A formula shortage triggered by supply-chain issues — and worsened by a recent recall by health care product manufacturer Abbott Nutrition — has had parents scrambling to find ways to feed their little ones. But the suggestion that women “just breastfeed” their baby — that is, feed their baby from the breast or by pumping or expressing their own breast milk — is much easier said than done for many women.
The breast milk versus formula debate has existed for decades in the U.S., and has revved up once more during the formula shortage. Bette Midler sparked outrage with her May 12 tweet, “TRY BREASTFEEEDING [sic]! It’s free and available on demand,” which incited renewed conversations around breastfeeding expectations for parents.
“To say casually, ‘Women have done this for thousands of years,’ ‘That’s why you have breasts,’ ‘Just breastfeed’ — I find that dismissive, uninformed and insensitive to make it that casual, because that is not the case for most people,” The View host Sara Haines said on May 13.
The reality is there are myriad reasons why a parent may rely on formula and not be able exclusively breastfeed, even if they would like to.
“It’s a very, very complicated topic. And anybody who thinks, ‘Well, just breastfeed,’ really doesn’t understand the nuances of how the system works, how the body works,” Sarah Siebold, an international board certified lactation consultant and owner of IMMA Lactation, tells Yahoo Life. “There’s so many layers. Pretending to understand all of them with just a flippant comment is really not OK.”
Here are five reasons why breastfeeding isn’t a viable solution to the formula shortage for many parents.
1. Some women have a naturally lower milk supply
The experts Yahoo Life spoke with agree that the number one way to increase milk supply is by increasing milk removal: The more a woman pumps or nurses, the more milk she’ll produce. But for women with insufficient glandular tissue (IGT), all the pumping and nursing in the world may not produce an adequate milk supply — because they don’t have enough of the necessary breast tissue.
“There are two kinds of breast tissue, and some women just don’t have enough of the milk-making kind,” Siebold explains.
While research on women’s breast milk production is limited, Dr. Christie del Castillo-Hegyi, co-founder of the Fed Is Best Foundation, tells Yahoo Life a woman’s milk supply often comes down to genetics; some women simply produce less than others.
“The literature shows that about 15 percent of women, even with maximum lactation support, will have chronic low supply issues or are unable to maintain breastfeeding within the first month after delivery,” del Castillo-Hegyi says.
For many moms, even if they are able to breastfeed, they may supplement their milk supply with formula. Sara Emanuel, a mom of three who lives in Chicago, supplemented with all of her children. She exclusively breastfed her eldest daughter, now 11, for the first few months. But when her daughter’s weight was keeping her below the growth curve, Emanuel decided to follow her pediatrician’s advice and supplement her breast milk with formula.
“If we’re talking about caring about what the child needs, then what the child sometimes needs is the extra nutrition, the extra quantity,” Emanuel tells Yahoo Life. “You wouldn’t tell someone, ‘Don’t get a tutor, you can just go to school.’ Some kids need both.”
And for mothers who haven’t been breastfeeding full-time or who stopped breastfeeding altogether, it’s not always possible to jump back into breastfeeding now that there’s a formula shortage. Re-lactation, or the process of resuming breastfeeding after a gap in nursing or pumping, takes time and isn’t always successful.
“It is cruel to tell a mother, ‘Hey, just relactate,’” Jody Segrave-Daly, registered nurse and co-founder of the Fed is Best Foundation, tells Yahoo Life. “It takes weeks and weeks and weeks, pumping every three hours or putting baby to breast, and there’s no guarantee it will happen. And if it does, it’s probably a smaller amount [of breast milk].”
2. Underlying health conditions can affect milk supply
Certain underlying health factors can also mean exclusively breastfeeding isn’t an option for some women. Conditions such as high body mass index, diabetes, thyroid problems and pregnancy-induced high blood pressure can all negatively impact breast milk supply; previous breast surgery, such as breast reduction or augmentation, can affect milk production; and some medications — including ones containing pseudoephedrine and certain types of hormonal contraception — can also lead to low milk supply.
Reproductive health can sometimes correlate with breast milk production too.
“If the mom has a history of irregular periods or has difficulty conceiving and needed to use IVF for one reason or another because of some kind of fertility abnormality, there could be a correlation to not making enough milk,” Siebold says, “because the hormones of lactation are so correlated with the hormones of fertility.”
Stress or a traumatic birth experience can also hinder the body’s ability to produce milk. Shalini Chanda tells Yahoo Life she was living in London and working as a communications manager with the NHS (National Health Service) when she gave birth to her eldest son. Chanda says she had a difficult 48-hour labor, and when her son was born he needed to spend time in the NICU. Still, Chanda says she was determined to breastfeed.
“I was literally crying myself to sleep every night, because my son was in intensive care on a different floor," Chanda says. "And because I didn’t have that skin-to-skin contact, there was nothing triggering my breast milk.”
She eventually switched to formula, and Chanda says her son is now a happy, healthy 11-year-old. She has since had two more children, who were also formula-fed.
