Abstract
Is infant feeding with formula much worse than breastfeeding? It’s complicated, so this essay explores the evidence and ways to think about it.
 There is a clear global consensus that in any population, feeding with infant formula is not as good as breastfeeding for infants’ health and also for their mothers’ health. Infant formula manufacturers agree. Nevertheless, there is an ongoing debate about when feeding with infant formula might be acceptable.
 Undoubtedly, compliance with the global recommendations for optimum breastfeeding is low partly because many new parents and policymakers believe there is little difference between the health impacts of breastfeeding and feeding with formula. It is important to consider not only the ranking of alternative methods of infant feeding but also the degree of difference between them. Is the difference small and unimportant or substantial and important to consider when choosing among the options? There should be an orderly way to take account of not only the relevant scientific knowledge, but also parents’ views and circumstances related to infant feeding.
Highlights
There is a clear global consensus that in any population, feeding with infant formula is not as good as breastfeeding for infants’ health and for their mothers’ health
The World Health Organization (WHO) recommends that breastfeeding continues until age 2 and beyond, yet less than two in three young children aged 12–23 months are benefitting from it
The reports on rates of compliance with the WHO-United Nations Children’s Fund (UNICEF) recommendations are not always comparable because of the diversity of research methods and variations in what is counted as breastfeeding (Binns and Lee 2019; Greiner 2014), but there is no doubt that the compliance levels are low
Summary
There is widespread agreement that feeding with infant formula is worse for infants’ and mothers’ health than breastfeeding. UNICEF summarizes the pattern: Analysis of data on feeding practices among infants and young children highlights the need for accelerated programming in this area. The World Health Organization (WHO) recommends that breastfeeding continues until age 2 and beyond, yet less than two in three young children aged 12–23 months are benefitting from it. In terms of continued breastfeeding among children 12–23 months, the range between regions is wide: the prevalence of continued breastfeeding at 12–23 months in South Asia is nearly twice as high than Latin America & the Caribbean. The reports on rates of compliance with the WHO-UNICEF recommendations are not always comparable because of the diversity of research methods and variations in what is counted as breastfeeding (Binns and Lee 2019; Greiner 2014), but there is no doubt that the compliance levels are low
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