What Research Can Tell Us About Breastfeeding Stigma

Stigma factors into our perceptions of breastfeeding and formula, with serious consequences for infant health.
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A mother feeds a baby with a bottle.

Research has long charted the barriers to breastfeeding, from lack of paid leave to social stigma against breastfeeding in public. And when the Trump administration defended its stance against a World Health Organization resolution in favor of breastfeeding last week, it too cited stigma—but against baby formula.

"The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children," a spokesperson from the Department of Health and Human Services told the New York Times.

President Donald Trump himself tweeted that, while the United States supports breastfeeding, "we don't believe women should be denied access to formula. Many women need this option because of malnutrition and poverty."

Decades of research prove that breastfeeding benefits babies and mothers, but a 2003 national survey found that only a quarter of U.S. adults believe a formula-fed infant is more likely to get sick. Research suggests that stigma factors into this perception, with serious consequences for infant health.

A 2011 report from the Office of the Surgeon General and the Centers for Disease Control and Prevention (CDC) cites stigma among the many barriers to breastfeeding, before calling for action to mitigate these barriers. A large body of research suggests that fear of judgment discourages mothers from breastfeeding in public places. Other studies have found that the sexualization of breasts in popular culture contributes to mothers' discomfort.

In contrast, evidence in support of Trump's anti-formula stigma runs from factual to politically motivated.

A 2016 study published in Maternal & Child Nutrition found that a "worryingly high" percentage of mothers felt guilty or stigmatized for their choice to use formula. Meanwhile, a 2014 qualitative study documented feelings of loss and self-blame associated with formula use among HIV-positive mothers. (HIV and other infectious diseases can be transmitted through breast milk, but the risk of infection is "extremely small," according to the CDC's website.)

Several high-profile cases illustrate a stigma against formula use, including a 2014 Washington Post editorial by a breast cancer survivor who described feeling judgment from her peers, despite being physically unable to breastfeed because of her double mastectomy.

Across the Web, lifestyle parenting blogs broadcast anecdotal evidence of this stigma from "Breast Is Best" supporters, who advocate for the health benefits of breastmilk over milk substitutes. In a post on Acculturated.com, writer and blogger Abby Schachter described feeling anti-formula stigma from what she calls a "strange cauldron of women's rights, which emphasizes working outside the home and the new liberal-chic trend of back-to-the-earth living."

But when it comes to policy, experts urge officials to focus on saving lives, not mitigating stigma. Andrea Freeman, a legal expert on health disparities in breastfeeding, described the administration's focus on formula stigma as a "very Western problem."

"[In the U.S.], we have the luxury to worry about making people feel bad when they can't breastfeed," Freeman said. "When you look at this as a global problem, I don't think that's an issue in poor countries where people are concerned for survival. ... The scale of the problem is so off. There's no point in trying to protect some people's feelings versus protect the lives of 800,000 infants."

A network of federal programs promotes formula use among low-income women, specifically black mothers. In the U.S., black women breastfeed at considerably lower rates, and their children suffer resulting health disparities.

In this sense, the mothers Trump envisions using formula "because of malnutrition and poverty" are a part of a self-fulfilling prophecy—a problem Freeman worries U.S. companies are now foisting onto women in other countries.

"We're seeing that white people in the U.S. and other developed countries are turning away from formula because they're getting good information about how breastfeeding is better, and they have more options, so they have more structural ability to breastfeed," Freeman said. "So the formula companies are turning to brown and black women in other countries to try to sell their formula to them, which will then lead to increased disparities in health there."

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