“My body just didn’t produce any milk. And the doctor said that’s very common after what I had been through, psychologically and physically,” Chanda says.
#3: Breastfeeding options are limited for parents of babies who were adopted or birthed by a surrogate
The formula shortage poses a big challenge for parents of babies who were adopted or birthed by a surrogate, and affects moms and dads at every echelon of American society. Even transportation secretary and former Democratic presidential candidate Pete Buttigieg recently said the formula shortage has been “very personal” for him and his husband, Chasten Buttigieg, and that “baby formula is a very big part” of their lives. The Buttigiegs are fathers to adopted twins Penelope Rose Buttigieg and Joseph August Buttigieg.
Single fathers and gay male couples don’t have the ability to breastfeed, and while lactation might be possible for mothers of adopted babies or those birthed by a surrogate, the process is difficult and far from a guaranteed success. It usually involves medication prescribed by a doctor that simulates the hormones a woman’s body produces during pregnancy, along with a tightly regulated breast pumping regimen in the weeks before the baby arrives.
“There’s some medications, but the efficacy is very limited, the studies are limited,” del Castillo-Hegyi says of the effectiveness of medications purported to trigger milk production. “Mostly they’re limited by the extreme variability of lactation potential in the population.”
Siebold says it’s very difficult to exclusively breastfeed this way, but that it has been “such a win” when parents she has worked with have been able to produce even a little breast milk for their babies. And despite this, parents generally still rely on formula.
“Most of the time they do need to supplement with formula or donor breast milk,” Siebold says. “Donor breast milk is a great alternative, but it is expensive and so it can be cost-prohibitive for a lot of families,” she adds.
4. Pumping milk on the job is often difficult for employed moms
Pumping is time-consuming. And for many women, time is money.
“Breastfeeding is not free by any means,” Siebold says. “I hate that argument, because it makes it seem like a mother’s time is not valuable.”
Many women returning to work after having a baby need to take time away from their job throughout the day if they want to continue breastfeeding. Often they’ll rely on a breast pump — which doesn’t always empty breasts as efficiently as a well-latched baby does. For at least the first few weeks after giving birth, this means pumping at least eight to 12 times a day — about every two to three hours — to keep milk supply up.
“Often one in four American moms is going back to work two weeks postpartum, and so asking a mom to exclusively breastfeed and then not have access to her baby. ... There’s just so many systemic barriers to making exclusive breastfeeding an option,” Siebold says.
Moreover, the logistics of pumping at work can be difficult and even have financial consequences for many women.
“Our low-income moms go back to work about two weeks after they deliver, and they’re in low paying jobs,” Segrave-Daly says. “If they do get permission to pump, they’re not paid for it, so that means they’re missing income. And ultimately they’re missing time with their babies because they have to make up for that time they missed financially.”
And it’s not just low-income workers who encounter impediments to breastfeeding at work; high-income earners can find it difficult to pump on the job and keep their milk supply up too.
“I had a patient recently who was an ER doctor, which is a good-paying job with high esteem, but she was the only doctor on-call for the entire emergency floor,” Siebold says. “So if she is not there, if she’s going to take a pump break, there’s no doctor.”
5. Access to lactation support is an expense some women can’t afford
For women who are struggling but determined to breastfeed, the advice of a professional lactation consultant can provide crucial guidance and even help increase milk supply. But up until a few years ago, insurance plans didn’t need to cover any kind of lactation support. Now, Siebold says, many PPO plans give women access to six or more covered visits.
“There’s some really big wins in getting a lot of insurance coverage for a lot of women, but we still have a long way to go,” she says.
For women without insurance, the options are more limited.
“There are free clinics available in some areas, but let’s face it — lactation support is just unaffordable, not available, and my philosophy is if you’re going to promote breastfeeding then you need to have access to skilled breastfeeding care,” Segrave-Daly says.
Nadia Rahman, a nurse anesthetist who lives in Brooklyn, N.Y., estimates she has spent about $3,000 out of pocket to breastfeed her son, who is now 6 months old. Between out-of-network doctors, a hospital-grade breast pump and medications, the expenses quickly added up, Rahman tells Yahoo Life. And in the end, Rahman says she still ended up producing about two-thirds of the milk her son needs; she supplements the rest with formula. But Rahman says it’s not just about the monetary cost — the mental load takes a toll on parents too.
“It’s the pumping, and then also the researching and trying to find lactation consultants. It takes a lot of time, and it’s a lot of mental load. Fortunately I was able to take time off to do this, but not everyone can,” she says.
While there are plenty of medical and socioeconomic reasons a mother may not be able to exclusively breastfeed, there’s another important reason breastfeeding isn’t an alternative to formula: For some women it’s not that they can’t breastfeed, they just don’t want to. And del Castillo-Hegyi says that should be considered a valid choice too.
“To say that the reason [mothers] are not breastfeeding is they were failed by a society that doesn’t support breastfeeding — well, you know, there are a lot of them that chose [not to breastfeed],” del Castillo-Hegyi says. “That is a choice, and that is their right to choose how they feed their babies.”
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