Historian explains why breastfeeding is not the effective alternative to formula many think it is

The United States is currently experiencing a severe shortage of baby formula. It has been nearly three months since the major formula manufacturer Abbott pulled its products off shelves after four infants may have fallen ill from bacterial infections, and two died. This, coupled with supply chain challenges and labor shortages, has resulted in a national formula out-of-stock percentage of 43%, US News reports. Amid the supply gap, many have suggested that mothers should simply switch to breastfeeding as they did in the past. However, as Carla Cevasco, Ph.D., illustrates in her now-viral Twitter thread, this may not be the brilliant idea people think it is.

"You may be hearing the argument that before the rise of modern commercial infant formula, babies all ate breastmilk and everything was great," she begins. "As a historian of infant feeding, let me tell you why that’s not true... First of all, throughout history, people have at times needed to feed infants using foods other than breastmilk." Cevasco goes on to list several reasons, including how sometimes the birthing parent was unable to breastfeed owing to death in childbirth, physical/mental health concerns or the need to return to work outside the home right after childbirth.

Notably, she highlights one imperative reason: When a mother's partner or enslaver forced them not to breastfeed so that they could return to fertility as soon as possible after giving birth. Cevasco continues, "Sometimes baby was unable to breastfeed. Because [of] poor latch, prematurity, cleft palate, [or] other health or disability reasons. Sometimes baby was being cared for by carers other than [the] birthing parent, including adoptive parents." She then answers what alternatives mothers resorted to when they could not breastfeed. "Sometimes someone else would breastfeed the child," she says. "This might have been a relative or neighbor doing it for free. Or it might have been a paid or unpaid servant or enslaved person doing it at the expense of their own nursing infant, who might starve to death as a result."

However, she highlights, feeding a baby other people’s breastmilk was not necessarily an ideal situation either, given the power dynamics of race, class and gender in the past. In other cases, babies thrived on alternative diets. Cevasco shares, for example, "Wabanaki women in the 18th century sometimes fed infants a mixture of boiled walnuts, cornmeal, and water; an English colonist, Elizabeth Hanson, reported that her baby thrived on this diet. In early modern Europe, babies often ate pap or panada, mixtures of animal milk or water, bread crumbs, or flour. Sometimes these were boiled, sometimes they were not." Unfortunately, these substitutes were not always safe or nutritionally complete.

"So before the advent of modern commercial formula (in the 1950s), a lot of babies died of illness or starvation because they couldn’t breastfeed and the alternative foods were not safe or adequate," she says. She reiterates the need for access to things like paid parental leave, free lactation consultants and breastfeeding education, pumping rooms and the right to breastfeed in public to encourage more mothers to breastfeed. Nonetheless, in the absence of such access, baby formula fills a crucial gap. "Let’s not demonize formula because of an imagined past in which everyone breastfed," she concludes. "In the ACTUAL past, babies starved and died of disease. Babies who would have survived today, because they would have had access to safe, nutritionally complete formula."