Breast, bottle, whatever: How You Feed is a shame-free series on how babies eat.
If you feel like there’s a never-ending tug-of-war between breastfeeding and formula feeding and “breast is best” vs. “fed is best,” you’re not wrong. The debate over how babies are fed goes back over a century — and it’s often a reflection of “bigger issues in our society,” says Jessica Martucci, associate director of undergraduate programs at the University of Pennsylvania’s history and sociology of science department.
“Whenever someone tries to make the argument that, ‘it’s just about making sure babies are fed; it’s just about making sure that they have the food they need; it’s just a nutrition thing’ — it’s never just that one thing. It’s so embedded in all of these big, culturally tense, politicized ideas about womanhood,” Martucci, who’s also the author of Back to the Breast: Natural Motherhood and Breastfeeding in America, tells Yahoo Life.
Here’s a look back at some of the highs and lows in formula and breastfeeding in U.S. history — and the societal shaming around them.
Late 19th century: "Treat the baby like a machine"
Until relatively recently in U.S. history, breastfeeding was the only safe way to feed infants.
“Before the last quarter of the 19th century, if a baby wasn’t breastfed, the baby died,” Jacqueline Wolf, a professor in the department of social medicine at Ohio University tells Yahoo Life.
Nursing for two years — or “through the baby’s second summer” — was long considered the norm. But rapid industrialization and urbanization towards the end of the 19th century brought about changes to child-rearing that would eventually send doctors scrambling for feeding alternatives. Wolf explains that while many mothers had previously nursed on-demand, cultural shifts caused by modernization changed the way parents were advised to feed their babies.
“The mechanical clock and having to pay attention to mechanical time as opposed to just nature was huge, and adults were having a terrible time with it,” Wolf says. “And suddenly you see in newspapers, in women’s magazines, in infant care books, the advice that if you can put babies on a [feeding] schedule, they won’t have the same trouble that adults are having adjusting to the new world. And they started using machine metaphors for babies: ‘Treat the baby like a machine. Feed the baby at fixed and convenient times.'’’
The more a mother nurses or pumps, the more breast milk she will produce, though many doctors at the time may not have understood this supply-demand correlation. And Wolf says the new feeding schedules were so rigid that they may have affected many mothers’ breast milk supply.
“Suddenly women were reporting in large numbers, ‘I just don’t have enough milk. I’m not able to breastfeed,’” Wolf says.
Doctors were baffled, and a range of theories popped up as to why so many women were having trouble breastfeeding. One idea was that humans were evolving and losing the ability to lactate; another was that women were living such stressful lives in cities that their bodies couldn’t function normally; and perhaps the wildest conjecture — which Wolf says “was taken very seriously” by experts at the time — blamed the education of women and girls for breastfeeding difficulties, claiming that if girls were in school as the bodies were developing during puberty, then their breasts were competing with their brains for energy.
Still, the pressure to breastfeed — and inability to do so — weighed heavily on many mothers.
“Women wrote about this problem a lot in diaries that are still in archives and letters to family members that lived far away. And not being able to breastfeed was really a tragedy, no matter the [social] class,” Wolf says. “Reading these accounts, I could hear the defensiveness in her voice and the anger. Because women were being scolded for not trying harder, for not breastfeeding longer, for putting their babies in danger.”
Early 20th century: Breastfeeding is "God’s plan"
As more women reported difficulty breastfeeding, Wolf says for the first time breastfeeding became “a medical problem.”
“Doctors even labeled it; they called it ‘the feeding question.’ And the question was, ‘If a woman can’t breastfeed, what can we use to feed a baby?’ So doctors became involved in all kinds of ways to come up with substances that could feed babies without killing them,” Wolf says.
One tactic doctors used to address “the feeding question” was the creation of public health campaigns to convince mothers to breastfeed — and the messaging in these campaigns could get very aggressive. A poster widely shared in Chicago implored mothers to breastfeed and discouraged them from substituting with cow’s milk, using the headline, “Mother’s milk for mother’s babe, cow’s milk for cows,” and concluding with, “You can’t improve on God’s plan. For your baby’s sake — nurse it!”
“Today, we would call it shaming,” Wolf says of these breastfeeding campaigns. “But then, it was considered a public health imperative. Thirteen percent of babies died before their first year in 1900.”
And concerns about cow’s milk weren’t unjustified. Refrigeration didn’t exist and ice was an expensive commodity, so cow’s milk was often unsafe to drink by the time it made its way from a rural farm to consumers in the city. So doctors launched “the certified milk movement” and began to work with dairy farmers who would agree to produce milk under safer conditions, such as pasteurizing the milk, keeping it cold constantly and sanitizing milk bottles.
“The dairy industry fought every innovation tooth and nail,” Wolf says. “They literally said it would be a job-killer, that milk would become unaffordable — everything we take for granted as keeping us safe and healthy was fought by the dairy industry.”
