COMMERCIAL PRODUCTION OF ARTIFICIAL BABY MILK (ABM)

Early human milk substitutes lacked a great deal nutritionally. Dry nursing included the milk of other animals, broth, and Pabulum (a bread like substance). Recipes were handed down from mother to daughter in much the same way breastfeeding information once was. The addition of such oddities as cod liver oil and the introduction of solids at two weeks of age were required to provide essential nutrients. Otherwise, the baby would not grow and develop normally. Human milk naturally contains all the necessary nutrients.
A home formula recipe from 1908 contained instructions to obtain the milk both morning and evening and then let it stand for several hours to obtain the top cream (Rossiter 90). This recipe included freshly scalded cream, cows' milk, lime water, brown sugar, and boiled water. The use of unpasteurized cows' milk spawned epidemics of diarrheal disease, tuberculosis and malnutrition in the artificially fed infants. Infant mortality rates rose. With the arrival of evaporated canned milk the need for fresh milk diminished. Artificial feeding recipes based on canned milk contained light corn syrup and lime water besides the condensed milk. There were strict instructions for sterilization. Everything that touched the formula, from mixing cups to bottles, needed to undergo a lengthy sterilization process (Ingalls and Salerno 209- 216). By the 1950's nearly 85% of all infants were artificially fed.
 

What Artificial Baby Milk (ABM) Lacks
Artificial baby milk has come a long way from the treasured family recipes of less than a generation ago. Extensive studies by scientists and chemists continue to pursue the ingredients that will bring artificial baby milk closer to human milk. Technically, that fact makes ABM the longest uncontrolled, mass experiment on helpless babies and trusting parents in history (Lawrence and Lawrence 1).

Beyond the irreplaceable living components in human milk, ABM still lacks a great deal. One hundred and thirty oligosaccharides are present in human milk but not in formula. (One company has added three oligosaccharides to its formula - that means that the other 127 are still missing.) The latest controversy is the need to add Omega-3 long chain PUFA (polyunsaturated fatty acids), especially DHA (docosahexaenoic acid). DHA is considered essential for proper brain growth and retinal development. Omega-3 fatty acids are not prevalent in the adult food supply. However, they are present in mass quantities in human milk. "Based upon clear evidence of an essential role in human development and health, the scientists recommended that all infant formula and [liquid] diets for humans should include Omega-3 fatty acids and they expressed concern that steps be taken to stop marketing enteral and parenteral formulas that fail to include any Omega 3 fatty acids (Simopoulos)." Safe additive DHA levels have not been determined and testing is underway. If DHA is added to artificial baby milk, the retail price of ABM may double.

ABM has been designed to meet the basic generic nutritional needs of infants. "Every drop [of formula] is the same as every other drop. (Macadam and Dettwyler 400)." All infants' nutritional needs are assumed to be the same at all times. The bottle fed infant will receive the same generic ABM for at least the first year. His breastfed counterpart however, will experience the ever changing composition and flavor of human milk that meets his immediate, individual nutritional needs for as long as he breast feeds.
 

Restricting Sales of ABM
Before the arrival of free market practices in the USSR, Czechoslovakia, the German Democratic Republic, and Hungary required a prescription for infant formula. Since 1977, Papua New Guinea requires "that baby feeding bottles, teats (nipples) and dummies (pacifiers) be sold at registered pharmacies and obtained only through medical prescription. Said prescription 'cannot be given unless the authorized health worker is satisfied that it would be in the best interest of the baby or infant.' The law was amended in 1984 to empower the Minister of Health to proscribe any feeding article considered hazardous to the health and well-being of infants (email communication, James Akre, Nutrition Unit, WHO, Geneva 12/12/95)." To encourage breastfeeding, China banned all artificial baby milk advertisements, giveaways, money and/or information to clinics and hospitals. The law effective October 1, 1995, also bans the distribution of free or discounted artificial baby milk to mothers (AP 7/4/95). In January 1996, the ministry of commerce in Saudi Arabia announced a blanket ban on all advertisement for breast milk substitutes.

