Thousands of years ago, breastfeeding was practically the only option for feeding infants before they were ready to eat solid food. If a mother could not nurse her baby because she did not have enough milk or because she had died in childbirth, a “wet nurse,” a woman who was producing milk from her own pregnancy, was found. Today, only 37% of infants in low-income countries are exclusively breastfed, and in the higher-income countries, the percentage is even lower. Both breast and bottle feeding have advantages and disadvantages. For working mothers, breastfeeding is more difficult because mother and child are separated during the day. Legislation has been passed at the federal level and in some states providing for working mothers to take breaks specifically for expressing breast milk.
Research shows that in almost all cases, breast milk is healthier than formula. Increased intelligence, fewer infections, and straighter teeth are associated with breastfeeding (Salone, Vann, and Dee, 2013). It is clear that there are antibodies in breast milk that protect children from diseases and infections that their mothers already experienced. Some research suggests that children who are breastfed exclusively have I.Q.s that are up to three points higher than those who are bottle fed with formula. Breastfeeding is also good for the mother. Evidence from nearly 50 research studies indicated that the risk of breast cancer is lower in women who breastfed their children for at least twelve months. Evidence also suggests that women who nurse may also be at a lower risk for ovarian cancer (Victora et al., 2016).

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Although breastfeeding prevents the development of malocclusions such as underbites and overbites, prolonged breastfeeding (longer than twelve months) can increase the appearance of cavities in deciduous teeth (Tham et al., 2015). This may be linked to the tendency of women to breastfeed their older children at night, for comfort or to induce sleep. Another disadvantage is that breastfeeding women may need to avoid certain foods that can alter the taste of breast milk, such as chocolate, spices, citrus fruits, onion, garlic, and cauliflower. Caffeine and alcohol should be avoided or limited. Finally, breastfeeding can be extremely painful for some women who have sensitive nipples.

The advantages of bottle feeding an infant with formula are primarily associated with lifestyle. First, the mother does not need to alter her diet or stop taking any medications that may pass into breast milk. If there are multiple caregivers, any of them can provide a bottle of formula. Feeding a baby a bottle of formula is much easier to do in public than breastfeeding, even though federal law (and some state laws) specific that mothers may nurse their babies anywhere. The prohibition is cultural, based largely on the sexualization of a woman’s breast as an erogenous zone, but like many cultural norms, it is very powerful.

Disadvantages to formula feeding are numerous. First, the child and mother do not get the benefits of breastfeeding that were discussed above. Formula feeding may cause the child to develop allergies (although the evidence for this is inconclusive) and may lead to obesity later in life. Finally, formula may have contaminants in it such as melamine, cronobacter, salmonella, or botulism (Lönnerdal, 2014).

Breastfeeding is often difficult for working mothers because they are away from their infants eight or more hours a day. If the child is receiving breast milk exclusively, the mother must express the milk while she is at work and arrange to freeze it immediately so that it will be safe. Federal law specifies that employers with more than 50 employees must provide breaks for working mothers who need to express milk, as well as a private location other than a bathroom. Some states have similar or broader laws (U.S. Department of Labor, 2016). Unfortunately, most of these laws lack enforcement procedures, so employers know that they can break the law with impunity.

    References
  • Lönnerdal, B. (2014). Infant formula and infant nutrition: bioactive proteins of human milk and implications for composition of infant formulas. The American journal of clinical nutrition, 99(3), 712S-717S.
  • Salone, L. R., Vann, W. F., & Dee, D. L. (2013). Breastfeeding: an overview of oral and general health benefits. The Journal of the American Dental Association, 144(2), 143-151.
  • Tham, R., Bowatte, G., Dharmage, S. C., Tan, D. J., Lau, M. X. Z., Dai, X., … & Lodge, C. J. (2015). Breastfeeding and the risk of dental caries: a systematic review and meta‐analysis. Acta Paediatrica, 104(S467), 62-84.
  • U.S. Department of Labor. (2016). Fact Sheet #73: Break Time for Nursing Mothers under the FLSA. Retrieved from https://www.dol.gov/whd/regs/compliance/whdfs73.pdf
  • Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., … & Group, T. L. B. S. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490.