The benefits of breastfeeding have been documented for years. But what’s "best" can be overwhelming — emotionally and physically.
Globally, the World Health Organization says less than 50% of babies are breastfed according to recommended standards.
"Among those who are choosing to breastfeed, the great majority cannot breastfeed for as long as they want. And that is a big problem because the question then becomes 'why?'" said Dr. Rafael Pérez-Escamilla, a professor at the Yale School of Public Health.
A new series from The Lancet, a medical journal, says some of the challenges stem from societal issues like a lack of support, a lack of universal paid leave or lack of accommodations like lactation rooms at work.
And then there's the formula companies. WHO researchers, like Dr. Cecília Tomori of the Johns Hopkins School of Nursing, say the companies mislead people about the benefits of their product.
"People may be working in the informal economy, may have zero protections whatsoever and really having to choose between going to try to put food on the table versus being able to be with baby," Tomori said. "There are claims about how the baby might sleep better. There are claims that, you know, the baby might be more settled, less fussy, calmer or more intelligent. These kinds of claims can lead people to misunderstand what's happening on a scientific basis."
According to Pérez-Escamilla, those claims for better sleep or a higher IQ then flood social media and online algorithms.
"They tailor these messages very specific to the search words that people input into their computers so they can tell if someone is a new mom or someone is pregnant," Pérez-Escamilla said.
A 1981 international code of marketing from the WHO lays clear what companies can and cannot do and say about their product.
But Pérez-Escamilla says some companies do not follow the guidelines. The U.S. didn’t sign the code at all.
A 2022 report from the WHO also accuses formula companies of manipulating consumers and flooding the market. 51% of the pregnant and postnatal women surveyed reported seeing or hearing formula milk marketing in the preceding year. That includes 97% of Women in China. Most of the ads coming from TV and TikTok.
A spokesperson from the International Special Dietary Foods Industries, who represents manufacturers like Nestle, told Scripps News in part, "ISDI members comply with all laws and regulations in the countries in which they operate. ISDI members are cognizant of their responsibility and are thus individually taking additional steps to actively raise awareness of the WHO Code and applicable laws amongst third parties. "
Pérez-Escamilla says it’s not just advertising. Formula companies also work through trusted sources like doctors.
"They would, you know, give them incentives. If they prescribe their products, they would pay for conferences, they would pay for expensive dinners, they would pay for books. Essentially, you know, the healthcare providers end up becoming like sales representatives," Pérez-Escamilla said.
Meanwhile, experts say encouraging breastfeeding in new parents isn't the work of any one industry, but several systems coming together.
That means hospitals encouraging the process at birth and public policy doing the same.
"People who are in the throes of trying to do their best, they are not accountable for trying to solve all these issues. What we're asking for is a completely different thing. We're asking for the social systems and structures of support so that everybody has the opportunity to make informed decision," Tomori said.