There are a number of reasons for a mother to choose formulas:

- baby has special diet needs

- mother doesn't produce sufficient amount

- mother is on medicine, supplements or drugs that would be expressed via breastfeeding

- mother works and preparing / preserving pre-pumped milk isn't feasible

- mother is dead

- mother chooses to use formula

Only in the last case is the availability of formula itself to blame, and even then the notion that it shouldn't be an option is somewhat cruel.

It seems to me like it could be prescription (though first a real health system would be needed) if there is a shortage. I mean I think the last one is 80% of the market and putting the other 20% of infants at risk.

Not all formula is the same, and since there isn't a prescription needed, the only thing holding back new entrants is either (a) the market is too small to be worth starting up a new company, or (b) the regulatory hurdles (as a food item, etc) make starting up a new company cost prohibitive compared to what they could make selling it.

Shortages of baby formula is pretty rare here in the states, and building a business is a costly time consuming endeavor- you won't be able to spin one up just to make money during the shortage (testing, inspections, FDA approval for the labels, etc). That leaves other companies who are already running food businesses to possibly expand into it, but getting FDA approvals still takes time and a lot of money, so you need a longer term game plan for keeping it going.

A doctor writing a prescription for it doesn't help you get any if there's not any available in significant quantities- it's not a one and done thing, it is literally all the baby can eat until they've grown enough to be weaned off.

> A doctor writing a prescription for it doesn't help you get any if there's not any available in significant quantities- it's not a one and done thing, it is literally all the baby can eat until they've grown enough to be weaned off.

If it is available in any quantity then needing a prescription keeps it from being used for infants that don't need it. (Market naturally drops but I don't think risking the health of many infants who don't need formula to keep it cheap is a great ethical move anyway.)

There are infinitely refillable prescriptions and nutritional prescriptions, they have an advantage that they can be billed to health insurance which is fairer if an expensive diet is a medical need.

The overall effects of losing the local market, importing for infants that need it and having insurance pay much higher costs may well pay for itself if we could measure the future health consequences of unnecessary formula use.. but the rule of do no harm means we shouldn't try to feed kids formula without a medical need.

> If it is available in any quantity then needing a prescription keeps it from being used for infants that don't need it.

Ah, I didn't realize you meant waving a fiat wand so that everyone had to get a prescription for it.

If that were the case, then I imagine we could do the same with bottled water, gluten free grains, alcohol, vitamin supplements, coffee, CBD, and more, and solve so many problems!

Alas, the FDA has certain authority over drugs, and certain authority over food. It does not have the same authority over both, and infant formula is a food, not a drug.

Baby formula is not really food, babies can't eat food and feeding your infant food would be abuse likely to kill them. Full nutritional replacements that need to be made in a safer environment than a kitchen to replace mother's milk is closer to penicillin than cheeseburger. But there are better categories, the FDA does recognize nutritional supplements and there are prescription health supplements.

This is just wrong. A non-insignificant fraction of women can't produce milk in high enough quantities to feed infants. This is an undisputed fact.

The only alternative to robust infant formula supply is to accept pre-modern levels of infant mortality. Period.

Wet nurses exist. Period. I know of more than one woman who donates breast milk. They both have continued to pump as their kids grow to give back to the community.

“Wet nurse” is a phrase for this very reason.

Wet nurses are extremely expensive, they also introduce a variety of challenges in modern times as you must trust a stranger to carefully and correctly preserve the milk, not dilute it with anything, and be in good health without any complicating factors.

When all is said and done, milk can be purchased peer to peer at roughly 4x the cost of infant formula or between 1 and 2 dollars per oz. Purchasing through a service with some notional guarantees on the above concerns increases the cost to 5 dollars per oz. A 3-6 month old can consume 40+ oz per day.

Can you elaborate on this? I've always been surprised at how many families use formula. Do mothers just not breastfeed much anymore?

Exclusively breastfeeding is very challenging to do while working, for one. Even at my megacorp with a dedicated space, a hospital grade pump, and 2 hrs a day dedicated only to that, it was a substantial hit to supply. Considering that most women don't have those amenities and support I'm not surprised they don't breastfeed exclusively after their mat leave (for most women in the US, 6 weeks unpaid)

Not to mention - it can be painful (if I had no option of course I would endure pain for my child, but there is no shame in looking for something less painful) or the baby can not learn to latch (formerly known as "failure to thrive" and a driver of infant mortality)

I've recently become a father and I do wonder how much US maternity leave (or rather, lack thereof) accounts for your high formula usage.

While my wife is coping, it's still very draining to handle a newborn and pump at regular intervals, even at 10 weeks. If she was in the US and had been forced to go back to work already, she may well have given up on breast milk already.

> Do mothers just not breastfeed much anymore?

Mothers who can't breastfeed adequately don't have any of slaves, paid wetnurses, or children that die of starvation as much as they used to.

Nursing is nearly a full time job. When I was doing it with a six month old via pumping, I tracked my hours spent one week and came up with 30 hours. With another baby, I was nursing in the evenings when home from work, and it was literally 3-4 hours a night. Every night. And often almost a full hour in the morning before work. It varies from baby to baby, but it's a brutal time commitment.

Also, when you're nursing full time, you can't leave the baby. Ever. Getting a haircut requires significant planning because if the baby gets hungry, it is your problem and yours alone. If you want to go shopping or see a movie or just leave the dang house for any reason at all, if you want to do any activity that occupies you for a length of time and is hard to interrupt, you need a baby plan. And for a period of months, when in love with a newborn, this seems totally fine and totally worth it. But somewhere on the road to a year? Being able to hand a baby to someone to watch for an hour or two and go do things is amazing.

