Multiple medical organizations including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG) recommend exclusive breastfeeding for the first six months of life followed by continued breastfeeding until age twelve months with the gradual addition of complementary foods. Breastfeeding should be continued after one year for as long as is mutually desired by both mother and child. There are multiple benefits of breastfeeding for both mothers and children (Ip, 2007; Goldman, 2007). Since breastfeeding is the physiologically normal gold standard for infant nutrition, health care providers are now starting to talk about the “risks of breast milk substitutes” such as formula instead of the “benefits of breastfeeding.”

Breastfeeding is much healthier than formula for both you and your baby for three main reasons. First, there are proteins including antibodies in the breast milk itself that cannot be replicated in infant formula (Heird, 2007). Second, there is a benefit to the act of breastfeeding itself, both at a cellular level and a nurturing skin-to-skin contact level. These are the benefits you and your infant only get from nursing directly at the breast but not from feeding a baby pumped breast milk. Third, when you breastfeed exclusively, there is no exposure to formula. Infant formula has the very real potential for contamination, usually by either infectious agents or by packaging components such as dyes or metal shards. Some of those contaminations are potentially life-threatening. Many of the risks or benefits mentioned above are dose-related which makes intuitive sense. A year of formula or a year of breastfeeding has more health risks or benefits than a day of each, respectively.

The specific risks of formula as compared with breastfeeding are significant for both mothers and their children. For mothers, immediate risks include a slower return to pre-pregnancy weight and more post-partum bleeding. Long-term maternal risks of formula feeding as compared with breastfeeding include higher rates of pre-menopausal breast cancer, ovarian cancer, and endometrial cancer, as well as lower post-menopausal bone density.

Children who are formula-fed have lower immunity than those who are breastfed. Breastfed children have a lower risk of multiple different infections, especially colds, ear infections, and gastroenteritis. Breastfed children who do get sick experience less severe episodes of infections than children who are formula-fed. They also have a lower risk of many chronic diseases such as type I and type II diabetes, allergies, eczema, and obesity. Lower IQ is another risk of bottle feeding. Breastfed children have a lower risk of both sudden infant death syndrome (SIDS) and overall mortality than formula-fed children.

Breastfeeding is less expensive than formula feeding for multiple reasons (HHS Blueprint for Action on Breastfeeding, 2000). Most obviously, a year of infant formula costs more than $4000. US families spend $2 billion per year on breast milk substitutes. In addition to the cost of formula itself, there are significant health care cost savings since you and your baby will both be healthier. Breastfed infants require 20 percent less medical care than formula-fed infants. The average medical cost for a breastfed infant during the first year of life is $200 less than that for a formula-fed infant. Healthier mothers with healthier infants have less absenteeism. Longer-term, if every newborn in the US were breastfed for just 12 weeks, the prevention of non-chronic diseases in the first year of life alone would save $2 to $4 billion a year in health care costs.