A Natural Family Online Special Report:
The deadly influence of formula in America
By Dr. Linda Folden Palmer
Editor’s Note: This groundbreaking analysis from noted author, health educator and advocate Dr. Linda Folden Palmer is the first time a health expert has published an examination of the available scientific research comparing the death rates of formula-fed and breastfed babies. While the results hold no surprises for breastfeeding educators and advocates, the study may prove to be a rude awakening for the millions of Americans who have bought into the myth that infant formula is a perfectly safe breast milk substitute.
Read the follow-up article on optimizing the health of formula-fed babies at http://www.naturalfamilyonline.com/go/index.php/226/optimize-health-formula-fed-baby/
Infant formula was designed to be a medical nutritional tool for babies who are unable to breastfeed. Formula does not fully meet the nutritional and immunity needs of infants, leaving their immune systems flailing. An infant’s immune system has three aspects: her own immature, developing immune system; the small component of immunities that passes through the placenta during natural childbirth (and to a lesser degree with premature births and cesarean sections); and the most valuable, living portion that is passed on through mother’s milk on an ongoing basis. Remove any of these components and you take away a vital support structure.
This brings us face to face with the safety and effectiveness of infant formula as a breast milk substitute. Is formula actually as safe as we have been led to believe? In fact, the answer is a resounding “no.” In fact, the use of infant formula doubles the risk of infant death for American babies.
While the dangers of formula feeding aren’t something you’re likely to hear in your doctor’s office, the conclusions can be derived through an examination of the available scientific research on infant mortality in the United States and across the world. There are studies showing artificial feeding’s impact on overall infant death rates in both developing and undeveloped countries. While studies offering comparative death rates are not available for industrialized regions, there are numerous studies providing comparative occurrence rates for many illnesses and disorders in the United States and other industrialized nations. Many more reports are available extolling superior survival rates and decreased illness rates among breastfed infants, but only those with solid numbers are useful here. We can assemble the statistics from these studies to build a firm picture of the ratio of infant deaths for U.S. formula-fed babies against those who are breastfed.
The relative risks of formula
It is clear that feeding infants artificial formula instead of breastfeeding increases their relative risk of death. A number of studies point to this fact. Table 1 shows figures from two studies measuring infant mortality risks during certain age ranges. A risk number of 3 in the chart represents three times the risk of infant death for infants who are artificially fed.
While the numbers in the charts reflect any amount of breastfeeding during the study period (and not necessarily exclusive breastfeeding), nearly all studies mention that during the first six months, exclusive breastfeeding produces much higher survival rates than partial breastfeeding. No studies refute this assertion. Figures for each age range listed here do not include children who died prior to reaching that age group. Figures reflect infants who received no breast milk or had weaned prior to reaching the reported age group versus those who received any breastfeeding through that age.
Table 1 clearly demonstrates that the disadvantages of formula are most devastating in the earliest months. Significant disadvantages for formula continue throughout the year-long study period.
Suggested Relative Risks for Infant Deaths
No Breastfeeding or Any Breastfeeding Ending Before Designated Age Ranges vs. Breastfeeding Through Designated Age Ranges1,2
| Country | Author | 0 to 2 Months | 3 to 5 Months | 6 to 11 Months | ||
| Mexico | Palloni | 13 | 6 | 3 | ||
| Brazil, Pakistan and Philippines (pooled) | World Health Organization | 0 to 2 Months | 2-3 Months | 4-5 Months | 6-8 Months | 9-11 Months |
| 6 | 4 | 2.5 | 2 | 1.5 | ||
A relative risk of 13 here means that a child who was not breastfed through the time period has thirteen times the risk of dying during his first year as a child who had received any breast milk through that period.
The studies cited in the next table compare no breastfeeding with 12 months of breastfeeding, each deriving a relative risk of death over the full first year.
