The Breast vs. Bottle Poll

by Sally Tusa

The Breast vs. Bottle Poll

"How dare these self-righteous mothers get on their soapbox and tell me that I am not bonding with my children unless I pull my boob out in front of the world and breastfeed? Not everyone wishes to see your stretch-marked boobs in public!"
 — A formula-feeding mom from Baton Rouge, Louisiana

"Babytalk states that breast milk is best for a baby, then says that no mother should feel pressured into choosing one method. Does this mean we shouldn't feel pressured to eat nutritiously when we're pregnant? Or to quit smoking? The truth is, if more women felt pressured to breastfeed, babies would benefit."
 — A breastfeeding mom from Oswego, New York

These are just two of the countless letters Babytalk has received over the years in response to virtually anything we print on the subjects of breastfeeding or formula-feeding. We couldn't help but wonder: Do all new mothers feel critical of women who feed their children differently, or do we only hear from a vocal few? To find out, we launched a national survey that garnered more than 36,000 responses, some of which met our expectations, butmost of which decidedly did not. Here are the eye-opening findings from Babytalk's 2001 Breast vs. Bottle Survey.

1. Breastfeeding moms think formula-feeding moms are shortchanging their kids…

Our breastfeeding respondents came down pretty hard on moms who formula-feed. On the surface, they say they support women who decide to formula-feed  — that these women "made the choice that best suits them" (75%). But almost three-quarters of them turn around and say that formula-feeders are outright "depriving their children of good health."

"There is ignorance on the part of women who formula-feed," says Marcelle Kinney of Valkaria, Florida. "If you know the benefits, how could you not breastfeed?" Two-thirds of our breastfeeding respondents told us they felt "sorry for the children" of formula-feeders. And more than four in ten believe that formula-feeders "couldn't be bothered to learn how" to breastfeed. "With all that we know about the benefits of breastfeeding," writes Scarlett Martin of Nashville, Tennessee, "I do not understand why so few women are willing to try and why even fewer are willing to try hard enough." A full third tell us that formula-feeders are "selfish and lazy," and one in five say that formula-feeders are "a little nuts"! "We need more breastfeeding information and less formula garbage," writes Willmar, Minnesota, mom Jackie Sawicki. "Breast is best! Formula is never, never best for a baby!"

2. …yet formula-feeders don't feel criticized by breastfeeders.

This was the first surprise the survey had in store for us. Breastfeeders openly admit that they judge formula-feeders, but apparently the criticism just doesn't register. Less than 20 percent of the formula-feeders felt that breastfeeders were "self-righteous." And more importantly, the vast majority of them (63%) say they've never been criticized for their feeding choice by a breastfeeder! Of the small group of formula-feeders who say they have been criticized, about half felt "angry" (56%) or "frustrated" (54%)  — but the other half said they just "didn't care" (51%), that the criticism rolled right off of them! "Abreastfeeding friend at my high school reunion just wouldn't let up on me," says White Plains, New York, mom Lizanne O'Toole, who formula-feeds her daughter. "But I never felt bad about it."

3. Formula-feeders say they are supportive of breastfeeding women…

The formula-feeders' live-and-let-live, carefree attitude also prevails when it comes to their support of women who breastfeed: An overwhelming majority (92%) say that breastfeeders "made the choice that best suits them." "I believe women who breastfeed are doing the very best they believe they can for their children," writes formula-feeding mom Heather Topcik of Beaufort, South Carolina. Did breastfeeding moms give up too much of their time for their children, we asked? No, said 92 percent of the formula-feeding moms. Were breastfeeding moms less busy than they were themselves? No again, said two-thirds of the formula-feeders. In fact, a third went so far as to say that breastfeeders were "admirable" and that they were "a littlejealous" of them.

4. …but breastfeeders say that formula-feeding moms criticize them all the time!

Here's where things get really interesting: An astonishing 83 percent of breastfeeders say they have been criticized by a formula-feeder! How to explain this huge disconnect? Was one of the groups lying? When we dove into the long, passionate letters sent by many of our respondents, the picture immediately became clear.

The criticism, the breastfeeders told us, is often so subtle that the formula-feeders don't even realize they are doing it. It's the look a woman may shoot a friend who prepares to nurse at playgroup or in the park  — a look that instantly conveys disapproval and embarrassment. It's the tone of voice a mom may use when her friend is still breastfeeding after 12 months, or six, or even three. "You're still doing that?" a Mount Kisco, New York, mom says she heard from people close to her  — the "that"telegraphing not just surprise, but "more than a tinge of distaste." Sadly, breastfeeders say they experience these kinds of looks and remarks all the time.

