October 1 – 7 was World Breastfeeding Week in Canada. Like many other provinces, Newfoundland and Labrador promoted a number of government-developed or co-developed breastfeeding resources, guides, and advocacy initiatives in anticipation of the event. Indeed, the amount of information and support related to breastfeeding appears more than plentiful. If the accessibility of these types of resources is so high, what is the ongoing purpose of World Breastfeeding Week, particularly when so few government-endorsed resources exist for formula-feeding families? In an attempt to support and encourage breastfeeding, an unintended result has been the stigmatization of formula or combination feeding. While advocacy events such as these are rooted in good intentions, the evangelism around breastfeeding may be creating a greater problem for people who do not or cannot breastfeed. It may be time to consider reframing this week to be more inclusive and supportive of all families.
A Recent History of Breastfeeding
World Breastfeeding Week is coordinated by the World Alliance for Breastfeeding Action (WABA), which was established in 1991 as “a global network of individuals and organisations dedicated to the protection, promotion and support of breastfeeding.” The formation of WABA came after breastfeeding rates had been decreasing globally for decades, likely due to the invention of formula in the late 19th century, among other factors. Once formula became more widely accessible, breastfeeding became stigmatized and was often seen as a symbol of poverty, and the only option for families who could not afford formula.
The “Baby Friendly Hospital Initiative,” was launched in 1991 by the WHO and UNICEF to ensure greater breastfeeding education and support in hospitals, and to help increase breastfeeding rates. Since then, the right to breastfeed has been enshrined in human rights legislation globally, including in federal and provincial law in Canada.
Today, pregnant women are provided with thorough breastfeeding prenatal education, resources, and support almost as soon as a pregnancy is confirmed. Lactation consultants work in most hospitals, and many obstetric nurses are well educated on breastfeeding. It certainly appears as though we have reached a new frontier in breastfeeding advocacy, but education and support for formula feeding has not kept pace. By focusing so narrowly on breastfeeding and ignoring the very real need for some families to formula feed, many parents, and particularly women, may see no option but to breastfeed. If breastfeeding turns out not to be an option, they may feel shame about formula feeding. Given the current state of infant feeding culture, are we doing enough in Canada, and particularly in Newfoundland and Labrador, to support parents who do not breastfeed?
I became pregnant in June of 2020, right at the start of the pandemic. At the time, I was living in Edmonton and began my prenatal care with Alberta Health Services. Due to the discovery of a genetic condition, my pregnancy was considered high risk and I spent more time in hospitals throughout my pregnancy than most. In various perinatal care centres and doctors’ offices, I would often notice information on breastfeeding, but it did not stand out to me as excessive. I was asked once by my Edmonton OBGYN if I planned to breastfeed, and she never addressed it with me again.
In January 2021 my partner and I, like many Newfoundland expats during COVID, decided to move home to the province. The pressure of the pandemic and the anticipation of becoming parents underscored the need for our family and our support network. I quickly transferred my pregnancy care to Eastern Health, and was booked right away for weekly appointments to follow my high risk pregnancy. Almost immediately I noticed the “vibe” about breastfeeding was different on the rock. I was asked many questions about my plans to breastfeed at multiple appointments. It was also during this time that I began my prenatal education, including an entire course devoted solely to breastfeeding.
Early in my pregnancy I believed I was going to be calm and chill on the matter. I had recently witnessed a close family member struggle with the expectations of breastfeeding. I told myself I would be different. If breastfeeding doesn’t work, I will just formula feed and it will be fine, I thought. I stocked up on formula and bottles, bought myself a breast pump and some nursing bras, and assumed I was prepared for all possible outcomes.
Eventually, however, my “chill” dissipated, and I found myself becoming more judgemental towards formula feeding. I was smug about my plans to breastfeed. “Why would anyone not want to at least try to breastfeed?” I thought, “Don’t they know how good it is for babies?” Looking back, I credit my quick change of tune on “the liquid gold” factor.
The Discourse of “Liquid Gold“
I don’t know how we allowed breastmilk and colostrum to be called “liquid gold” but I will confidently hypothesize that this is where a lot of postpartum depression and anxiety can begin. I know it did for me. I am sure I had heard breastmilk referred to as “liquid gold” before. But this time, in a virtual class, as the instructor talked about the numerous benefits of this liquid gold, my ears really perked up. I was full of anxiety and hormones and I was attracted to that messaging. The marketing works, people.