Suggested Relative Risks for Infant Deaths
No Breastfeeding vs. Any Breastfeeding for 12 Months3-7
| Country | Author | Current Infant Mortality Rate (IMR) | IMR During Period Study was Performed | Relative Risk To Formula-Fed Infants |
| United States | 7 | Number we wish to find | ||
| Malaysia | Habicht | 19 | 30 | > 2 * |
| Mexico (from Table 1) | Palloni | 24 | 38 | 10 * |
Philippines | Guilkey | 28 | 31 | > 5.5 |
| China | Tu | 27 | 36 | > 3.0 |
| Peru | Palloni | 38 | 100 | 2.5 |
| Brazil, Pakistan, and Philippines, pooled (from Table 1) | WHO | 48 average | 4.5 * | |
| India | Srivastava | 61 | 106 | > 1.5 |
Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.
A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying as an infant who is partially or completely breastfed.
* These values are calculated from numbers provided in the studies, with averages weighted by percentages of total deaths occurring in each age range. More than two-thirds of deaths occur during the first month.
While the United States has a current infant mortality rate of 6.75 per thousand, many countries have rates approaching 100, with 16 of 225 reporting nations suffering well over 100 infant deaths for every 1,000 children born.8 The nations in the above table with lower infant mortality rates can thus be seen as somewhat comparable to the U.S.
Factors influencing high infant death rates include malnourished mothers, high numbers of births per mother with short spacing between births, poor weaning foods, the early use of cow’s milk, inadequate medical attention and supplies, poor sanitation leading to high infection rates and a rapid spread of infectious disease, and limited education about methods of limiting infection and the spread of disease.
Why do U.S. babies die?
Below are the percentages and total numbers of U.S. infants who die from various leading causes, according to the 1999 National Vital Statistics Reports.9,10
| Total U.S. births in 1999: | 4,000,000 |
| Total U.S. infant deaths in 1999: | 28,000 |
| 20% | Congenital abnormalities (birth defects) | 5,500 |
| 16% | Low birth weight and premature birth | 4,500 |
| 10% | Sudden Infant Death Syndrome (SIDS) | 2,700 |
| 8.5% | Complications during pregnancy and birth | 2,400 |
| 6% | Respiratory distress: lung collapse, influenza, pneumonia | 1,750 |
| 3% | Accidents (unintentional injuries) | 850 |
| 2.5% | Bacterial sepsis (infections) | 700 |
| 2.4% | Circulatory system diseases | 650 |
| 1.4% | Necrotizing enterocolitis | 400 |
| 1% | Intestinal inflammations (diarrhea) | 300 |
| 0.3% | Meningitis | 100 |
| 0.3% | Cancer | 100 |
Numbers account for 70% of total infant deaths
So how does formula play into these deaths? Let’s look at some of the common causes of infant death and see what current research has to say on the involvement of infant formula.
Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) accounts for a full 10% of U.S. infant deaths. Several studies performed in the United States and other industrialized nations reveal increased risks of SIDS among babies who receive formula instead of breast milk. In the table below, the 2002 Scandinavian study takes into account variables thought to have affected the 2000 U.S. study, finding even stronger risks associated with formula.
The most recent U.S. study (2003) takes advantage of the lessons from these earlier studies to raise confidence in its final results. Its finding of five times the risk of infant death from SIDS for formula-fed infants seems to be the most powerful statistic yet.
Studies Demonstrating Relative Risks of Infant Death from SIDS
Formula-Fed vs. Breastfed11-17
| Country | Author | Year of study publication | Relative risk for SIDS, formula-fed infants |
| United States | Hauck | 2003 | 5 |
| Scandinavia | Alm | 2002 | 1.6 to 5.1 |
| United States | McVea | 2000 | 2 |
| Germany | Schellscheidt | 1997 | 7.7 |
| England | Gilbert | 1995 | 3.1 |
| United States | Klonoff-Cohen | 1995 | 2.7 |
| New Zealand | Ford | 1993 | 2 |
A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying from SIDS as an infant who is breastfed.
Heart, Circulatory and Respiratory Failure
Premature infants and those with circulatory abnormalities often display one or more warning signs of potential death, including inadequate oxygenation of the blood, apnea (episodes where breathing stops) and high blood pressure. Studies illustrate the dangers of formula for these infants. One study observed better body temperature and superior oxygenation in pre-term infants receiving breast milk. Formula-fed infants demonstrated many episodes of inadequate oxygenation and some apnea, both of which were not seen among the breastfed infants. A Scottish study found significantly better blood pressure among naturally fed infants.