In 1995, Professor Roger Short, submitted a formal request to the Australian government to require artificial baby milks to carry this warning label on the outside of the can: "Warning: Infant formula is potentially hazardous to the health of your baby in the first 4-6 months of its life." An additional warning for an insert inside: "Feeding an infant artificial formula during the first 4-6 months of its life instead of breast milk puts the baby at much greater risk of: diarrhoea, respiratory infections, sudden infant death syndrome, necrotizing enterocolitis, lowered intelligence (IQ) in later life, allergies in later life and early age onset diabetes. Failure to breastfeed also has adverse effects for the mother: she is at greater risk of developing breast cancer in later life, she is denied the contraceptive effect of lactational amenorrhoea." Professor Short asserts that Australia should do this to set an example for the rest of the world. Short's proposal is reminiscent of the fight to place warning labels on tobacco and alcohol products in the United States.
Every can of infant formula sold in the United States is required to carry a label that reads, "Breastmilk is best for baby and is recommended for as long as possible in infancy." The U.S. is a long way from restricting artificial baby milk sales or distribution of free materials.
 

Artificial Baby Milks: A Great Sales Campaign

Occasionally, women entering the United States may abandon breastfeeding falsely assuming all Americans give babies formula (Lawrence and Lawrence 15). The Welfare Department reported that formula can be provided for two years because two years is how long immigrants would have breastfed in their native countries (Salisbury and Blackwell 105). In some Third World countries, a can of formula can equal a week's wages and formula use can become a status symbol as if to say, "only poor women breastfeed." In the United States, people from all walks of life have been sold a lie. We have been led to believe that the dangers of formula do not apply to the United States and developed nations. This is far from the truth.

The artificial baby milk companies are as powerful as the tobacco companies in keeping the dangers of formula use away from the public. Their marketing tactics are equally as subtle. In "Physicians, Formula Companies, and Advertising: A Historical Perspective," the authors talk about a history of collusion between doctors and the infant formula industry (Greer, F.R. and R.D. Apple). Milk, Money and Madness contains a similar detailed account (Baumslag and Michels). Formula companies openly give hundreds of thousands of dollars to medical professionals, sponsor medical seminars and research, and provide massive amounts of "free" formula to hospitals every year. Some major medical centers may use more than a quarter of a million dollars in "free" formula every year. What these hospitals fail to realize is that in essence, they are doing "free" advertising for the formula companies. As the BFHI grows across the U.S., formula companies are moving toward direct marketing to the consumer. (IBFAN 3/18/98) Pregnant mothers innocently sign up for new baby "clubs," and receive coupons and cases of formula mailed directly to their homes. Watch television for any length of time and not only will you will see commercials for infant formulas, but commercials for adult "formulas" as well. The implication is that adults are too busy to chew their calories or have nutrient deficient diets.
 

THAT "GUILT" THING
Health care professionals who truly support breastfeeding, will face a major dilemma: the fear of instilling guilt feelings in the mother who chooses to bottle feed. The literature does not support this position. Women do not say they feel guilty about not breastfeeding. Rather they feel that they did what was right for them. "The only individuals who ever mention guilt are the older generation whose daughters are now choosing breastfeeding." (Lawrence and Lawrence 213) At least two recently published books, address the issue of how not to "feel guilty," when bottle feeding.
"The medical profession has been hesitant to take anything but a neutral position in discussions of breastfeeding for fear of pressuring the mother . . . Parents have the right to hear the data. They can make their own choice. Fear of instilling guilt is a poor reason to deprive the mother of an informed choice (Lawrence and Lawrence 243)." It is odd that the same fear of instilling guilt is not applied to such hazards as smoking, unprotected sex, not using car seats, drugs, and obesity.