But the trouble is, it's not just formula-feeding moms who are judging breastfeeding moms. In fact, breastfeeders feel criticism from just about every corner of society. We at Babytalk thought that because the American Academy of Pediatrics recommends a full year of breastfeeding  — and even formula advertisements say "breast is best"  — there was a wide net of support for breastfeeding women in America. But nothing could be further from the truth. Here are the alarming facts reported by our breastfeeding respondents:

* Close family members  — including husbands  — often actively discourage breastfeeding. "My family was not supportive of breastfeeding," says Springfield, Ohio, mom Julie Nourse. "I was constantly asked when I was going to quit." Some breastfeeders heard criticism from those they turned to for advice: "My husband's aunt told me that you only nursed your baby if you couldn't afford formula," says Danyell Rager of Gambier, Ohio. And still others heard it from the spouse they counted on to support them no matter what. "My husband would probably have preferred that I formula-feed our children," writes Sherry Kennedy of Vandenberg Village, California. "Most women probably give in to their husband's wishes; I did not." Husbands, the women tell us, disapprove of breastfeeding for two reasons: They fear that it will mean a change in their sexual relationship with their wife, and they fear being left out of the mother-baby dyad that forms with exclusive breastfeeding.

* Many think breastfeeding is gross. "I know people who think breastfeeding is disgusting," writes Lackawaxen, Pennsylvania, mom Deborah Seid. Cincinnati mom Jill Eysoldt remembers a friend looking at her "like I was some pre-civilized cave woman. She said breastfeeding was so gross, and she couldn't believe people did that." (Again "that"  — as if people can't even bring themselves to say the word "breastfeed"!)

* Public breastfeeding is still not accepted. "Even though it is the most natural thing, it's socially unacceptable to nurse a baby or toddler in public," writes breastfeeding mom Rita Ester of Baton Rouge, Louisiana. Breastfeeders tell us they've had people stare at them and give them dirty looks when they nurse in public, forcing them to cover themselves and their baby with blankets or coats or turn their back to those around them  — even when they were with friends. But perhaps the saddest and most telling story is the one we heard from a New Jersey reader who, after nursing her baby in a restaurant, was approached by another female patron. "I wouldn't change my baby's diaper in public," sniffed the other woman, "so why would you do that?" Yes, "that"again  — in this context, telling us that some people think of breast milk as being akin to bodily waste.

* Working moms who breastfeed get little support from their employers. "When it came to accommodating my desire to pump at the office, my company installed a plug in the handicapped bathroom for me," writes Jennifer Tickell of Houston, Texas. "My desire to continue breastfeeding was strong enough for me to ignore that I had to walk to the bathroom through a room full of men with my Medela case in hand." We also heard from moms who've been reduced to pumping in taxis on the way to business meetings and women who pump in the car on the way to work, trying to focus on the road while hoping their fellow commuters won't notice. "I told a friend how busy I was traveling for work and trying to manage breastfeeding and pumping," says a breastfeeding mom in New York City, "and she responded with 'You are crazy. Why don't you just stop that nonsense already?' Some friend, huh?" And Kay LaRosa of Springfield, Illinois, says, "I've heard of people who had to pump in the janitor's closet at their office  — and had the janitor walk in!"

* Americans are extremely intolerant of long-term breastfeeding. Despite studies that have shown long-term breastfeeding to be beneficial to both mother and child, it's too often looked at as aberrant behavior. "After a couple of months, it's time to wean," states formula-feeding mom Christina Rohrer of East Petersburg, Pennsylvania. Marcelle Kinney says that people are "shocked" that she's still breastfeeding her 17-month-old. As Jill Eysoldt, who breastfed her child for 18 months, says, long-term breastfeeding moms are almost seen as perverts. "Someone once said to me that breastfeeding after a year is more for the mom's enjoyment than for the child's benefit," she says.

* Even some health-care providers aren't encouraging breastfeeders to persevere. Though we believe that most doctors support breastfeeding, some, we learned, clearly do not. One mom told us of an emergency room physician treating her for a urinary tract infection who got angry when he had to find an antibiotic that was compatible with breastfeeding. "My son was only seven months old, and this doctor wanted to know why I hadn't weaned him yet," she writes.

What's going on here is patently clear. Support for breastfeeding exists in an ivory tower, and it is years, perhaps even decades, away from reaching the grass roots. Breastfeeding women feel they are in a distinct, downtrodden minority  — and they are right. According to the 1999 Mothers Survey conducted by formula manufacturer Ross Products Division, Abbot Laboratories, only 30 percent of women are still breastfeeding by the time their baby is 6 months old. Because breastfeeding is not the norm, and has not been for many years, deep veins of prejudice and disapproval surround it.

5. This lack of support for breastfeeders is often why moms choose to formula-feed…

"Breastfeeding isn't right for me," said 87 percent of the formula-feeders. Why? The number one reason: "inconvenience" (65%). These moms had to go back to work, where breastfeeding was difficult if not impossible. "We own a business and I don't know when I would have had time [to breastfeed]," says Lenox, Iowa, mom Courtney Brown, who, like many women, realized she wouldn't be in a breastfeeding-friendly environment once her baby was born. "I did not breastfeed my first child because people were not supportive and I had to go back to work after eight weeks," says Karly McCutchan of Dumas, Texas. Most women receive a maternity leave of only six to eight weeks, barely enough time to learn how to breastfeed and become comfortable with it.