Three U.S. studies are available examining feeding methods for infants with early circulatory problems. One study reported that more than half of infants with congenital heart disease lost oxygenation during bottle feedings, while none did so while breastfeeding. Another study also dealing with heart disease found infants’ growth to be significantly inferior and their hospitalizations to be longer when they were fed formula. A third study of very low birth-weight infants found twice as many episodes of inadequate oxygenation among formula-fed infants as in those who received breast milk.
Heart and Circulatory Disease in Formula-Fed vs. Breastfed18-22
| Country | Author | Year | Findings for formula-fed infants |
| Scotland | Wilson | 1998 | Higher blood pressure |
| Taiwan | Chen | 2000 | Apnea and many episodes of oxygen desaturation (none among breastfed infants) Inferior body temperature regulation |
| USA | Bier | 1993 | Double the episodes of oxygen desaturation |
| USA | Combs | 1993 | Less growth; longer hospital stays |
| USA | Marino | 1995 | Oxygen desaturation during more than half of bottle feedings (none during breastfeeding) |
Necrotizing Enterocolitis
Necrotizing enterocolitis is a severe intestinal inflammatory disorder that affects around 4% of low birth-weight babies and 1% of full-term infants. About one-third of low birth-weight infants and 20% of full-term infants who contract this disorder die. While necrotizing enterocolitis is reported to be responsible for 1.4% of infant deaths, many more unconfirmed cases are likely to be responsible for some portion of infant deaths reported as caused by prematurity.
In the United Kingdom, it was discovered that confirmed cases of necrotizing enterocolitis occurred in three times as many infants who received no breast milk as in those who received both breast milk and formula. For infants who exclusively received breast milk, necrotizing enterocolitis occurred six to 10 times less often than among wholly formula-fed infants.
Necrotizing Enterocolitis23
| Country | Author | Year | Relative risk of necrotizing enterocolitis, formula-fed infants |
| United Kingdom | Lucas | 1990 | 6-10 times more often |
Diarrhea
A World Health Organization (WHO) study revealed a risk of diarrhea for formula-fed babies in developing nations averaging more than six times that of breastfed babies. A summary article for industrialized nations demonstrated an average of triple the risk of diarrhea for formula-fed babies. The risk in China and Israel is reported as slightly less than triple (2.8); in Scotland, the risk is five-fold; and a doubled risk is measured in Canada.
While one study noted nearly twice the risk of developing diarrhea for artificially fed infants in Brazil, other studies have demonstrated that the risk of actually dying from diarrhea was an astounding 14 to 15 times greater. The latter studies demonstrated not only that the artificially fed infants suffer higher rates of illness, but also that the severity and duration of their illnesses are even greater when they do occur and result in proportionately more deaths. This same assertion is demonstrated in a study from India, where formula-fed infants suffer six times the death rate, once diarrhea occurs, as breastfed infants with diarrhea.
Four separate studies in the United States all deduce a doubled risk of diarrhea for formula-fed babies. The U.S. studies also reiterate the well-established factor of greater severity and extent of illness once diarrhea does occur among formula-fed babies. Death rates for formula-fed U.S. infants who get diarrhea may be three times higher or more than their breastfed contemporaries.
The table below collates the reported risks of diarrhea for formula-fed infants from many studies.
