Formula Feeding vs Breastfeeding— A Thing Called Stigma and the Data Behind It

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Author Karen Gill

Many mothers experience shame and stigma for how they feed their infants, and feeling pressure to do things a certain way can affect a mom’s well-being.

Stigma is a set of negative and unfair beliefs that a group holds; a social phenomenon rooted in social relationships and shaped by the culture and structure of society. The reactions of others can affect normal identity (Goffamn, 1963). It’s a universal phenomenon – every society has norms and values that define acceptable behavior. However, what is stigmatized will vary from culture to culture and from one society to another based on their own beliefs and values (Ainlay, Becker & Coleman 2010)

We as individuals will carry this cultural template of beliefs and values with us, and it can guide our thoughts, actions, and behavior often in an unconscious way. We may not be aware of how and why we think and feel the way we do.  

The Guilt Is Real; 2/3rds of Moms Feel It

A quantitative study in the UK (Fallon et al 2016) examined the emotional and practical experiences of mothers who used formula. They found a worryingly high percentage of mothers experienced negative emotions including guilt (67%), stigma (68%), and the need to defend their decision (76%) to use formula. Mothers who had intentions to exclusively breastfeed during pregnancy were at a significantly higher risk of experiencing guilt and dissatisfaction as a result of their feeding method when they used formula. Whereas, those who intended to exclusively formula feed in pregnancy and initiated exclusive formula feeding from birth, were at higher risk of experiencing stigma, as a result of their feeding method. We also know psychological pressure around breastfeeding contributes to postpartum depression symptoms (Forbes, 2018). 

Shame and negative emotions not only rest with formula use. Breastfeeding mothers experience shame about showing their bodies to nourish their babies in public, often being asked to go to a designated area or to cover up. An international study found mothers felt ‘marginalized and ashamed’ when they breastfeed in public, and that many new mothers are put off breastfeeding by negative comments. Mothers reported being stared at or tutted at; others reported wanting to breastfeed after 12 months but feared public disapproval (Hunt & Thomson 2016). 

Culture Can Define the Level of Stigma

How women feel will vary depending on the cultural norms. Breastfeeding might be assumed in many urban and upper-middle-class parenting circles, and those using formula will often hide their formula use because they are going against the norm and fear judgment. Similarly, a breastfeeding mom in a predominately bottle-feeding area or country may experience stigma – if we do something different than the social or moral norms we’re going to feel different and often judged. 

So how do we shake the stigma around feeding methods and choices? And most importantly provide unconditional support to mothers, at what is a very vulnerable time in their life. Mothers need to feel confident and secure in their choice. The Fallon study suggests that the current approach to infant feeding promotion and support may be paradoxically related to significant issues with emotional well‐being. Information on breastfeeding should be educational and informative but not absolutist with education around formula being beneficial as up to 83% of parents will supplement at some point (Wakefied, 2019). Breastfeeding and formula feeding is often not one or the other – so many do both. Why do we present it as a dichotomous issue?

Breast Is Best… Until It Isn’t

Given the dominant narrative is breast is best, we must be aware that there are a whole host of reasons that exclusive breastfeeding does not work out for women including physical and medical issues, insufficient glandular tissue, Polycystic ovaries, Hypothyroidism, previous breast surgery or radiation treatment.

Many medicines a mother takes for her health may not be suitable for the baby or cause a decrease in milk supply. There are also many factors individual to the baby that can prevent breastfeeding, such as galactosemia, PKU and maple syrup urine disease. Latch issues and significant pain on behalf of the mother can also prevent successful breastfeeding. 

This is not to mention a plethora of environmental factors such as women needing to go back to work quickly after having a baby to support their family, or having access to or allocated time to pump. Working mothers report feeling overwhelming pressure to be both the perfect parent and employee.

We must also acknowledge that women may simply choose not to breastfeed for reasons specific to them, every woman should have the right to self-determination in how they feed without feeling judged or stigmatized. 

The American College of Obstetricians and Gynecologists recommends exclusive breastfeeding for the first six months of life, it also officially recognizes that a baby’s mother “is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding or formula feeding is optimal for her and her infant.”

The image of a breastfeeding mother or a bottle-feeding mother should not signal different factions of divergent beliefs, but just a baby being nourished by mama. The truth of the matter is, that the same mother will have completely different experiences with each of her children, depending on other factors such as mental well-being, working outside of the home, and access to pumping rooms. Not to mention, health and factors individual to the baby will determine what each feeding journey looks like. 

Polarizing this issue as binary, as best and worst, as right and wrong only serves to mark the boundaries between us as mothers and deepen a chasm of conflict. It pushes us into guilt and makes us feel insecure affecting our well-being and mental health. We can offer a more balanced and compassionate standpoint and assume all mothers do what is best for themselves and their babies.

It feels like there are enough things in the world right now that are highly politicized and divisive, let’s not make how we feed our kids one of them. Let mothers unite and put this thing called stigma to bed.

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.

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.