Experts Tell All

The stigma around infant feeding is real— for parents and researchers alike

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Bobbie is proud to partner with the American Society for Nutrition (ASN) to bring you this article. ASN is a globally respected organization made up of over 8,000 nutrition scientists and practitioners working toward a healthier world through evidence-based nutrition.

Contributors to this article include: 

  • Morgan Leafe, MD, MHA, a board-certified pediatrician, medical writer, and medical editor
  • Elieke Kearns, PhD, RD, a Registered Dietitian, Nutrition Scientist, and Bobbie Medical Affairs lead
  • Leanne Redman, PhD, Professor, the Founder and Director of the Reproductive Endocrinology and Women’s Health Laboratory at Pennington Biomedical Research Center and chair of ASN’s Maternal, Perinatal and Pediatric Nutrition subgroup
  • Carol Boushey, PhD, MPH, RD, an Associate Researcher in the Epidemiology Program of the University of Hawaii Cancer Center and an Adjunct Professor in the Nutrition Science Department at Purdue University and active member of ASN’s Maternal, Perinatal and Pediatric Nutrition subgroup

The issue with breast milk and formula research

If you have an infant, you’ve surely heard that breastfeeding is best for them. And there are piles of scientific research on breastfeeding and breast milk that confirm this without a doubt. But the fact of the matter is that a majority of infants (75%) will have infant formula within the first 6 months of life.1 Since parents and researchers alike want babies to receive the best possible nutrition, it’s critical that research funding for both breast milk and infant formula is prioritized. Scientists are eager to explore how new discoveries about breast milk can be applied to infant formula, but just the way parents feel stigmatized to use infant formula, there is a stigma that researchers experience when wanting to study this critical food.

Breast may be best, but it’s not always possible

Countless studies have shown that infants who are breastfed have lower rates of some infections and immune diseases, and moms who breastfeed go on to have a lower risk of high blood pressure and certain cancers.2

However, there are parents who are not able or choose not to breastfeed for many different reasons. Adoptive parents, moms who’ve had breast surgery and moms or babies with certain conditions are not able to breastfeed.2 And there are many personal reasons that a family may choose not to breastfeed their infant or be unable to do so.

In addition, because of factors like unsupportive work policies and lactation difficulties, 60% of moms aren’t able to breastfeed for as long as they intended. Although 84% of infants receive at least some breast milk, less than half of infants are exclusively breastfed for the first 3 months of life and only one quarter are exclusively breastfed through age 6 months.3

Bottom line- even though parents and pediatricians both know exclusive breastfeeding for the first 6 months followed by breastfeeding while introducing solid foods is best, the reality is that most infants are going to have infant formula at some point. So why not maximally support scientists to research both breast milk and infant formula to ensure that infants are getting the best nutrition they can right from the start?

Measuring baby formula

Shifting the dogma in infant formula research

According to researcher Leanne Redman, PhD, Professor and the Founder and Director of the Reproductive Endocrinology and Women’s Health Laboratory at Pennington Biomedical Research Center and chair of ASN’s Maternal, Perinatal and Pediatric Nutrition subgroup, we need to shift the dogma around infant formula in the research world.

As a researcher focused on understanding (and bettering) maternal and infant nutrition, we too face unrecognized stigma for conducting research on infant formula. I often feel as though we need to justify why our research of infant formula is important and of interest. Wherever we advertise our trials to moms-to-be or new moms, we are always having to defend our position and educate people that ‘breast is not available to all babies’. Whatever may be the reason to feed formula, without fail, parents are united in the same goal- to nourish a healthy baby into a healthy and thriving child.”

As science evolves, so does infant formula

Even though infant formula has been around for over 100 years, importantly, it has changed over time as scientists learn more about infant nutritional needs and the components of breast milk. Since we know that breastfeeding is best because of the many benefits to mom and baby, it makes sense to keep learning what makes it so special so that infant formula can have as many of these benefits as possible.

This task is harder than you may realize. If you think breast milk is a simple substance, think again. Not only is breast milk different from person to person, but one woman’s own breast milk also changes over the course of breastfeeding.4

Breast milk contains carbohydrates, fat and lots of important vitamins and minerals. And identifying all the components isn’t the end of the story- it’s also important to understand the ratios of each component because this affects how well they are digested and used by babies.4

In short, breast milk is a very complex substance with many components working together to create the final product. So while it’s great to know the health benefits of breast milk, learning more about how to replicate it and why infant formula does not offer some of the same benefits is also just as important. And this learning process requires data, which can only be obtained through scientific research.

U.S. infant formula today is very safe

In 1941, the US began regulating infant formula, and around this time commercial formula companies really took off. Before this, many families made their own infant formula at home with ingredients like Karo syrup and canned milk.5

The extensive regulation we are familiar with today that ensures the safety of the food our little ones enjoy began in 1980 with the passage of the Infant Formula Act.6 At the time, this was noted by researcher Raymond Newberry to be “one of the most specific and detailed acts ever passed by Congress“.7 The Infant Formula Act has been updated over time and is part of the Federal Code of Regulations, which establishes minimum amounts of 30 nutrients and quality measures to ensure safety. 