Diarrhea Risks for Formula-Fed vs. Breastfed24-40
| Country | Author | Year | Relative risk of diarrheal illness (or death), formula-fed infants |
| Israel | Palti | 1984 | 2.7 (during the first 5 months) |
| Brazil | Victora | 1989 | 14 times the death rate |
| Scotland | Howie | 1990 | 5 (compared with infants with 3 months of breastfeeding) |
| India | Sachdev | 1991 | 6 times the death rate with diarrhea during the first 6 months |
| Canada | Beaudry | 1995 | 1.9 |
| Philippines | Yoon | 1996 | 9 times the death rate |
| Mexico | Lopez-Alarcon | 1997 | 4 to 6.3 |
| Industrialized nations, pooled | Golding | 1997 | 3 (gastroenteritis and diarrhea) |
| China | Fu | 2000 | 2.8 (during the first 4 months) |
6 developing nations | WHO | 2000 | 6 (during the first 6 months) |
| Italy | Gianino | 2002 | 3 (rotavirus, including increased severity) |
| Brazil | Escuder | 2003 | 15 times the death rate (during the first 6 months) 2.2 times the death rate (from 4 to 11 months) |
| Brazil | Vieira | 2003 | 1.8 |
| USA | Dewey | 1995 | 2 |
| USA | Scariati | 1997 | 1.8 |
| USA | Wright | 1998 | 2 |
| USA | Raisler | 1999 | 2 (during the first 6 months) |
Respiratory Illnesses
Numerous studies document higher numbers of respiratory infections among formula-fed infants than among those who are breastfed. It is clear that respiratory infections are at least triple in the United States for formula-fed infants. The death rate is likely to be even higher, since some of these studies note that both the severity and extent of respiratory illnesses are considerably higher once they occur.
Respiratory Illness Risks for Formula-Fed vs. Breastfed41-50
| Country | Author | Year | Relative risk of respiratory illness (or death), formula-fed infants |
| Israel | Palti | 1984 | 3.7 (during the first 5 months) |
| Brazil | Victora | 1987 | 3.6 times death |
| Italy | Pisacane | 1994 | 4.5 |
| Mexico | Lopez | 1997 | 2 to 8.5 (during the first 4 months) 1.5 to 3 times as many days for each occurrence |
| Scotland | Wilson | 1998 | 1.9 (during the first 4 months) |
| Brazil | Cesar | 1999 | 17 times hospitalization for pneumonia |
| USA | Wright | 1998 | 2 (bronchitis) 4 (pneumonia) |
| USA | Levine | 1999 | 3.7 (pneumococcal disease, 2 to 11 months) |
| USA | Blaymore- Bier | 2002 | 6 times as many days of upper respiratory infection (during the first month) |
| USA | Bachrach | 2003 | 3.5 (severe respiratory tract illnesses) |
Cancer
A joint study between the United States and Canada on neuroblastoma, a common childhood cancer, revealed a doubled risk for children who did not receive breast milk for more than one year. This study is consistent with several other childhood cancer studies in other nations, with results ranging from 1.45 to 4 times the risk for developing various common childhood cancers for formula-fed babies.
Childhood Cancer Risks for Formula-fed vs. Breastfed51-56
| Country | Author | Year | Findings for formula feeding and cancer risks |
| China | Shu | 1995 | 1.5 (leukemia and lymphoma) |
| UAE | Bener | 2001 | 2.8 (leukemia and lymphomas for no or less than 6 months breastfed versus longer breastfeeding) |
| France | Perrillat | 2002 | 2 (leukemia for breastfeeding over 6 months) |
| U.S. & Canada | Daniels | 2002 | 2 (neuroblastoma) |
Low Birth-Weight and Pre-term Birth
Representing 16% of U.S. infant mortality totals, premature birth and low birth-weight are the second leading diagnoses on death certificates of U.S. infants. While prematurity may lay the foundation for difficulties in tiny infants, the factors that actually take their lives include infection, respiratory distress, unconfirmed necrotizing enterocolitis, circulatory deficiency and diarrhea. These diagnoses are often detectable only with a biopsy, so the listed cause in these cases is often simply prematurity. One study that performed autopsies on a group of extremely low birth-weight infants who had not survived found that infection was the actual primary cause of death for half of the infants. Prematurity was the cause of death predominantly for infants who weighed less than one pound.
Preemies in India who received only preemie formula were found to develop more than twice as many infections as those who received some human milk. Another Indian study on high-risk newborns found that those receiving human milk plus formula suffered twice the infection rate of those receiving only pasteurized human milk and triple the rate of those receiving only raw human milk. A Columbian study found a nearly doubled death rate for low birth-weight infants who were partially or completely formula fed. And a Malaysian study found a huge difference in total infant survival among extremely low birth-weight babies who received expressed breast milk as opposed to those who did not.
