So, public commentary around the formula shortage in the US. This was always something I was going to have Opinions and Feelings about. But I’m particularly riled up to see this tweet from Bette Midler, someone I’ve previously thought of as someone I’d like if I met her socially:

Disclaimer: If your first thoughts on reading this are “Isn’t formula bad for babies/not as good as breastmilk?” or “But what about the terrible history of formula companies promoting their products in the developing world in the 20thC?”, those are valid questions to ask, but I will need to engage with them another day and in another post.

For now, let’s just go with the assumption that there are as many different reasons why people might choose formula-feeding or breastfeeding/chestfeeding as there are human beings on the planet (and that’s not to mention combi-feeding and exclusive pumping! Hi to all my fellow awkward misfit toys out there!). Leaving aside the fact that OF COURSE I support people making their own decisions about their bodies, I want to do a quick breakdown of my personal angle on why “urrrr why not just breastfeed?” is an appallingly ignorant take on this issue. The fact is that despite the narrative we are often fed of breastfeeding being “natural and free”, many people who would like to breastfeed/chestfeed physically cannot (this was me with my first child), while for others some formula supplementation is what makes it possible to safely breastfeed (this is currently me with my younger child).

My first kid, Squirrel (now 2.5) had a frightening and dramatic birth and early feeding history which I’m not going to go into today — it’s another blog post, or series of posts, which I’m still in the process of planning and drafting. Take home summary: Breastfeeding went to shit, 5-day-old baby went to hospital, we ended up doing exclusive pumping (with some formula supplementation) for 14 months. Incidentally, just in case you’ve ever thought to yourself “Gee, I wonder what it’s like to jam your boobs into a plastic squeezing machine every three hours for a year?”, it isn’t a life I’d wish on my worst enemy, my high school bully, or even those people who keep phoning everyone up about car accidents they weren’t actually in. Thankfully Squirrel is now the world’s happiest and most rambunctious toddler, so all’s ultimately well.

What I will say is that with baby Otter, who is just about to turn 12 weeks old, I am right now basically a caricature of someone who has every possible breastfeeding advantage:

1. Annoyingly middle-class older mum who is economically privileged to have access to a year’s worth of maternity leave.

2. Further economically privileged to have been able to spend vaguely silly money on in-home professional assistance to establish breastfeeding this time around.

3. Highly supportive partner able to assist with more than their share of household duties while I’m feeding Otter.

4. Currently direct-nursing 8 times per day (~3am, ~7am, ~9am, ~midday, ~3pm, ~6pm, ~9pm, ~11pm) — which is another marker of privilege in that I have the levels of mental and physical heath to be able to sustain this.

5. Further physically privileged in that Otter’s birth was very straightforward compared to her sister’s and happened with minimal intervention, which can have an impact on lactogenesis and milk production.

And even with all these advantages, guess what… I am still supplementing with formula. On top of her eight nursing sessions round the clock, Otter also gets ~250ml of the evil science milk throughout the course of the day.

And she bloody-well needs it. You can tell this because even with the top-ups she is still gradually descending through the centiles (ie. her growth is still slower than one would expect to see) — from just over 50th centile at birth to just over 25th now. This isn’t the dramatic fall that Squirrel had; her growth is being monitored, and her GP and health visitor have signed off on the formula supplementation plan. Nevertheless it’s still a source of worry, and pretty good evidence that I’m not quite keeping up with her needs unaided.

I am totally thrilled that breastfeeding is at least somewhat functional this time around, and that I’m mostly feeding Otter directly rather than pumping around the clock like I did with Squirrel. But my point here is that even with all these advantages, without access to clean, safe formula my younger daughter would likely be starving right now. Not in the hyperbolic sense of “she would be very hungry”, but in the actual “her body and brain would be at risk of sustaining permanent damage” sense. Sadly, it does happen (warning for infant harm and death discussed at the link). And we are not the only family in this situation — low milk supply is something that the “breast is best” crew like to downplay and even gaslight women like me about (I have experienced this) but it is a real thing. Plus of course as this tweet points out, once the decision to formula feed has been made months or even years ago, one can’t simply reverse it because a shortage is now occurring:

I can imagine a little of what the parents in the US who are currently struggling to deal with the formula shortage must be going through, having experienced a few empty shop shelves during the first lockdown in 2020 (not to mention the spectacle of scalpers on a certain site named after a river in South America selling £8 boxes of formula for double and triple the price!). Uncertainty about the ongoing supply of safe formula during the pandemic was certainly a factor in my decision to keep exclusive-pumping for as long as I did. And to sneer at formula-feeding parents — who are right now living in fear of not being able to feed their babies — that they should have made a different choice is both incredibly heartless and a great way to demonstrate that you’re ignorant of the nuances of how infant feeding works both physiologically and socially/culturally.

The implication that breastfeeding is “free” is also pretty laughable given the list of economic resources I’ve cited above which were necessary to make even partial breastfeeding happen for me — if I needed to be doing paid work right now, there would be no way I could sink upwards of six hours per day into just feeding, not to mention the spending on lactation support, shortcuts such as prepared food for the adults in the house so I can nurse instead of cook, etc. And we won’t even go into the fact that I’ve spent at least a modest skiing holiday’s worth of money on the collection of manual, electronic and wearable pumps I’ve amassed since Squirrel’s feeding drama! Finally, while I might be happy and privileged to offer my kid nursing whenever she needs it, that doesn’t mean that the milk is necessarily there, which puts paid to the “on-demand” side of the argument too.

So yeah, Ms. Midler, I’m pretty confident that I can say I have “tried breastfeeding”. Why don’t you try having some understanding and compassion? I hear those are free and available on demand too.

Further reading:

Why breastfeeding isn’t a solution to the formula shortage — Dr Rebekah Diamond, Columbia University