I don’t want to debate the science of breastmilk or colostrum. I believe in science and if medical professionals tell me there are great nutritional and immune supporting properties in breastmilk and colostrum, I fully accept this information. However, we now know that there are many factors that influence children’s health outcomes. It’s not just a matter of how they are fed as infants. I wager that the golden promises of breastfeeding are potentially overstated. In recent years, numerous studies have indicated that the ties between breastfeeding and its countless health benefits are weak and murky at best. In fact, the more likely predictors of child health and cognitive abilities are socio-economic status and access to healthcare, a matter of which is of much discussion in this province.
But data aside, once I heard the “liquid gold” descriptor, I was sold. And let me clarify: this was not a phrase I heard once. It was recited to me repeatedly. Not just in these classes but also in the hospital both pre and post birth. This had to be the only option for my child. She was going to be healthy and strong and immune to illness because I made the decision to breastfeed and put the effort behind it.
I remember being hooked up to the hospital’s industrial strength breast pump, days postpartum, trying to get small amounts of colostrum to flow from my body. At the first session, I only got 2-3 millilitres. Literal drops. The nurse collected it from me and I actually apologized to her, saying that I knew it wasn’t very much. But the nurse’s response to my “production” was that any amount is amazing: “we call it liquid gold around these parts!” Those precious drops, that couldn’t even fill a quarter of a teaspoon, were collected and given to my baby and treated like the rarest substance on earth. They held the promise of health and survival for my newborn.
This spectacle really stayed with me. If a few drops of crusty breast milk was so good for my baby, imagine what a whole breastfull could do! This messed with my perception of the necessity of breastfeeding. It changed my valuation of my time and mental health. There was now no limit on the amount of physical and emotional exhaustion I was willing to expend to achieve my goal of breastfeeding. The limit did not exist.
Meanwhile, I overheard a patient in the bed across from me in conversation with a nurse. The patient had just given birth and the nurse was trying to convince her to breastfeed, even though she didn’t want to. I heard yet again all those arguments for breastfeeding, and of course, the liquid gold. At the time I was full of judgement. That will not be my journey, I thought, I will be better. Looking back now, I feel empathy for this person trying to assert her wishes.
Ultimately, my “journey” with breastfeeding was a challenging one, to put it delicately. Upon recommendation of the pediatrician, my baby was given formula at two days old to deal with jaundice. Perhaps due to the early introduction of formula, or my pre-existing genetic condition, or simply as a result of me “not trying hard enough,” I could never produce adequate breast milk for my child. As such, I learned that the most common messages and beliefs about breastfeeding are a myth.
Myth 1: All Women Can Breastfeed
For the first five months of my child’s life, I spent my time in a cycle of nursing, pumping, bottle-feeding breastmilk, bottle-feeding formula, sterilizing bottles and pump parts, rinsing and repeating. It was mentally, emotionally, and physically exhausting. But the drive to be a “good” mother proved to be a greater force that kept me pushing through.
Breastfeeding was sold to me as natural. It’s what mothers do! When I would take my baby to her public health check ups, or meet up with friends, or chat with family members, the inevitable question about breastfeeding would come up. I was relieved that I could say with pride that yes, I was in fact breastfeeding! Well, I was combination feeding, but still breastfeeding! And I would be met with praise. I was reassured I was a good mom. I was so motivated to maintain this title, and yet…my body wouldn’t cooperate. My production declined.
Myth 2: Breastfeeding is Free and Available On-demand
I tried everything to increase my supply as I was so desperate to become the exclusively breastfeeding mama the WHO, Health Canada, Eastern Health and many family members so frequently told me to be. Nursing cushions. Multiple breast pumps. Lactation cookies. Lactation teas. Supplements. These are just some of the items I purchased to help increase my supply. A quick calculation indicates I spent at least $2000 on breastfeeding. This was not a free endeavour for me.
It’s easy to vilify formula companies for being profit driven and unaffordable for many families–because it’s true. We can’t let companies like Enfamil or Nestlé off the hook, but we also cannot ignore the fact that breastfeeding is also a commercialized industry with high valuation. The breast pump market alone is worth billions and is growing each year. Profits are being made from all methods of infant feeding. Big Formula might be a villain in this story, but breastfeeding does not exist outside the market
One of the biggest expenses associated with breastfeeding is time. Even if the experience I had had with breastfeeding was seamless, the hours that must be devoted to breastfeeding a baby is more than a full time job. It is work to feed a newborn. Yes, it can be enjoyable and gratifying, but it is still work. To categorize breastfeeding as “free” is to devalue the mother’s time. The expectation of breastfeeding for two years or more–which is the recommendation from Health Canada–perpetuates gendered poverty, especially for women wage-workers who do not get the privilege of extended maternity leave. On the flipside, if you can share that work with a partner, your family, and your friends through formula feeding, you can protect your time, energy, and your mental health, which can make you a better parent.