A U.S. study performed at George Washington University Hospital found 2.5 times the number of infections among formula-fed infants in the intensive care unit than among those receiving human milk. Another study at Georgetown University Medical Center also found more than double the number of infections in very low birth-weight infants not receiving human milk. A San Diego study found twice as many infections in pre-term, formula-fed infants compared with infants who received human milk.
As shown in many other studies, the extent and severity of infection among pre-term and low birth-weight infants are generally greater in formula-fed infants as well. One study gives a solid example for preemies, finding respiratory infections among U.S. formula-fed preemies to run six times as many days as those in their breastfed counterparts.
Pre-term Infant Illness and Death Rates57-64
Country | Author | Year | Relative risk for illness or death, formula-fed pre-term and low birth-weight infants |
| India | Narayanan | 1980 | 2.25 times the infections for no breast milk as opposed to some |
| India | Narayanan | 1984 | 2 times the infections for formula plus pasteurized breast milk as pasteurized breast milk alone3 times the infections as raw breast milk alone |
| Malaysia | Boo | 2000 | Many times the death rate for no breast milk |
| Columbia | Charpak | 2001 | 2 times the death rate for any amount of formula as for exclusive breastfeeding |
| USA | el-Mohandes | 1997 | 2.5 times the infections |
| USA | Hylander | 1998 | 2 times the infections |
| USA | Schanler | 2001 | 2 times the infections |
| USA | Blaymore-Bier | 2002 | 6 times the duration of upper respiratory infections |
Exclusive feeding of raw breast milk is not always an option for premature infants, although it is common in some hospitals with excellent support. Sometimes, less-effective pasteurized breast milk is used and often fortifiers are added. Several studies show decreased survival for infants fed milk with added fortifiers as opposed to those fed unfortified milk,65-68 but the picture is complex and the choices of fortifiers vary greatly.
And finally, it is worth noting that the eye damage that can occur in very low birth-weight infants, retinopathy of prematurity, occurs only half as often in infants who receive some breast milk.69 Even a disorder as apparently unrelated to feeding methods as inguinal hernia has been discovered to occur twice as often in artificially fed infants and even more frequently when compared with infants who are exclusively breastfed.70
Congenital Abnormalities
Twenty percent of U.S. infant deaths are attributed to birth defects. The most common potentially lethal birth defects include heart disorders, various chromosomal or genetic defects and underdeveloped lungs. In terms of infant formula’s impact, we have the least amount of statistical information in this category. However, many factors suggest that formula-fed infants with congenital abnormalities have smaller chances of survival than their breastfed counterparts.
While death certificates often list the initial abnormality as the cause of death, infection is actually the final factor in many of these deaths. We have already seen how drastically infection rates and deaths are reduced by breastfeeding. It is clear that the youngest and weakest infants are the ones who are most strongly endangered by infant formula’s inadequacies.
Studies suggest that formula-fed infants suffer inferior blood oxygenation and higher blood pressure as well as more episodes of apnea (cessation of breathing for a short time) than their breastfed counterparts. While no studies compare the actual survival of such infants in the United States, it is obvious that some proportion of babies with congenital heart abnormalities is being seriously disadvantaged by formula feedings. Artificially fed infants with heart defects requiring surgery are less likely to live until their surgery and less likely to recover from surgery’s challenges.
A wide variety of common birth defects has been shown to have better survival rates among breastfed infants, although the actual figures are not available. Most birth defects have not been specifically studied in this regard. The background information, nonetheless, is striking.
For example, infants born with phenylketonuria (PKU), a defect in handling a certain protein in the diet, need specialized supplementation to breast milk in order to prevent mental retardation and other difficulties. Yet a study demonstrated that infants who had been breastfed before being diagnosed with PKU fared far better than those who had been fed on formula.71 The greatest complications for infants with cystic fibrosis are lung infection, decreased oxygenation and malnutrition – all of which are recognized to be complicated by formula feeding.72 The negative impact of formula on neurological development has been demonstrated in healthy infants.73-76 One study that quantified the effect reported double the amount of neurological “non-normality” in formula-fed infants.77 It is reasonable to assume that neurological damage or problems stemming from birth disorders can be exacerbated by artificial feeding.