Don't get me wrong, nursing is a wonderful experience and very important for the health of mother and baby. But the value diminishes over time. With a preemie, it is downright lifesaving. With a newborn it has proven lifelong benefits. But somewhere around the time they're eating cheerios and licking the floor and snacking on apple juice, and you have other things to do, you ask yourself if it's really worth what it costs. At least, I did.

Where you come down on the value of breastfeeding vs formula really depends a lot on your life circumstances and the relative priorities you place on mothering via milk, and mothering via other activities. When and where you leave off is very personal. Some women want to nurse toddlers, and I support that. Some women want to use formula from day one, and I'm not crazy about that, but life is varied and sometimes circumstances dictate and when they do, I'm glad we have the option. In particular, I think this is really common after a C-section, which makes sense -- mom is recovering from surgery and breastfeeding can involve resting a baby on a recovering wound! I'd certainly never second guess someone who thought it more important to have the energy to be emotionally present with the baby, even if that meant feeding baby a different food than they'd wish for in a perfect world. Milk has its benefits, but having an emotionally healthy mom counts for a lot, too. Probably more. And it's a long journey. Trying too hard to do everything perfect can result in mental health issues for mom, which isn't good for anyone, baby included.

Some women transition early, and I support that, some do late, and I support that, too. All parents try to do right by their children, and for some that looks like laborious custom homemade food and for some that looks like neighborhoods and education and opportunities. I do think we'd be better off as a society if it were more practical to nurse for the first year--I think a lot of women would choose it if it were easier. But that involves understanding it like the full time commitment it is. Can I put a year of "full time mom" on my resume? Three times? Can I take a year off of work? Is spending a year nursing seen as a normal and honorable career choice? That's essentially the ask. Whether the gap is made up by state or society or family or whatever, the world would have to look pretty different for me to find it a practical option to make such a commitment to nursing that formula was entirely unnecessary. For some people it's that important. Some would like to, but it's too hard. Some people aren't cut out to be full time moms. And sometimes even full time moms think it's better to use their energy for other things.

> "Also, when you're nursing full time, you can't leave the baby. Ever."

outside of the first few weeks (not months), a healthy baby can wait an hour or two to nurse. you certainly don't want to constantly deny feeding for hours on end, but a couple hours is well within the environment in which we've evolved over the past many millenia. our bodies are amazingly adaptive and tolerant, even as infants. mothers, nursing or not, shouldn't feel any guilt for not dedicating every single waking second to infants (after the first few weeks). that said, i fully support multiple months of paid parental leave (socially supported rather than employer supported) for both parents to adjust to the new human in their lives.

Yeah, I suppose I'm overstating it. It would be better to say that when you're full time nursing, going and doing things requires planning and support.

When I was directly breastfeeding exclusively, stepping outside the house for an hour felt crazy and scary. You're right that it got easier as the baby got older, and I knew the baby wouldn't die, but I wanted to be there for him!! Who wants to leave a kid hungry when they need you? So from a practical perspective, I rarely did anything.

When I was pumping, I worried about supply and timing and what I'd left behind and if I'd make it back in time to sufficiently support everyone's biology. It was doable but I was always planning around it. Better, and now hours on end became practical, but the hassle still made it hard to want to go out. You're always worrying, if you miss your pumping appointment, if that means ultimately baby won't get enough. I mean, you know that's not true, but you worry. The practical effect for me is that something fun and easy that doesn't fit perfectly in the schedule -- like seeing a movie -- just doesn't seem worth the stress. So you never see movies.

But man, the sheer freedom of being able to tell grandma "Here's the baby, here's a box of unlimited food" and not think about it. Man. If you want to know why people make that call, I'm sure that's a factor. That's really what I mean.

yah, the need to always be planning is definitely a drag, and it dampening the deisre to step away is completely understandable. it totally makes sense to me that parents often choose the hybrid approach (of supplementing with formula) because of this.

Not surprising at all in a country with very little to no paternity leave. The mother is not with her infant 24/7, and the baby has to eat.

Check the female workforce statistics. We decided as a culture it was more important for women to be working than “wasting time” raising and caring for their children.

This development has occured in most of the world, including some rather conservative societies like Japan and Iran. The sad truth is that modern economies need a lot of educated workers.

How exactly is it a problem caused by infant formula manufacturers?

Infant formula makers market their goods aggressively to new mothers. The formula makers fully understand that once a child is on formula, a mother will soon stop being able to create her own milk and the baby will have to use formula from then on.

Not every new parent fully understands this, especially in places that don’t have a lot of marketing dollars spent influencing people at one if the most vulnerable times of their life.

This can, and does, lead to situations where the mother’s milk dries up “early” and then formula isn’t available and the baby dies.

See https://www.ranker.com/list/nestle-baby-formula-boycott/meli...

It's also incredibly common for mothers not to have sufficient supply regardless of formula use. This results in a negative spiral where the baby won't be fed enough, and the mother isn't able to sleep, resulting in even less supply. Formula allows the mother to sleep, and the baby to be properly fed, even when they mother wants to breast feed.

See, your problem here is you're assuming the mother is the only one feeding a child.

I deliberately said “new parent”.

Some mothers want to breastfeed but don’t produce enough milk.