Studying infant nutrition is really hard 

It may seem like infant nutrition is simple and should be easy to study. But there are a few things about breastfeeding and formula feeding that make this a tricky area of research.

First, you may know that when scientists study a medicine, there is usually one group that gets the medicine and one group that doesn’t (they get a placebo instead). Neither group, and usually the scientists, knows who is getting what. This helps to eliminate bias, or people expecting a certain outcome.

As you can imagine, this can’t really be done for breast and bottle feeding– it’s pretty obvious who is getting which one! In addition, when medications are tested, volunteers are randomly assigned without any choice to the group getting the medication or the group not getting the medication. Again, this can’t really be done for infant feeding because it wouldn’t be ethical to make this decision for parents and their baby.8

Second, as discussed above, infant formula has changed a lot over the years as new scientific studies learn more about breast milk and ideal infant nutrition. Once research on infant formula is completed, it may be outdated within a few years as formulations change and improve. Not only that, but there are many different infant formulas, so is it accurate to put all infants who are formula fed in the same group?9

All of these complex issues point to the need for more and ongoing research funding for infant feeding and outcomes.

What do scientists want to study in infant nutrition?

According to Dr. Redman, there are many aspects of infant nutrition that scientists want to learn more about.

Dr. Redman notes that nutrition early in life has life-long effects on our health and wellbeing. She notes, “We need more research to understand how to optimize baby’s first foods. For example, parents and caregivers receive very little guidance on how much to feed and how often, or how to adapt feeding to their infants’ cues. With childhood obesity affecting one in every five children by kindergarten, research on infant nutrition in general, which includes infant formula, needs more attention.”

In addition to studying formula and its metabolic effects, Dr. Redman also stated that learning more about ideal bottle nipples, caregiver habits in preparing bottles and infant sucking behavior are necessary to understand the entire process of infant formula feeding.

One of the most vulnerable groups of infants- those who were born prematurely- are especially likely to benefit from further nutrition research. These infants have specific nutritional needs that full term infants do not and are at higher risk for certain diseases compared to full term infants.

What needs to change in infant research?

Given that so many infants will consume infant formula in the first year of life, more research money would offer a better understanding of the necessary components and long term effects of infant formula use.10 According to Dr. Redman, both the NIH and the United States Department of Agriculture (USDA) would be ideal candidates to support this work.

As the USDA oversees the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which supplies infant formula and breastfeeding support to low income families, it would be particularly beneficial for this organization to have more data about infant formula. Additionally, Dr. Redman noted that philanthropic organizations studying childhood obesity and formula companies can also be important contributors to this research.

Beyond studying infant formula itself, the social circumstances surrounding its use warrant further investigation. Dr. Redman stated, “Let’s face it – caregivers who feed their babies infant formula are stigmatized! This needs to be a topic of future research. We need to understand how to better embrace all kinds of feeding not only human milk feeding.” Researchers like Dr. Redman also battle the same stigma when seeking research funding.

Looking to the future in research funding for infant feeding

While an extensive amount of research has been done on breastfeeding, breast milk, infant formula and infant nutrition, there are areas that need continued or additional focus to ensure babies are receiving the best nutrition possible during this important time of growth and development. And while the available research has already shown that breast may be best, the focus must remain on how to optimize infant health through any method of feeding rather than only focusing on one form of feeding that may not be accessible to all. Additionally, the use of the word ‘best’ in reference to breast milk vs formula needs to evolve — this invites stigma and automatically puts infant formula in a secondary tier when we know that infant formula grows healthy infants and is a common feeding choice. 

Let’s break the stigma associated with infant formula (for both the caregivers and the researchers) so we can meet parents where they are and better support them in their goal to nourish and support their newest family member.

Sources:

1- Breastfeeding report card | Centers for Disease Control and Prevention

2- Breastfeeding and the use of human milk | Pediatrics

3- Breastfeeding facts | Centers for Disease Control and Prevention

4- Comparing infant formulas with human milk | Institute of Medicine (US) Committee on the Evaluation of the Addition of Ingredients New to Infant Formula

5- In pursuit of a better baby formula | Smithsonian Magazine

6- Code of Federal Regulations Title 21 | Food and Drug Administration

7- The Infant Formula Act of 1980 | Journal of Association of Official Analytical Chemists

8- Breastfeeding, cognitive and noncognitive development in early childhood: a population study| Pediatrics

9- Formula feeding exposure is not homogenous | Pediatrics

10- Challenges of infant nutrition research: a commentary | Nutrition Journal

The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant's pediatrician. Never disregard professional medical advice or delay it based on the content on this page.
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