A 1988 study suggests that the strongest predictor for breastfeeding duration may be prenatal intent (Coreil and Murphy). Ruth Lawrence believes that if women are given complete information on risk : benefit ratios, they will choose to breastfeed (Macadam and Dettwyler 401). Health care professionals are familiar with risk: benefit ratios. The process is called informed consent. To make an informed decision, parents need to be fully informed about the risks that may be avoided by breastfeeding. When a woman chooses to breastfeed, or bottle feed, she is making a decision that will have long lasting consequences for her child's health. Breastfeeding should not be presented as a lifestyle choice. Health care professionals have a duty to provide the information necessary for informed consent. The facts need to be presented as expert medical guidance toward health. Then we can be assured that the mother who chooses to bottle feed does so because it is truly right for her.

In her article, "When Women Decide not to Breastfeed," Gigliotti says, "Women find themselves reacting to the implication that they somehow deprived their otherwise healthy children of a once-in-a-lifetime experience (315)." Breastfeeding is a once-in-a-lifetime experience, professionals cannot change that fact.
 

The Reasons Women Bottle Feed
The only justification a woman who chooses to bottle feed needs is that, for whatever reason, breastfeeding is not the right thing for her. Underlying motives for her decision may include:
1) A feeling that breastfeeding is repulsive or lacks appeal,
2) A sense that breastfeeding is too embarrassing,
3) A busy lifestyle or feeling that breastfeeding will tie her down,
4) She feels that she is too nervous to breastfeed,
5) Breastfeeding seems too complicated or restrictive,
6) Her partner expresses jealousy,
7) She is overly concerned that she can't measure the baby's intake. (Eiger and Olds 15-18)

Proper education will help alleviate most of these concerns.

Once she has expressed her choice, that choice must be respected. Health care professionals are often surprised at lactation consultants' attitude toward bottle feeding mothers. Nurses expect lactation consultants to be harsh toward those who are not breastfeeding. On the contrary, lactation consultants will not push or force any woman to breastfeed. They will answer the bottle feeding mother's questions about drying her milk or other feeding concerns. Occasionally, if a mother feels trapped or torn or if she really didn't want to breastfeed, she may need "permission" from a medical professional to bottle feed. Sometimes the only medical professional a mother will "trust" for that permission is a lactation consultant. Whenever it is needed, lactation consultants freely give that permission.
 

Human Milk Is NOT Interchangeable With Other Nutrient Sources
The more breastmilk is studied, the more apparent it becomes that human milk is not interchangeable with other nutrient sources [Table: Comparison of Human Milk to ABM] Fresh breastmilk is a living fluid. An ancient title of "White Blood" was very accurate. A Chinese text by Sun Simiao (581 to 682) refers to xueqi "the complementary terms xue and qi literally translate as 'blood' and 'vital energy' (Gartner and Stone 533)." Breastmilk is composed of over 200 known ingredients including; vitamins, minerals, trace elements, protein, fat and carbohydrates. Breastmilk contains 4,000 live cells per milliliter, mostly leukocytes. It is the living component of breastmilk that cannot be replaced by artificial feeding. "Human milk is a highly complex fluid with a nutrient balance and an array of functional properties that may promote a level of metabolic efficiency that is not attainable when cow milk-based formula is fed (Garza 27)." An important factor in human milk is antibody protection. The infant will be protected (through passive immunity) from any diseases for which the mother has developed antibodies. This protection continues as long as the baby is breastfeeding.

Human milk is not a uniform body fluid. Variations in milk composition are not random but functional (Akre 25). The constituents of human milk are multi - functional and interactive. Human milk contains "species specific" nutrients. When an infant suckles at the breast "there is a large outpouring of 19 different gastrointestinal hormones in both the mother and infant . . . which stimulate growth of the baby's and mother's intestinal villi and increase the surface area and the absorption of calories with each feeding (Kennell and Klaus 7)." In human milk there are ingredients, not present in formula, which provide for improved brain growth (Lucas 261-264). The optimum development of the brain and nervous system requires the presence of a precise balance of specific amino acids, fats, simple sugars, salts and minerals (Lawrence and Lawrence 105-152).

Milk production requires very little maternal energy and the process is about 95% efficient (Lawrence and Lawrence 59). As study methods improve, it is now possible to look at human milk's intricate components and their variations throughout the nursing experience. Early studies were often limited to a period of weeks. Researchers are now extending their studies into the second year of lactation. The one question that remains unanswered is how much milk is taken by the baby at each feeding. Lawrence and Lawrence calls this a "scientific challenge (95)."