Myth 3: Breastfeeding is the Best Way to Bond with Your Baby
At five months and five days postpartum, I threw in the towel. Some might say I quit, but I like to think I consciously uncoupled from my Medela breast pump. Once I stopped breastfeeding, I know I became a better mother. I had more time, but more importantly I had more emotional space to explore the parts of motherhood I had to push to the backburner while I was so focused on breastfeeding.
Much of the messaging around breastfeeding today argues that it aids in the mother’s mental health and her bond with the baby. Perhaps this is true for some, even many, mothers, but in my experience this promise couldn’t be further from the truth. Because I was devoting so much of my time to nursing and pumping and sterilizing, I witnessed my husband bond with our daughter in ways I was unable to. He would often feed her from a bottle, and had more time to hold her, play with her, and read to her. My heart crumbled watching these moments while I was participating in some pumping related task. To this day I feel like I missed out on the first 5 months of my daughter’s life.
Things started to shift once I retired my breasts. I started participating more in other acts of parenting and my mental health started to improve. The bond with my child was better than ever and I developed an identity as a mother that wasn’t linked to breastfeeding.
Lack of Formula Resources
I especially enjoyed preparing to start my child on solid foods. I spoke to my public health nurse about it and she recommended I check out the Health Information “HI” on Eastern Health’s website for information. Not surprisingly, I was met with heaps of information on the site about transitioning a baby from breastfeeding to solids, and how to maintain breastfeeding after 6 months. However, I found virtually nothing about doing so for formula feeding.
In fact, a deeper dive revealed that there is hardly any information on formula feeding at all from the province. A few resources have an annotation at the beginning directing the reader to replace the word “breastfeeding” with “formula feeding” if applicable, but they are completely silent about the differences between feeding methods. A “Choosing How to Feed Your Baby” page reads like a persuasive pro-breastfeeding argument. The only resource I could find fully devoted to formula feeding–which was buried, I might add–was a guide called “Infant Formula: What you Need to Know.” The first three pages were devoted to more arguments for breastfeeding before providing any helpful information on formula feeding. Meanwhile, a google search for “baby feeding Alberta Health Services” yielded much more balanced results, and their infant feeding guide didn’t include the word “breast” once. So yes, it is possible to provide unbiased formula feeding resources. Maybe it’s time to take a hint, Newfoundland and Labrador.
Support All types of Feeding
Formula is a safe and healthy option for feeding babies. It is a highly regulated product that is essential for many families. But I will not ever try to convince someone to use formula over breastfeeding, and I think it’s time for the same courtesy from breastfeeding activists, governments, and international organizations. New parents need support, regardless of feeding methods. Breastfeeding is hard. Sterilizing bottles is hard. Paying for formula is hard. Picking up a breast pump is hard. None of this is a cake walk. And modern parenting is a lonely road as our “villages” have morphed into baby play groups, day cares and evening sitters. For those of us who are lucky to have family close by, support shouldn’t come at the price of judgement about feeding.
It is clear that Newfoundland and Labrador is way overdue for a revamp of their perinatal resources. While many individual health care professionals I encountered here were very kind and understanding about formula feeding, it is not hard to follow the thread from the 1991 Baby Friendly Hospital Initiative to today’s baby feeding framework offered by Eastern Health. And while it is true that a more balanced approach is needed in Canada and throughout the world, it does appear that Newfoundland and Labrador is further behind than other jurisdictions in the modern baby feeding discourse.
Breastfeeding rates are still collected by many countries globally and published as metrics for national health. But the reality is today there are a myriad of reasons why a family may not rely on breastfeeding. And ultimately the rationale behind the individual choice to breastfeed or not doesn’t matter. There are much more effective metrics for measuring the health and well-being of a society, an economy and a nation other than breastfeeding. Should governments want to “step up” for families, the focus must shift. Ensuring safe drinking water, food security, housing, access to an affordable and reliable supply of formula and proper formula feeding education are all avenues for governments to support better health outcomes for children.
While I believe World Breastfeeding Week was born from good intentions to support mothers who were ostracized and stigmatized by a misinformed society, the pendulum is close to swinging too far the other way, and we are losing sight of the need to support all families of all babies. We must stop treating formula feeding as inferior and as though it is not safe. And heck, if modern formula is lacking, push manufacturers to do better! Let us make it more accessible and affordable for all.
So do I think it is time to retire World Breastfeeding Week? Eh, maybe not yet. But perhaps we should start our own version of a festivus for the rest of us: a World Infant Feeding Week for all.
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