These so-called “milk wars” battling the dairy industry began in the 1880s and continued until the end of the 1920s.
In the meantime, parents turned to other methods for feeding their babies, such as canned milk, which had been available since the Civil War era in the mid-1860s. “Proprietary infant food companies,” which created a product akin to today’s formula, also sprang up around this time and invented powdered concoctions with ingredients like grain, wheat and oats designed to be mixed with water or milk.
Wealthier women who didn’t want to hire a wet nurse to breastfeed their baby might turn to mathematical formulas written by their doctor that could supposedly “humanize cow’s milk.”
“Mothers would take the prescription — this mathematical formula — to a milk laboratory, hand it to a chemist, and then they’d be given this liquid back. Based on the mathematical formula, doctors would tweak cow’s milk to roughly mimic the percentages of protein and milk sugar and fat in human milk,” Wolf explains. “From the 1890s through the 1920s, the main thing they learned in medical school and in their practice was how to write these complicated formulas. That was the focus of pediatrics.”
By the 1930s “the milk wars” were over, cow’s milk was safe to drink — and doctors claimed the formulas had become obsolete, joking that the complex equations didn’t seem to have a function and had turned pediatrics into “higher astronomy.”
“These formulas just disappeared. But the word ‘formula’ did not,” Wolf says.
Post-World War II: Formula and the era of "we can do better than nature"
With a safe cow’s milk supply and other alternatives to breast milk becoming more mainstream, Wolf says people began to wonder if maybe breastfeeding wasn’t so great after all.
“You had pediatricians saying — and others echoed the sentiment in different words — ‘Just because it comes from the maternal glands, doesn’t mean it’s good. It may be nothing but water.’ A pediatrician actually said that about human milk, and that sentiment was echoed constantly after that,” Wolf says. “And that’s when the formula industry as we know it today began to burgeon.”
The formula industry gained steam in the 1930s and 1940s, then took off after World War II. Rather than making their products available to babies who would have died otherwise, formula companies focused their efforts on becoming a growth industry — and courted doctors in the process with gifts and elaborate vacations. Wolf says that for many doctors, it wasn’t a tough sell to convince them that formula was superior to breast milk.
“This was the era of ‘we can do better than nature,’” Wolf says.
In fact, the medical community became so dismissive of breast milk that by the mid-20th century many women weren’t even given the option to breastfeed.
“Obstetricians assumed by the late 1950s that mothers would not be choosing to breastfeed, and so women were very often immediately after birth given a hormone shot to dry up their milk. They weren’t even consulted; it was part of the normal routine of after-birth care,” Wolf says. “I talked to mothers who were just shocked that they weren’t able to breastfeed because they received this hormone shot without even being told. No discussion at all. But for doctors, they believed they were doing what was best for their patients, because formula was thought to be better and ‘why would anyone want to breastfeed?’”
Wolf says the procedure was “virtually universal” for hospital births at the time, though some women — especially if they had an at-home birth, which was still common — were still able to breastfeed.
Martucci says how socially acceptable breastfeeding was likely depended on class and what was considered “normal” in a woman’s local community, but evidence suggests breastfeeding had become extremely unpopular — even “old-fashioned.”
“You can find plenty of articles from the popular press from that period or cultural references that suggest people had developed a kind of negative view of breastfeeding overall,” Martucci says. “It was something viewed as backwards, primitive, like, ‘Why would you do that? It’s not the modern thing to do. It doesn’t fit in our modern American lifestyle anymore.’”
“Most of the urban mothers I talked to who gave birth to the Baby Boomers in the 1950s, they would speak in very derogatory terms about the isolated neighbors they knew who did breastfeed,” Wolf adds. “I can’t tell you the number of times I had a woman literally shudder in front of me and go, ‘Oh it just went against my grain to see her do that, to see her breastfeed.’ So there were some [breastfeeding] women who probably were shunned — because we really had become a formula-feeding culture at that point.”
1970s: A grassroots movement to bring back breastfeeding
Breastfeeding rates continued to plummet, and by the early 1970s reached the lowest point in U.S. history. In 1972, breastfeeding initiation rates — or the number of women who nursed their baby before being discharged from the hospital — fell to 22%.
But from there, breastfeeding rates began to tick up again, with Wolf saying “so many things just coalesced at once.”
“So many ingredients went into the sudden surge in the popularity of breastfeeding — largely, what was going on in the society at large during the 1970s,” she says.
The Women's Health Movement began pushing against post-World War II norms such as heavily medicated births, and advocating for more bodily autonomy and control over health decisions.
“That’s when the so-called natural childbirth movement got so much play in women’s magazines and newspapers, and women aspired to reject unnecessary medications,” Wolf says. “And along with that came, ‘Wait a minute, let’s relearn breastfeeding.’”
That movement overlapped with the environmental movement, which questioned the notion that the “scientific feeding” of babies with formula was better than “natural” solutions like breast milk.
