When my baby boy arrived, he weighed 4 pounds, 13 ounces. He entered the world 8 weeks early and spent 29 days in the Neonatal Intensive Care Unit (NICU).

When your baby is in the NICU, there is enormous pressure to breastfeed. The nurses rolled a hospital grade pump to my bed side just hours after delivery and minutes after my first visit to my baby’s incubator in the NICU. “Breast milk is like medicine for preemies,” I was told.

Every day I pumped around the clock and delivered milk to the NICU in the insulated bags they provided … like I was packing his lunch for school. Every milliliter was carefully inventoried and measured by the NICU nurses. I always knew from the looks on their faces if I had made enough to feed him for the day. Like I said- ENORMOUS pressure.

Things were going okay until about 10 days after delivery. I developed mastitis on the right breast. For those unfamiliar, mastitis is an infection of the breast tissue. I had pain, high fever, and chills. After two antibiotics it resolved. Then I developed a second mastitis infection on the other side. The pain was excruciating. The infections did a number on my body, my sleep, and my milk production (and yes we worked with lactation consultants and did all sorts of tricks to try and increase production).

I was exhausted, emotionally raw and in extreme pain.  My husband and I made the decision to switch my son to formula at 3 weeks old. We did it for his health, my health, and my ability to care for him when he was discharged. I can easily say it was the best decision we could have made. My sweet boy absolutely thrived on his special preemie formula. He tolerated it very well, grew, and got stronger. We are incredibly grateful for formula. We consider it an amazing public health innovation. Formula fed our baby when I could not.

I’m a public health practitioner, so I’ve known for years that “breast is best,” but I’m also now a proud formula-feeding mom so I think this gives me a unique view on how we, in public health, talk about breastfeeding.  A recurring theme for me is concern about the language being used in these campaigns. Somehow public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

For example:

  • Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn't possible for all women.

    Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn’t possible for all women.

    All birthing hospitals in Philadelphia (where we live) have officially discontinued the practice of giving free formula to new mothers. While I understand that this strategy is supported by evidence, it is part of a larger international initiative to make hospitals “Baby Friendly”. So using that logic, providing formula is “unfriendly” to babies? This message was reinforced by Nurse McGinn who was interviewed for the philly.com story. She reports that she “was given free formula and threw it out”. Quotes like these reinforce the message that feeding with formula is equivalent to giving your kid something bad. Every mother wants to do what’s best for their child, no mother wants to harm their child.

  • A friend sent me a link to a wonderful story about supporting formula feeding moms during World Breastfeeding Week. This article does a great job of examining the language being used in their recent campaign. The terms connect breastfeeding with “winning” and achieving “goals.” So is the flip side “losing” and “falling short of your goals”? This can be a rough reminder for formula-feeding moms. For many women, the switch to formula was made after extreme pain, guilt, and feelings of failure. Around the same time a public health colleague tweeted that we should use the language “breastfeeding is normal” instead of “breast is best” Although it was not her intention, I read that as meaning that anything other than breastfeeding is abnormal. So formula feeding is abnormal?!
Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

We also see many efforts promoting the message that “breastfeeding is natural”. In the Olivia Wilde photo spread for Glamour Magazine which includes a photo of her feeding her son, she says “Breastfeeding is the most natural thing…” In the June 2015 issue of Australian Elle, we see model Nicole Trunfio breastfeeding her son on the cover.  According to US Magazine, “the powerful cover shot by Georges Antoni captures the natural moment between mom and child.” And while of course breastfeeding is natural…we have to think about the flip side of this message- are we telling parents that formula feeding is an unnatural act?

When thinking about health communication, we need to not only test the key terms for our campaigns but we need to consider their antonyms. Normal-Abnormal. Natural-Unnatural. Public health practitioners are (or should be) familiar with the theory of unintended consequences, but it seems that when it comes to infant feeding we aren’t thinking about the unintended consequences of our messaging.
So I ask readers

(1) While these breastfeeding and baby-friendly campaigns have well-intentioned public health goals (which I support):

  • What are the unintended consequences of their language and communication choices?
  • Do they help reinforce the divide between formula feeding and breastfeeding mothers?
  • What about the women who both formula feed and breastfeed? Where do they fit in?

(2) What are your suggestions for more effective language? How can we simultaneously promote breastfeeding without stigmatizing formula feeding?

Readers can comment below! 

*An earlier version of this post was published on Pop Health on August 7, 2014.




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Categories: Food, Nutrition, + Infant Feeding, Mental, Emotional, + Behavioral Health