘working toward informed choice in infant feeding’. Many of those allied to the healthcare profession, who are committed to promoting vigorously the ‘breast is best’ message, have turned down invitations to speak on the basis that any discussion sponsored by baby milk companies is likely to be somehow tainted. This indicates the passions ignited by the question of how to feed a newborn baby, and the strength of dislike and suspicion that some feel towards the manufacturers of formula milk. But why should a mother’s choice about how to feed her baby become such a polarised, political issue?

As anyone who has run the gauntlet of maternity care will know, the message of the leaflet cited above is standard. It is a given that a woman will be continually fed the message ‘breast is best’ throughout her pregnancy, and if she goes on to bottle-feed her baby at all she will incur the sorrowful disapproval of health professionals and no small amount of personal guilt. This is the successful side of the public health campaigns that promote breastfeeding in the UK today – everybody knows they should do it, and those who don’t invariably feel bad.

On the other hand, it remains the case that the majority of women do bottle-feed their babies at some point. The Department of Health reports that the ‘Infant feeding survey’, which takes place every five years, found that 69 per cent of babies were breastfed initially in 2000, a small increase from 1995. However, a fifth of these breastfeeding mothers gave up within the first two weeks and over a third within the first six weeks. The proportion of all mothers breastfeeding at two weeks was 52 per cent, at six weeks 42 per cent, at four months 28 per cent, at six months 21 per cent, and at nine months 13 per cent (2).

The World Health Organisation recommends exclusive breastfeeding for the first six months of a child’s life – a recommendation that has been adopted by the UK government and is fed through to all new mothers. This indicates a major gap between the message of breastfeeding promotion campaigns, and the reality. Given that, in reality, most new mothers bottle-feed, it is surely worth questioning the uncompromising message put out by breastfeeding promotion campaigns – that these women are making the wrong choice, for illegitimate reasons. By the same token, it is worth questioning whether the climate that currently surrounds discussions about breast- and bottle-feeding in the UK is a healthy one, for health professionals, parents or their babies.

The point often made by those who wish to promote breast-feeding above bottle-feeding is that we do not live in a culture that is conducive to breast-feeding. It is argued that women find breast-feeding difficult, they feel stigmatised about breast-feeding in public, and that they are vulnerable to the power of the formula milk companies, who appear to offer an easier, quicker, less personally demanding alternative to the gruelling, if rewarding, experience of breast-feeding.

Of course, there is a large amount of truth to this. Breastfeeding does not ‘come naturally’ to today’s young mums, many of whom will not have grown up surrounded by family members suckling their own infants, and able to advise and support a young mother about her breastfeeding technique. Women can feel awkward about breast-feeding in pubs, restaurants and art galleries. And baby milk is big business. Despite heavy restrictions on the promotion of formula milk, everybody knows it exists – and after hours, days or weeks struggling with a fractious baby, sore breasts and no sleep, how tempting it is to turn to the bottle.

Yet the complaint that we do not live in a ‘breast-feeding culture’ often misses the fact that, while this culture might be bad for breast-feeding, in so many other respects it is good for women. The use of the bottle is, among other things, a consequence of women’s emancipation. Women go to work, they go out socialising, and they do not grow up in large families filled with young children. Our culture actively promotes the involvement of fathers in parenting – another positive development, but one that is often experienced as flying counter to the assertion that a mother should spend the first six months of a baby’s life as its sole nurturer, with the exclusivity and intimacy that this implies.

These social shifts provide the backdrop to a culture that is not conducive to exclusive breast-feeding, but is conducive to women making more choices about their lives in general. And in this context, the choice about whether to breast-feed, bottle-feed, or combine the two, should be seen as a legitimate choice made for a number of valid reasons.

Some women find it difficult to breast-feed, for physical reasons or for social reasons such as returning to work. Their decision should be respected as much as that of anyone else. For many other people, feeding their baby, like all other aspects of parenting, will involve balancing a number of concerns and desires – a baby’s good health, a father’s role in caring for the baby, a woman’s need to sleep, desire to go out and ability to go back to work when she needs or wants to – all of which are valid, and none of which can be decried as merely lazy or selfish. To bully pregnant women and new mothers into making ‘the right choice’ in the way that current breastfeeding promotion campaigns often do is to add to the burden of anxiety and guilt that new parents already have. Is that best for baby? I don’t think so.

As for the baby milk companies – yes, they are powerful, and yes, they want to sell their products. But they are not brainwashing anybody: they are selling something that women clearly want and need. It is hard to see who benefits from the range of promotional restrictions and ‘no platform’ policies that are currently applied to these companies, and the official moves to tighten up these restrictions: including restricting the availability of formula milk on healthcare premises (3). Despite the tendency of some breast-feeding promotional literature to hype the magical qualities of breast milk and to hype the alleged dangers of formula, it should be remembered that formula milk is a safe and nutritious alternative to, or addition to, breast milk.

To argue that women are incapable of choosing to breast-feed simply because of the widespread existence of an alternative is deeply patronising to new mothers. If they are considered incapable of sticking with breast-feeding because they can see tubs of powder on TV or on the supermarket shelf, how are they ever to be considered capable of withstanding all the other pressures of parenting, or making other choices about feeding, and raising, their children?

To argue that a discussion sponsored by infant formula companies is tainted by association patronises all those who feel themselves capable of having a discussion at all. However large the financial resources of the formula milk companies might be, in Britain at the moment it is the breastfeeding promotion campaigns that have the ear of the media, pregnant women and new mothers. People can be influenced by this propaganda, and influenced by the advertising of formula – but ultimately they will make their own choices about what is right and wrong.

Jennie Bristow is chairing the session Breast- and bottle-feeding: Is ‘better’ always best?, at the spiked conference ‘Whose choice is it anyway? Questioning the new conformism’, in central London on Friday 11 March 2005. Speakers in the session are: Christina Hopkinson, journalist and novelist; Ellie Lee, lecturer in social policy, University of Kent and author of Abortion, Motherhood and Mental Health; and Kaye McIntosh, editor, Pregnancy and Birth. For information about conference, see http://www.spiked-online.com/choice.

(1) Feeding your baby – breast or bottle?, Leaflet produced by midirs and the NHS Centre for Reviews and Dissemination (reproduced on the Informed Choice website)

(2) Infant feeding survey 2000, Department of Health, 13 May 2002

(3) Choosing Health: making healthier choices easier, Department of Health