What’s in baby formula, and why does everyone think it’s so terrible?

By Marie Holmes

Years ago, when my daughter was still a baby, another mom confessed to me her breastfeeding woes. I’d heard a similar version of the same story so many times before. She was nursing, she was pumping, and it was never enough. She was tired. It would be so nice to just let the baby have a bottle of formula when she was away from home. 

She hadn’t dared to do so, though. Formula was bad for babies, wasn’t it? 

What is infant formula made of? 

This impression, that infant formula is some sort of toxic elixir, is common. Nursing advocates can be zealous, and from their well-intentioned warnings that giving your baby even an ounce of formula can threaten your own milk supply, parents planning to breastfeed digest the message that any amount of formula can spell disaster. 

Add to this the wrongdoings perpetuated over the years by formula manufacturers in the name of selling more product, and the deaths this year of two babies (four were sickened) after consuming cronobacter-tainted formula from Abbott’s Sturgis, Michigan facility, and it’s understandable that people feel like formula is basically poison.

It just isn’t true. 

When this mom confessed her secret desire to feed her baby formula, I asked her if she knew what was actually in it. She’d never touched a can. 

Deborah Malkoff-Cohen, a pediatric nutritionist who works with babies and their parents at a cleft palate clinic, lists these basic building blocks: “They have to put in a sugar, a protein, a fat source, and vitamins.” 

There are similarities between cow’s milk and human milk, but babies can’t properly digest the fat in cow’s milk until they’re one, so powdered nonfat milk is the base of most regular infant formulas. To replace the missing fat, manufacturers usually add vegetable oil. Then sugar of some sort, and the equivalent of a multivitamin. 

Formula is made from regular food substances that you eat all the time. In order to be FDA-approved in the U.S., an infant formula must contain a minimum amount of 29 nutrients, and no more than a maximum set for 9 of those nutrients. 

Of course, there are a multitude of variations. Dairy proteins broken down to be hypoallergenic. Soy protein instead of dairy. It can take some trial and error to find one that agrees with your baby — hence many parents’ panic during the formula shortage.

What’s not in infant formula?

Of course, there are reasons that so many people — the World Health Organization, the Centers for Disease Control, your local pediatrician — encourage breastfeeding. The benefits to parent and baby are so great, in fact, that the American Academy of Pediatrics has recently revised its recommendations, advising that nursing continues for at least two years instead of one.

Breast milk contains things that can’t yet be replicated in infant formula. We’re still learning about them, and while some formulas now feature additions like probiotics (good bacteria), prebiotics (the fiber that good bacteria eat), DHA, and other Omega-3 fatty acids, there is still no formula that can offer your baby exactly what human mammary glands produce. 

If you’re a combo feeder, you may have noticed that when you leave out a bottle of breast milk it will stay good for a remarkably long time, while a bottle of formula quickly goes putrid. This has to do with the balance of different bacterias found in breast milk that inhibit the growth of dangerous bacteria.

In addition to sharing your beneficial bacteria with your baby, breastmilk contains antibodies to diseases that you’ve had, offering your baby some protection from them. This even works when your immunity comes in the form of a vaccine, as evidenced by the presence of Covid antibodies in the milk of vaccinated people. “Getting your mom’s immunity from breast milk,” says Malkoff-Cohen, “is huge, because you’re not vaccinated for anything till eight weeks.” 

Why does everyone think formula is so terrible?  

But the backlash against formula manufacturers isn’t about antibodies or probiotics. It’s about money, and terrible things done by formula companies — namely Nestlé, which is responsible for sickening untold numbers of children whose parents were convinced, often by healthcare workers, that formula was the best thing to feed their babies. 

By the 1950s, breastfeeding was on the wane in rich countries, and researchers from the UN were touting the power of protein — like that in powdered milk — to restore malnourished children to health. This paved the way for Nestlé to peddle its powdered milk infant formula in poor countries as the best way to nourish babies. 

The marketing practices they employed were egregious. Nestlé hired “milk nurses,” women who were not healthcare workers but dressed in nurses’ uniforms, to hang around hospitals handing out free formula samples. Hospital practices only made things worse. Babies were routinely kept away from their mothers in the nursery, where they were fed formula by real nurses. New moms were also sent home with a free container of formula. If a woman was prevented from breastfeeding during those first days postpartum, her body would stop making milk, and Nestlé gained a loyal customer for the next twelve months. 

Babies got sick, not because the formula was toxic, but because the people using it were poor. Many didn’t have refrigerators to safely store prepared formula. They might lack access to clean water, but even if they used boiled water, they often diluted the formula to stretch it out — as low-income people do with many other food products. A study in Indonesia found that only a quarter of families were preparing formula per the instructions. Babies ended up malnourished and ill. Formula caused the very problem it was purported to prevent. 

When these tactics came to light, they galvanized a group of unlikely allies, including conservative Christians and feminists, who rallied together around a massive, global boycott of Nestlé in the 1970s. While it was successful to an extent — the milk nurses disappeared, and the World Health Assembly adopted an International Code of Marketing Breast-milk Substitutes in 1981 — formula companies still advertise aggressively throughout the world. Just this February, the WHO published a report showing that 51% of parents and pregnant people across eight countries were targeted with marketing from formula manufacturers, often in violation of the international code. Companies are still using promotions and free samples to encourage dependence on their product, and are continuing to influence the training received by healthcare workers.  

Formula itself isn’t dangerous, but the people who sell it have been doing a convincing impression of big tobacco executives. 

Rather than casting judgment on the parents who need, or want, to feed their babies formula, we could reserve our criticism for the shareholders that profit off of unethical marketing tactics, and pressure businesses and elected officials to back policies, like paid family leave, that support parents who want to breastfeed. 

Just as it is poverty, not ignorance, that leads people to over-dilute their formula, it is often the economic necessity of having to work, not a lack of knowledge of breastfeeding’s benefits, that derails parents’ plans to exclusively nurse their children — like my friend, who did eventually feed her child some formula, safely and without incident. 

Marie Holmes is a contributing writer for Motherwell. She lives in New York City with her wife and their two children. She fed her children both breast milk and infant formula. You can find her on Twitter at @holmes_marie

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