Martucci explains that much of breastfeeding’s comeback can be traced to a grassroots movement led by women and mothers in the 1950s, which by the 1970s had grown into a national presence through a now-international organization called La Leche League.
“La Leche League was very involved in helping form things like the International Lactation Consultants Association and getting involved in credentialing requirements for lactation consultants,” Martucci says. “Because they sort of saw that in order to get breastfeeding more institutionalized, they would need to have experts on the inside of the healthcare system who could advocate for this stuff.”
Martucci cautions against the idea that this was some kind of “golden age” for infant feeding in the U.S. Breastfeeding supporters were still pushing against the normalization of formula, breastfeeding in public was still controversial (and “that has never changed,” Wolf says of breastfeeding in public) and there was some tension in the feminist movement over breastfeeding advocates’ message that “breast is best.” But Martucci does believe the 1970s was the beginning of a decades-long lull in the cultural battles over how babies are fed.
“There was this period in the '70s and '80s and even into the '90s where the two kind of co-existed with a little bit more equanimity than we see today,” Martucci says of breastfeeding and formula. “During those decades when the healthcare sector was kind of ambivalent about whether breastfeeding or formula feeding was better, women during that time had the ability to make a choice that was not as fraught as maybe we have today.”
1990s: Breastfeeding gets a powerful endorsement
The 1990s saw a surge in breastfeeding promotion — both nationally and internationally.
In 1991 the World Health Organization and the United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative, which encourages breastfeeding immediately after birth by implementing steps like mothers and newborns rooming together and a hospital staff that’s knowledgeable and supportive of breastfeeding. The first Baby-Friendly hospital in the U.S. was designated in 1996 — which Martucci says was a major milestone in pediatrics’ transition away from formula.
“Once you have entire hospitals that are institutionally, structurally devoted to breastfeeding, they’re actively denying women access to formula and education about how to formula feed, you’re kind of moving in the opposite direction at that point,” Martucci says.
The first World Breastfeeding Week was celebrated on Aug. 1, 1992, to raise awareness of breastfeeding and its advantages.
But perhaps the biggest boost for breastfeeding in the U.S. came in 1997, when the American Academy of Pediatrics (AAP) issued a policy statement recommending breastfeeding exclusively for the first six months of a baby’s life.
“That was new for the AAP to be making policy statements in favor of breastfeeding,” Martucci says. “And that was something that came about as a result of women themselves pushing for the ability to breastfeed.”
2000s and beyond: "Fed is Best" and expectations to "just breastfeed"
But around the mid-2000s, many U.S. parents began expressing frustration with pressures to breastfeed, and saying breastfeeding was starting to feel more like a mandate than a suggestion. The “fed is best” movement began to spring up in response to the “breast is best” message being shared by many in the medical world — and on the internet.
“[Fed is best] was an online community that formed around this feeling that by that point breastfeeding had started to become something that was expected and demanded and no longer seen as a choice among many acceptable choices for how one feeds their baby,” Martucci says. “And I think it kind of grew out of the world of the mom blogs and social media kind of getting off the ground, and the kind of cyberbullying that women would experience around decisions they made about how they chose to feed or mother their children.”
Even with early bloggers like Fearless Formula Feeder and organizations like The Fed is Best Foundation normalizing formula, today many parents say they still feel guilty and ashamed if they choose not to or are unable to breastfeed. During a nationwide formula shortage in early 2022, many desperate parents took offense to the suggestion that they “just breastfeed” if formula is unavailable. And for some parents that frustration was exacerbated weeks later when, on June 27, AAP issued a policy statement updating their breastfeeding guidance, extending the recommended breastfeeding period from one year to two years or more. While some hailed AAP’s move for normalizing breastfeeding older babies, others called it “tone-deaf” and “out of touch” given that the U.S. doesn’t offer paid family leave or other workplace protections that would make breastfeeding more attainable for working mothers.
“When guidelines are untethered from what’s possible or even desirable for many mothers, it sets up a situation where some people will feel judged no matter what they determine is best for themselves or their families,” Jessica Grose, an opinion writer for the New York Times, wrote of the guidance in an op-ed published a week after AAP’s policy statement. “And that’s the last thing American parents need right now.”
AAP acknowledges in their policy statement that social and systemic changes are needed to support breastfeeding mothers, including universal paid maternity leave and reduced stigma around public breastfeeding.
“The American Academy of Pediatrics understands — and I think a lot of people who aren’t on the inside of health policy-making may not understand — that by making this recommendation, there’s a lot of hope that it will drive additional policy-making to support it,” Martucci says. “But there’s this other side to these guideline changes, which is that it really changes the expectations and pressures that women feel and are possibly subjected to in healthcare settings.
“We are still a society that is clearly wrestling with how we’re going to treat and value women,” she adds. “And I think as long as we’re not clear about that and we are wrestling with those values, then breastfeeding is going to be a fraught thing that can’t just be seen as a way of feeding a baby.”
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