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In places where clean water access is a problem, it is well-established that feeding an infant with human milk rather than formula-feeding saves lives. In Switzerland, clean water access is not a problem. And yet, the creed of «Breast is Best» holds strong. Online parenting forums, midwives, and even infant formula websites and product labels emphasize and reemphasize the message that exclusive breastfeeding¹ at the beginning of a child’s life provides the best form of nutrition – a «healthy start to life,» as per the slogan of a widely-distributed booklet issued by Breastfeeding Promotion Switzerland. There is something distinctively moralizing about the «Breast is Best» message: It implies that a parent who feeds their young baby formula is not giving them a «healthy start to life.»

It’s important to point out that the modern «Breast is Best» movement arose as a deliberate corrective to unethical infant formula marketing practices. The World Health Organization’s «International Code of Marketing of Breast-milk Substitutes» was adopted by the World Health Assembly in 1981. This code is the reason why you don’t see advertisements for infant formula in trams or on television. It’s why, if you go to the products page of infant formula websites, there’s a pop-up window with a notice that the World Health Organization recommends exclusive breastfeeding.

But there are some who have asked whether the ubiquitous message of «Breast is Best» goes too far. It may contribute to guilt on the part of those who cannot or do not wish to breastfeed – or chestfeed, as it’s often called in the trans community. Worse, it may push new parents to carry on with breast/chestfeeding in the face of obstacles, sometimes with a negative impact on one’s postpartum mental and physical well-being.

Why human milk feeding is not a moral requirement

Such worries are at the heart of recent work by Fiona Woollar, a UK philosopher who conducts research on pregnancy and birth (see website). Her argument goes something like this. When our moral duties are «defeasible,» we are answerable for our conduct to others. It is not necessarily wrong to not act on a defeasible duty – thus the language of «defeasibility» – but if you don’t, you have to have good reasons, and you may be called upon by others to say what these reasons are. As Woollard argues, feeding babies with human milk is often treated as a defeasible duty. After giving birth, one hears the message time and again that breastfeeding is the right thing to do. It is easy to feel compelled to explain oneself if one ends up feeding their child with formula.

After giving birth, one hears the message time and again that breastfeeding is the right thing to do. It is easy to feel compelled to explain oneself if one ends up feeding their child with formula.

According to Woollard, however, feeding one’s child human milk isn’t a defeasible duty, and shouldn’t be treated by society as such. There are moral reasons to breast/chestfeed due to the health benefits for the child, but it isn’t the case that defeasible duties arise in every situation where there is a moral reason to do something. She uses the analogy of running a race to raise money for charity. There are moral reasons for doing this, but someone who doesn’t participate isn’t required to offer a justification to others. Running for charity and human milk feeding are morally elective – or supererogatory, i.e., «beyond the call of duty» in the language of moral philosophy – morally good, but also morally optional. 

Rethinking human milk feeding

Alas, the health benefits of a human milk diet are often overstated by breastfeeding advocacy organizations. In countries with safe drinking water and high-quality formula options, the only well-established health benefits for babies fed with human milk are modest and short-term.² Myriad myths circulate about long-term health benefits of a human milk diet in infancy, such as a reduced risk of obesity or higher IQ scores. But most studies finding that human milk feeding produces life-long health benefits for children suffer from selection bias – parents who are affluent and healthier are less likely to use formula. Since correlation is not causation, such research is hardly conclusive. As for the non-health-related benefits, many breastfeeding advocates talk about the distinctive powerful and intimate bond between mother and child that results. This, quite frankly, carries a suggestion insulting to those of us who use formula—that our bond with our child is deficient.³ 

Most studies finding that human milk feeding produces life-long health benefits for children suffer from selection bias.

Feeding one’s child with formula has benefits that often go undiscussed, as my husband and I would discover soon after our baby was born.⁴ Formula-fed babies drink larger amounts of milk and thus need to drink less often. Fewer night feedings translated into more sleep for my husband and me. We heard many stories from friends of nights filled with cycles of short interlude of sleep – feeding session – repeat, repeat, repeat, and feeling like zombies all day long. This wasn’t our experience. Also, by using formula, my husband and I found it easy to share feeding-related tasks equally. Pumping makes it possible to split up feeding sessions, and I don’t want to suggest that couples that feed their baby human milk are less successful at equal parenting than formula-feeders. But when only one person is producing milk, the logistics of equal parenting are more challenging, especially when a baby is young. Arguably, a child benefits from having less exhausted parents who are having an easier experience sharing childcare tasks.⁵

From this perspective, Woollard’s argument can mislead one into thinking that breast/chestfeeding is somehow unique as a parental decision in that there are moral reasons, but not a moral requirement to do it. However, there are all sorts of benefits one could potentially provide as a parent that generate moral reasons. There are moral reasons to put a child in daycare since it is beneficial for a child’s social development and communication skills. There are moral reasons to keep a child at home since spending all day in a daycare group with other children can be long and tiring for a child. If the short-term health benefits for a child give rise to a moral reason to breast/chestfeed, a child also benefits from the above-described aspects of formula-feeding. Thus, there are also moral reasons not to breast/chestfeed.

Demoralizing breastfeeding as the «right» thing to do

In light of all this, the moralized picture of feeding a child human milk can be questioned. Woollard’s labeling it a beneficial practice that is morally good though not morally required, while not going into moral reasons in favor of formula-feeding, reinforces the operative societal assumption that breastfeeding is nevertheless better and the «right» thing to do. For individuals who do not wish to breast/chestfeed, or who cannot due to health problems, this moralized picture can be difficult to contend with. Given rates of the «baby blues» and postpartum depression, this is no small matter. Moreover, there may be many families out there for whom bottle-feeding would be the right decision, but who have an exaggerated impression of how beneficial human milk is, and who are not fully informed about the benefits of formula.

In contrast to a vision of a world where those who formula-feed do not feel compelled to explain themselves, I’d like to see breastfeeding advocacy completely drop its moralizing language. In a country like Switzerland, breast/chestfeeding, formula-feeding, and «combination» feeding should all be presented as good options with their own pros and cons; no single option should be considered the default.⁶ New parents should not only be given brochures on how to breastfeed, but also brochures with information about formula and combination feeding and explanations about how to properly sterilize and make a bottle. Awareness campaigns aimed at destigmatizing human milk feeding in public are quite obviously important, as is advocacy work aimed at making it easier for parents back at work to regularly pump milk. Breast/chestfeeding can be difficult, and those who wish to do it should be supported, so it’s a good thing that basic health insurance in Switzerland pays for consulting sessions with lactation specialists. But campaigns and advocacy work geared at a lopsided promotion of human milk’s benefits should be scrutinized. It seems far from justified that public funds are used for moralizing «Breast is Best» campaigns in countries with clean and safe drinking water.