When cows' milk is used as a base, it is first denatured and then fortified to be suitable for consumption by human infants. In this altered state, ingredients remain that are unused by the infant. The unused portions of breastmilk and formula produce biological waste. Visible evidence of biological waste is seen in infant stooling patterns. The formula fed infant has stools once or twice daily resembling thick yellow paste. Artificially fed infants are prone to constipation. An exclusively breastfed infant has very little biological waste because he uses every portion of the milk. Breastfed infant stools resemble runny egg yolks with occasional milk curds. Formula has a higher mineral and ash content than the infant requires. Artificial feeding results in higher blood urea and amino acid levels, thus the infant has a two thirds higher renal solute load and higher urine specific gravity (Akre 26, Lawrence and Lawrence 129, Riordan 34). Higher sodium concentrations in artificial baby milk require a greater water intake for excretion and produce increased thirst. The increased thirst in the formula fed infant is often interpreted as hunger by the mother and the infant is fed more formula. A greater water intake is required by the artificially fed infant for excretion of biological waste. However, traditionally they have not been given water feedings.
 

Hazards Associated With The Use of Artificial Baby Milks
Artificial baby milk carries inherent dangers that are not associated with breastmilk. Many of those dangers are not known by women giving formula to their infants. Information on the dangers of formula may be purposely withheld in much the same way as tobacco companies did. For example, data on breastfeeding rates in the United States comes from a major formula company. Artificial baby milk companies have strong economic reasons that may prevent the release of any negative information to the public. There have been over twenty formula recalls in the U.S. since 1982 (Walker 107). The FDA formula report "Petition to Alleviate Domestic Formula Misuse . . . " contains approximately 100 pages of the dangers associated with formula use.

Dr. Ruth Lawrence testified before the US senate in 1991, "UNICEF estimates that one and a half million babies a year still die from bottle-feeding-related illness" (Mantell 5). In 1997, the WHO confirmed that the number of infant deaths from artificial feeding remains unchanged (IBFAN 3/18/98). A baby who is artificially fed is ten times more likely to be hospitalized in the first year of life for serious illness than his breastfed counterpart.

Known Risks Associated With Artificial Baby Milk

  1.  Increase in gastrointestinal illness (vomiting, diarrhea and dehydration).
  2.  Increase in respiratory illnesses (pneumonia, asthma, and RSV).
  3.  Increased ear infections. Otitis media is four times more prevalent in the formula fed infant (Walker 97).
  4.  Increased likelihood of childhood obesity.
  5.  Increased risk of tooth decay (nursing bottle carries).
  6.  Risk of contaminated formula (either at the factory or at home). Ingestion of "allowable" amounts of insect parts, rat hairs, droppings, iron filings, and accidental excesses of chlorine and aluminum (Stuart-Macadam and Dettwyler 161).
  7. Severe illness resulting from improper dilution or home additives.
  8. Increased allergies ranging from skin rashes to asthma. (Salisbury and Blackwell 28, Lawrence and Lawrence 617-629).
  9. Increased risk of immune system disorders.
  10. Increased risk of Sudden Infant Death Syndrome. [Nicole Bernshaw reports in a study of Sudden Infant Death Syndrome (SIDS) published in the Journal of Human Lactation (June 1991): "It is difficult to single out any particular factor responsible for the occurrence of SIDS. However, epidemiologic studies suggest strongly that the popular hypotheses have a common denominator; the lack of breastfeeding . . . Despite our current lack of understanding of the causes of SIDS, it appears that breastfeeding is perhaps one of the easiest, most loving ways to reduce a baby's vulnerability to this fatal condition (7:73-79)."]

Does formula have any advantages? One. Anyone can feed the baby at any time.
 

WHAT BREASTFEEDING PROVIDES

Breastfeeding Disadvantages
None, except those perceived as inconvenience.
 

Copyright Marie Davis, RN, IBCLC 1999 
Revised: Wed, Nov 8, 2006
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