The U.S. baby formula crisis has dominated headlines in recent weeks, sparking heated conversation online.
The nationwide shortage is a result of pandemic supply chain issues exacerbated by a February safety recall from Abbott, the nation’s largest manufacturer of formula, and shutdown of its Sturgis, Michigan, plant. At least four babies were hospitalized with bacterial infections — and two died — after consuming formula from that facility. Abbott recently reached an agreement with the Food and Drug Administration to restart production at the Sturgis plant, provided the company corrects the unsanitary conditions that caused the closure.
If you’ve been following the social media discourse around the formula shortage, you’ve seen the same unhelpful “solutions” to the problem popping up again and again. One of the most common and frustrating takes — we’re looking at you, Bette Midler — is that instead of relying on formula, women should “just breastfeed” because “breastfeeding is free!”
This is patently false: There are significant physical, mental and financial costs to breastfeeding that are so often overlooked.
As Jessica Owens-Young, an assistant professor in the department of health studies at American University, pointed out in a now-viral tweet: “The ‘breastfeeding is free’ narrative in the midst of an infant formula shortage is a great example of public ignorance of what it actually takes to successfully breastfeed.”
The Cost Of Breastfeeding
The time commitment alone is monumental, especially during the newborn phase. Breastfed babies eat every two to three hours around the clock (and sometimes more frequently than that). Feeding sessions can last 30 minutes or more. According to one conservative estimate, nursing for a year would equate to 1,800 hours of the mother’s time. It’s truly a full-time job.
“Breastfeeding — and relatedly pumping breastmilk — is not free because it consumes women’s time and resources in ways that amount to another job on top of being a mother,” organizational psychologist Allison S. Gabriel, a professor at the University of Arizona’s Eller College of Management, told HuffPost. “This means that breastfeeding is only free if we do not value women’s time and the efforts it takes to physically be the ones to produce breastmilk to feed their child.”
“Breastfeeding is only free if we do not value women’s time.”
The misconception that breastfeeding is free is tied to the belief that it just “comes naturally” to mothers when that’s not the case for many, many women.
Karrie Locher — a registered nurse, certified lactation counselor and mother of four — said many women devote considerable resources, both financially and emotionally, to trying to make breastfeeding work — herself included. Her youngest son had a lip and tongue tie when he was born, which affected his ability to latch and breastfeed effectively. Locher detailed their journey on her Instagram account, which has nearly half a million followers.
“I spent over $1,500 for the releases of those oral ties and the lactation consultant visits to try and salvage my breastfeeding journey,” she told HuffPost. “Along with that, I spent endless time nursing, then pumping to sustain my milk supply. I felt like I was feeding or attached to a pump around the clock. I was exhausted, overwhelmed, frustrated, anxious and felt defeated. The constant worry of ‘is he getting enough’ or ‘am I doing enough’ can be mental anguish itself.”
There are also other financial expenses people don’t consider: nursing or pumping bras, breast pads, nursing pillows, nursing covers, nipple care ointment, storage bottles and bags, milk coolers, breast pumps and replacement parts.
Plus, “prescriptions needed for nipple cream — mine wasn’t fully covered — doctor’s visits and prescriptions needed for mastitis or other breast problems and lactation appointments,” Locher said. “Of course, most women don’t need all of these things during their journey, but some may.”
Health insurance may cover some of the above expenses, but many plans do not.
“It’s going to vary from situation to situation and can actually add up to a considerable cost,” Locher added.
Then there’s the physical toll nursing takes: the exhaustion, engorged and leaking breasts, cracked nipples and the feeling that your body is no longer your own.
“The effort, the willpower, the sleepless days and nights, the mental anguish, the time, the energy, the money ― that is not ‘free.’ It all comes with a cost,” Locher added.
“The effort, the willpower, the sleepless days and nights, the mental anguish, the time, the energy, the money ― that is not ‘free.’ It all comes with a cost.”
Gabriel, the organizational psychologist, gave birth to her daughter in March 2020, just days before COVID-19 shutdowns began. Several weeks into breastfeeding, her daughter started having trouble latching effectively. Gabriel spent anywhere from three to eight hours a day nursing, but she was unable to produce enough milk for her daughter, which hurt her mental health — and cost her money, too.
“I tried everything — from lactation cookies, to different nursing pillows, to multiple lactation consultants, to multiple types of pumps and pump parts — to produce enough breastmilk for our daughter,” she said.
“Without a doubt, my struggles with breastfeeding and pumping contributed significantly to my struggles with postpartum anxiety and depression,” she added.
There’s some research to back this up: Early negative breastfeeding experiences have been linked to postpartum depression (although the association between the two isn’t entirely clear). In another study, moms who planned to breastfeed and did so successfully had a lower risk of PPD. But for those who intended to breastfeed and were unable to, the risk of PPD increased.
“I spent over $1,500... to try and salvage my breastfeeding journey.”
The ability to breastfeed at all is a luxury in the U.S. — one of the few countries worldwide without national paid parental leave. Woman who must return to work weeks after giving birth need to pump breastmilk every couple of hours in order to maintain their supply. Under federal law, employers must provide employees break time to pump during the workday and a private place, other than a bathroom, for them to do so. But those breaks don’t have to be paid, which means potentially missing out on income. And the area doesn’t have to be a dedicated lactation space. Sometimes it’s a dusty storage closet or a room that doesn’t lock — not exactly the calming atmosphere some women need in order to pump.
“Our research in 2020 found that women report spending about 45 minutes per workday in a standard 8-hour workday having to pump breastmilk,” Gabriel said. “This means rescheduling meetings, pumping during what should be real breaks away from work and overall having to add more significant demands in their day-to-day work.”
People who don’t work in office settings — like teachers and retail and food service workers — may struggle more to find adequate time and space to pump on the job.
Mothers also need access to a fridge to safely store their pumped milk during the day and a way to transport it home, which may mean purchasing a cooler bag. And those who travel for work may need to pay out of pocket to ship their breastmilk home if the cost isn’t covered by their company.
Saying ‘Breastfeeding Is Free’ Is Not Only Wrong — It’s Damaging, Too
Caregivers of infants are under enough stress as it is right now as they scramble to make sure their babies’ nutritional needs are met during the shortage. Saying “breastfeeding is free,” as if it’s a solution to the problem, just adds insult to injury.
“[It] dismisses the challenges people are facing, diminishes the reasons why formula is needed, and assumes that breastfeeding is an option for everyone,” Owens-Young said.
Breastfeeding is one of those things that “no matter how much you want it, it doesn’t always happen for you and your body or your baby,” Gabriel said.
In addition to latch and supply issues, parents may be unable to breastfeed because of a previous breast surgery, such as reduction, or because they’re on a medication that’s incompatible with nursing, among many other reasons. Babies may be unable to nurse because of an allergy, health condition or premature birth.
Locher also pointed out that the “breastfeeding is free” narrative ignores the reality for many parents and caregivers. Consider, for example, situations in which there’s two non-birthing parents and nursing isn’t possible.
“What about the parents who adopted their baby?” Locher said. “What about the woman struggling with severe postpartum depression who’s feeling even worse each time her baby won’t latch?”
The infant formula shortage is a structural problem that requires structural solutions, Owens-Young said.
“More individuals breastfeeding won’t solve the structural factors that led to the shortage; there will always be a need for infant formula,” she said.
The crisis should be a national outrage, said Gabriel — not because women aren’t breastfeeding, “but because it is another example of us not realizing that to support women is to make sure they have the supports they need to thrive as mothers and employees. Access to formula is one such support.”