By Deborah Jeanne Sergeant
Shortage of baby formulas raises questions about the low number of moms who breastfeed
A few different factors have contributed to the recent shortage of baby formula, including breaks in the supply chain and fewer mothers choosing to breastfeed during the pandemic.
The latter reason stems from the limited availability of lactation consultants at hospitals and other nursing experts, sick mothers fearful about nursing their infants and fewer peer and family supports available to help.
Experts estimate that about 95% of mothers are physically and medically capable of breastfeeding. However, only 24.9% do for six months for a variety of reasons.
Perception of breastfeeding can cloud the issue, according to Mary Miller, certified lactation consultant and perinatal doula.
“The way the framing of ‘breast is best’ is a red herring,” she said. “It’s parental choice. Many who go to formula didn’t intend to.”
She believes that the real issue is a lack of support for women who want to breastfeed. If they had that support, “reliance on formula would be reduced,” Miller said.
Miller is a Ph.D. candidate in interdisciplinary studies with a concentration in public policy and social change and leader of the Greater Buffalo Area Chapter of Breastfeeding USA and offers lactation counseling and breastfeeding classes.
While some circumstances such as double mastectomy and certain medication would prohibit a mom from breastfeeding, many more could breastfeed. Miller said that doctors and nurses usually lack knowledge on breastfeeding while on medication.
“Breastfeeding as a discipline is taught within a single lecture for doctors and nurses,” Miller said. “OB-GYNs aren’t generally well educated in that unless they seek it out. Because of lack of education, physicians are more likely to recommend to not breastfeed if a medication is not cleared for breastfeeding.”
Sometimes, moms taking a prohibitive medication may be able to switch to something safe for nursing or nurse part-time, depending on how long the medication stays in their system.
While breast milk is free, the family’s socioeconomic level matters, especially if the mother experiences challenges.
“The virtual inability of low-income parents to get professional lactation support or buy a pump is a big barrier,” Miller said. “They may need to take a bus to pick up a pump when WIC will give you free formula from the bodega on the corner. WIC provides 50% of the formula sales in the US.”
New York Milk Bank in Valhalla, Westchester county, provides milk by prescription for sick or premature babies whose mothers cannot provide milk, or adopted or surrogate babies (although it is possible for women to induce lactation, even if they have not given birth), as well as full-term, healthy infants. Milk donors are screened for health issues and the milk is pasteurized and tested for bacteria. But donated milk can cost around $5 per ounce.
Education on breastfeeding makes a difference. Without knowledge or experience, it can be tough to get it right.
“The first time you get on a bicycle, you’re going to fall down,” said physician Fred Archer with UBMD Pediatrics. “A lot of times, it’s only because the body hasn’t done it before.”
He encourages members of the mom’s network to help foster a lower stress environment to help her succeed in breastfeeding.
Some women believe that they need to eat a special diet to produce healthful milk and think that because they cannot afford those “special foods,” breastfeeding will not work. Archer said that is not true: a basic balanced diet is all that is needed. Spending more for specialty foods is not necessary.
Many women who begin nursing quit within a few weeks because of concerns about milk supply. Normally, milk does not immediately come in when the baby is born. It can take a few days. Once it does, factors such as stress, hydration, and sufficiently frequent nursing or pumping all contribute to adequate milk supply—not the woman’s cup size or clothing size.
Some women fear that their baby is not getting enough to eat while nursing because they cannot measure milk consumption as with a bottle.
“If your kid is making five to six wet diapers, they have plenty of liquids,” Archer said. “You’ll see pooping every time they feed for a new baby. Especially for a first-time parent, that’s a metric to look at.”
Matching the pediatrician’s weight gain chart can concern parents enough to cause them to add formula. But supplementing with formula reduces the milk supply, as the body generates milk according to demand. Miller encourages mothers to ask if the baby growth chart is based on the Centers for Disease Control and Prevention information or World Health Organization. The CDC is based on US statistics among more formula-fed infants compared with the WHO statistics that includes a greater percentage of breastfed babies. This difference skews the growth chart.
Cultural variations also matter closer to home. Marixsa Sanchez, program manager of community health programs at Buffalo Perinatal Network and runs the baby café, said that some women have never seen a woman breastfeed.
“Seeing this is valuable,” Sanchez said. “Some have not breastfed generation after generation. They do not think it is normal. They think it is hard. We let them know what to expect.”
Although she helps women connect with a lactation specialist, stigma still exists among many population groups. To counter this, Sanchez promotes the many benefits of breastfeeding that many people have not heard.
For working moms, returning to work represents another barrier to long-term nursing. Learning how to use a breast pump can help moms leave behind milk for their baby’s childcare provider. However, they must pump during the workday to keep up the milk supply. Just nursing while home will not do it.
“We encourage at least breastfeeding at night and whenever at home,” Sanchez said. “Many jobs have only half an hour for lunch.”
LuAnne Brown, RN and CEO of Buffalo Prenatal Perinatal Network, said that she encourages clients to reach out to their hospital’s certified lactation consultants for help and education.
“Healthy Families and the fatherhood program also help,” she added.
As odd as it may sound, many women do not realize that breastfeeding can include bottle feeding.
“Some don’t know about pumping and fear going back to work,” said Tammy Kowalik, bachelor’s trained nurse and international board-certified lactation consultant at Mercy Hospital. “There are options other than directly breastfeeding.”
Kowalik said that most insurance companies cover a breast pump purchase or rental at least in part.
Margaret Doerzbacher, Ph.D., RN, and clinical assistant professor in the UB School of Nursing, said that too much is expected of new moms: recovering from birthing while managing a household, working and caring for children, plus the new baby.
“It’s not a realistic expectation,” she said.
Formula seems an easier route, especially for working moms.
Recently passed legislation requires employers to provide a place for moms to pump.
But “there are tons of loopholes and for a large company, they still have to provide only one space even if there are many moms,” she said. “Sometimes access to that space is difficult. You need access to a sink for handwashing, if for nothing else.”
There’s a difference between providing the bare minimum to meet the requirements. For example, a conference room with a locking door would be considered sufficient, even though psychologically, some moms may find it hard to pump in a room where they sat in a meeting with colleagues minutes beforehand. Or moms may have to use a room where scheduling is problematic. Waiting to pump can cause leaks and contributed to mastitis.
Creating a working environment where lactation is accommodated and honored can encourage more mothers to continue to provide breastmilk. Nursing babies longer can mean fewer missed days for mom as breastfeeding reduces illnesses among infants.