Another big reason breastfeeding isn't right for many women: modesty. "I did not feel comfortable breastfeeding," says Christina Rohrer. "It was a modesty issue for me." Writes Heather Topcik: "The prospect of breastfeeding made me nervous and uncomfortable. I knew right away that I did not want to do it."

6. …and most of the formula-feeders are perfectly happy with their decision.

A full three-quarters of these moms say that formula is "just as good as breast milk." "I was formula-fed, and my husband was formula-fed, and we turned out fine," says Anne Scholl of Richmond Hill, New York. These moms also tell us that formula-feeding has many benefits of its own. Ninety-four percent are glad that their spouse can share feeding responsibilities, 62 percent are happy they can get some sleep at night, and 49 percent feel like they "finally have their body back."

Formula-feeding moms aren't ignorant; they know breast milk is best. "My husband is a doctor and I was a health major in college, so I know all the good things about breastfeeding," says O'Toole. "But I simply had no desire to do it." Forty percent of the women do worry about the health benefits their babies may be missing out on, but as a group, the formula-feeders are largely content. They know that the quality of today's formula is excellent, and they are joined in their decision by the majority of moms in America. They don't need to confront disapproving husbands or overcome their own feelings of modesty. They don't need to barnstorm social barriers every day, as their breastfeeding sisters do. We at Babytalk thought we would see a good deal of conflict and guilt among women who formula-feed, but the data simply didn't support that expectation.

It takes great courage and commitment to persevere with breastfeeding. It may also take a level of support unavailable to most American women. In what was virtually the only demographic difference between the groups of women we polled, the breastfeeders' household income was significantly higher than the formula-feeders' ($54,800 as compared to $46,700; see sidebar at left). This indicates that the breastfeeders may more often have the luxury of staying home with their children, or that their jobs are more professional and thus more conducive to pumping (just think of the difference between an office with a door andthe janitor's closet). With such low support for breastfeeding at home, at work, and out in the world, formula-feeders cannot be blamed for making the perfectly reasonable choice they do.

"Breastfeeding is still taboo," writes one breastfeeder. "Women are made to feel ashamed of their bodies and breasts." We as a nation must overcome the puerile notion that a woman's breast is more of a sexual object than a lifegiving force. And we must support every woman's prerogative to make the feeding choice  — breast, bottle, or both  — that is right for her and herbaby.

How about both?

"Breastfeeding or formula-feeding  — it is not always an absolute choice," writes Friendsville, Tennessee, mom Karen Anderson. She is among a growing group of moms who "do the combo"  — feeding their baby both breast milk and formula during the first 6 months of life. Seven out of ten combo moms say they do it because they "wanted to formula-feed and give their baby the health benefits of breast milk." In fact, 74 percent of them say they "have the best of both worlds." "My son went back and forth from breast to bottle beautifully from day one," writes Allison Lansdowne of Gainesville, Florida. "It was so convenient."

But a large group of combo moms were eager to let us know that formula supplementation wasn't their original plan. A full 50 percent say they are "disappointed that they couldn't breastfeed exclusively," with two out of five admitting that they wanted to breastfeed their baby from the start but were faced with complications that made exclusive nursing close to impossible. Sixty-one percent of combo moms say they admire women who breastfeed exclusively and are even a little jealous. "I got very depressed, to think that I couldn't give my child the health benefits that breast milk has," writes Lima, Ohio, mom Amie Green, who had to stop trying to breastfeed exclusively when she was diagnosed with an insufficient milk supply (a condition that affects about five percent of women). "It is embarrassing to admit that I can't do something that is supposed to be a naturalthing for a woman to do."

Most of these moms (70%) say they have not been criticized for their feeding choice by a fellow mom. But the ones who have been are more upset than any other group of moms. Unlike the full-time formula-feeders, who "didn't care" when someone gave them a hard time, the combo moms were angered (74%), frustrated (72%), and hurt (63%) by their critics. "I did exactly what I thought was best for my baby," writes Melissa Peterson of Fountain Valley, California. "However, I found myself explaining why I was formula-feeding, as if I needed to explain that I was not a bad mom and that we had tried breastfeeding."

The good news is that the vast majority of combo moms arethrilled with the way their feeding method has worked out.Eighty-nine percent are glad they could give their baby thehealth benefits of breast milk, 83 percent are happy their spouse could share feedings, and 73 percent are glad they have some control over their life. "The stress and pressure of pumping milk so I could go to work was off," says East Windsor, New Jersey, mom Patricia De Cristofaro. "My husband and I could leave the baby with our parents and actually have some 'he and she' time. It's been great!"