Risks and ethics of breastmilk substitutes

Reading Time: 3 minutes

“Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group,” says the WHO.1

When breastfeeding does not happen, parents and caretakers generally turn to infant breastmilk substitutes. The World Health Organization (WHO) and UNICEF recommend that health care providers inform parents and caretakers about the health risks of artificial feeding and the benefits associated with breastmilk.2 The risks are numerous, but rarely is proper handling and preparation taken into consideration, “[…] Formula must be refrigerated and discarded after the first feeding attempt because it contains no antibodies or infection protection factors.”3

In ‘Milk sharing and formula feeding: Infant feeding risks in comparative perspective‘, Karleen Gribble writes: “There are risks associated with all forms of infant feeding, including breastfeeding and the use of manufactured infant formulas. However, health authorities do not warn against using formula or breastfeeding; they provide guidance on how to manage risk. Cultural distaste for sharing human milk, not evidenced-based research, supports these official warnings. Regulating bodies should conduct research and disseminate information about how to mitigate possible risks of sharing human milk, rather than proscribe the practice outright.”

Unlike breastmilk, breastmilk substitutes need to be carefully measured out based on its caloric content to ensure that your baby is getting the suggested portion. Caregivers need to be warned against diluting or over-mixing, as doing so may begin a child on a path of battling with obesity or malnourishment. Infact Canada outlines a list of the risks associated with artificial feeding to help make a more informed decision about feeding babies.

The WHO writes: “Powdered infant formula (PIF) has been associated with serious illness and death in infants due to infections with Enterobacter sakazakii. During production, PIF can become contaminated with harmful bacteria, such as Enterobacter sakazakii andSalmonella enterica. This is because, using current manufacturing technology, it is not feasible to produce sterile PIF. During the preparation of PIF, inappropriate handling practices can exacerbate the problem.”4 Please see this WHO document for proper guidelines.

Susan Orlando, RNC, NS writes that “the protective properties of breast milk are unique and cannot be duplicated in the laboratory. The components identified in breast milk are multifunctional and interactive. The composition of breast milk complements the developing host defense system in the newborn infant. Since breastfeeding is the biological norm for infants, this means that there are risks to using any and all other artificial breastmilk substitutes for infant feeding purposes.” For more information on how breastmilk substitutes affect the bacterial colonization in the gastrointestinal (GI) tract, see the article, ‘“Just One Bottle Won’t Hurt” –or Will it?’ by Marsha Walker, RN, IBCLC.

In ‘The Risks of Not Breastfeeding for Mothers and Infants,’ Dr. Alison Stuebe concludes that “Formula feeding is associated with adverse health outcomes for both mothers and infants, ranging from infectious morbidity to chronic disease.”

La Trobe Table #6 summarizes a list of contaminants in infant formula that have caused infections. Other risks and/or contaminants that have been found in breastmilk substitutes include phthalates, bisphenol A (BPA), melamine, genetic engineering, and microbiological risks. For more information on safe practices, sterilization and the microbacterial content in powdered formula see the Codex Alimentarius.

When it comes to premature babies, Necrotizing Enterocolitis (NEC) is a very dangerous complication of feeding with breastmilk substitutes. Breastmilk has been associated with a decrease in NEC in premature babies and should be widely available to all infants in hospitals. Please see ‘What about premature babies?’ for more information.

Another concern regarding artificial feeding is the ethics behind formula companies’ marketing and distribution of their products. Formula companies have misinformed consumers by making false statements about their products and by neglecting to provide key information. This has widespread health and economical implications in many countries, but is devastating to developing nations in particular. Please view these 6 episodes of ‘Formula for Disaster’ on YouTube for a closer look at the ethics of formula companies in the Philippines.

There is an overall lack of support for people who struggle with breastfeeding. Parents and caretakers are exposed to clinical or hospital environments filled with formula advertisements which gives a strong message to new parents, one that undermines any form of ‘lip-service’ paid to breastfeeding. This type of marketing and distribution goes directly against the ‘International Code of Marketing Breast Milk Substitutes.’

When using formula, education about the risks associated with artificial infant feeding is important. Follow the ‘Alerts & Safety Information and Reporting Illnesses, Injuries and Problems’ for the latest recalls in formula.

Please see ‘HIV and the global context of infant feeding’ for the WHO’s position on breastmilk substitutes.


  1. ‘Global Strategy for Infant and Young Child Feeding’ bullet 19. []
  2. International Code of Marketing of Breast-milk Substitutes.’ bullet 4.2 []
  3. Lawrence, Ruth. Breastfeeding, A Guide for the Medical Profession. P. 438. 2005. Print. []
  4. http://www.who.int/foodsafety/publications/micro/pif2007/en/ []

One Response to Risks and ethics of breastmilk substitutes

  1. Pingback: nutrition for pregnancy, breastfeeding and children | Pearltrees

Leave a Reply