Why America’s breastfeeding rates are falling: The role of Big Formula | Health Wellness

You’ve probably heard of Big Pharma, Big Oil, Big Tobacco, and even Big Sugar. But how about Big Formula?

Infant formula is a billion-dollar industry with an insular market. Only a handful of companies—led by Abbott, Mead Johnson (a subsidiary of Reckitt), Nestlé, and Perrigo—produce most baby formula sold in the United States. To protect their market share, they’ve spent millions of dollars in Washington D.C. lobbying for their interests, which include resisting a federally mandated family leave policy.

Breast milk is considered an ideal food for infants because it is packed with nutrients and antibodies that protect against illness. Although health organizations, including the American Academy of Pediatrics, widely consider exclusive breastfeeding for the first six months of life optimal for infant health and the well-being of new mothers, just 1 in 4 babies in the U.S. breastfeed for this duration, according to Centers for Disease Control and Prevention data.  

Disparities in breastfeeding rates

Among infants born in 2019, around 83% of infants received some breastmilk at birth, but by 6 months of age, a little more than half were receiving any breast milk, while about a quarter were receiving breast milk exclusively.

Roughly 20% of mothers living in the Southeast breastfeed till six months. Meanwhile, more than 32% of mothers in Oregon, Montana, Minnesota, Colorado, and Vermont breastfeed through the same period. Notably, these states are among those with some version of mandatory family leave policies, while Southeastern states with the fewest mothers breastfeeding till six months—including Mississippi, Alabama, Florida, Georgia, and South Carolina — do not. Even in states with mandated family leave policies, those policies are not always paid.

Breastfeeding rates also diverge along racial and economic lines. Non-Hispanic Black infants are less likely to be breastfed at all compared to their counterparts, and infants who are eligible to receive nutritional support through the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, are less likely to be breastfed than infants who are ineligible for these services. What’s more, young mothers aged 20-29 are less likely to breastfeed than mothers 30 and older.

Many mothers from marginalized communities face numerous obstacles to meeting breastfeeding goals, including but not limited to unsupportive hospital practices and policies, and a lack of insurance coverage for support services like pregnancy education, lactation consultants, and doula services. 

Exploitative formula marketing

Recent social media and pop culture “mommy wars” between breastfeeding and formula have framed this choice as having a clear right and wrong, when the reality is more complex. Individuals may weigh several factors when determining how to feed their infant; the influence of pervasive digital marketing for formula complicates these decisions.

While the American commercial milk formula industry has long been criticized for aggressive marketing tactics, a groundbreaking 2023 report published in the Lancet argues the industry has become exploitative. The report’s authors, a group of medical professionals, detailed how the industry promoted unsubstantiated claims in its marketing that linked typical baby behaviors to breastfeeding. 

Notably, the U.S. does not regulate formula industry marketing, while many other countries do, nor did it commit to the World Health Organization’s globally accepted International Code of Marketing Breast-Milk Substitutes, which set a precedent in 1981 to prohibit formula marketing.

It wasn’t until the late aughts that hospitals began to stop sending new parents home with free samples of formula, a practice many surmised would tempt an exhausted, sore breastfeeding parent to stop the practice before the recommended six months — particularly if they had to return to work.

Big Formula’s lobbying efforts

Federal maternity leave was introduced into political debate as a legally protected necessity 105 years ago, in 1919. Since then, at least eight attempts to pass federally protected family leave have failed, including the recent Momnibus Act, supported by 72% of people in a survey of 999 registered voters conducted by Navigator in 2022.

Despite overwhelming support, thwarted attempts to pass a paid leave policy are partly the result of the decades-long relationship between formula industry giants and the U.S. government. 

A 2020 analysis in the International Breastfeeding Journal found that Nestlé had actively cultivated relationships with key opinion leaders and spread misinformation through digital media that would benefit the formula industry. Abbott, for example, disclosed more than $4 million spent in lobbying dollars in 2021 and $1 million in the first three months of 2022 alone.

Special interest groups use political contributions to incentivize legislators to make decisions favoring their corporate interests. These groups, or lobbies, negotiate behind closed doors, meaning that despite required disclosures, the public often remains in the dark. By currying favor among lawmakers, lobbyists have long helped powerful businesses expand their influence through tax breaks by sidestepping regulations, securing government contracts—and even altering public policy.  

Breaking away 

A 2023 survey from the Democratic polling firm Lake Research Partners found that nearly two-thirds of voters in battleground states would be motivated to vote by a paid leave plan. The poll, taken on behalf of the advocacy group Paid Leave for All Action, also found that support for paid leave is bipartisan: 85% of Democratic voters and nearly half (47%) of Republicans said they would vote for a candidate who supports a paid leave policy.

Despite overwhelming support for paid leave, historically, just a handful of votes in Congress have denied plans. The most recent and comprehensive effort, the Momnibus Act, was part of President Biden’s Build Back Better initiative, a sweeping proposal that included $585 billion for family and child programs. Among the pieces of the initiative cut were $200 billion for a federally mandated, four-week parental leave program and $270 billion for six years of a childcare subsidy program.

Proponents of federally protected parental leave argue families would be better equipped to decide what infant feeding path best suits them with postpartum recovery coverage. Detractors cite the high costs; studies show that investing in parental leave (including increased breastfeeding support) will create billions in savings over the long term due to improved public health outcomes overall.

Many countries consider access to resources to safely feed and raise children without undue marketing influence a basic human right. The well-established link between breastfeeding support, maternity leave, and improved health outcomes for infants and new mothers may buoy future legislation protecting family leave policies and stricter rules for formula marketing.