Clearly, feeding choice may have a significant impact on the survival of infants born with various defects, although there is not enough information available to render an actual ratio of survival.
Complications of Pregnancy and Birth
Complications of pregnancy and birth produce a wide range of injuries and problems for babies. Some certainly pose no hope of survival. Infection, insufficient neurological recovery and inadequate oxygenation lead to many infant deaths. Artificial feeding certainly has some degree of impact on mortality in these cases. Based on a lack of further detailed evidence, we will apply a very modest number to figures for increased risk of death for formula-fed infants in this category.
Accidents
It seems logical that accidents happen equally among artificially and naturally fed infants. Figures bear this out. One paper actually measured accidental injuries between breast- and formula-fed infants, finding an equal number in both.78
Examining the numbers
So now we are left to examine artificial feeding’s actual impact on all American babies. First, we note that there should be a relationship dictating that if rates for a certain disease are doubled by formula feeding, for instance, then death rates for that disease may also be somewhere in the neighborhood of doubled when compared with rates for breastfed infants. In fact, the evidence suggests that the death rates would be even higher. While formula feeding may result in twice as many episodes of a certain illness, a great number of studies demonstrate that each of these episodes are also longer and more severe. This would suggest that the rate of death among artificially fed infants from various causes would actually be higher than the rates that the various illnesses occur.
The reported percentages of U.S. infants dying from each cause include a certain number of infants who were breastfed and a portion who were formula-fed. Because formula feeding’s impact is much more or less influential in some disorders than others, we need to weigh each category accordingly. (This exercise will account for the assumption that a lower proportion of infants who died from congenital abnormalities, for instance, were formula-fed infants than the proportion who died from SIDS.) Because two-thirds of all infants die in the first month, and because exclusive breastfeeding runs about 50% during the first month, this number can be used in the calculations to help weigh the greater or lesser impact of breastfeeding for each cause.
2001 U.S. Breastfeeding Rates79,80
| Study | Hospital Initiation | 4 Months | 6 Months | 12 Months | |||
| Any BF | Exclusive | Any BF | Exclusive | Any BF | Exclusive | Any | |
| Ross/Abbott Labs | 69.5% | 46.2% | 32.5% | 17.2% | |||
| National Immunization Survey | 65.1% | 59% | 35% | 24% | 27% | 7.9% | 12.3% |
An overall risk rate of infant death for formula-fed infants has been selected conservatively based on the available information presented in this paper for each cause of death in the table below. Assuming that 50% of the total infants born were breastfed, we can calculate formula-fed and breastfed infant death rates and totals for each cause.
Because one-third of the deaths actually occurred as the percentage of infants breastfeeding was dropping to a much smaller number, the use of 50% throughout the calculations keeps the resultant finding very conservative. Although the literature reiterates time and again how the extent, severity and frequency of disease is greater in formula-fed infants, I have only taken this factor into account in an extremely conservative manner in instances where the literature provides solid numerical examples. In other instances where this aspect is not clearly demonstrated, I have not used this factor at all. Again, this effort keeps the final quotient conservative. Finally, the ratios from many studies used are for full formula feeding versus any amount of breastfeeding. Some of these ratios would be much higher if formula feeding were compared to exclusive breastfeeding. This factor again keeps our final conclusion conservative.
Here’s the math
There are 4,000,000 births annual births in the United States. Using 50% as the number of infants who have actually been breastfed, the number of infants breastfed (B) equals 2,000,000. The number of formula-fed (F) infants also equals 2,000,000.
| B = F = 2,000,000 | |
| R = Infant Mortality Rate (IMR) for each cause | |
| RB = IMR for breastfed | |
RF = IMR for formula fed | |
| Rel = Estimated Relative Risk for formula feeding versus breastfeeding, for each cause | |
| RFF + RBB = Total Number of Deaths for that cause = TND | |
| RF = Rel x RB | |
| RF x 2,000,000 + RB x 2,000,000 = TND | |
| Rel x RB x 2,000,000 + RB x 2,000,000 = TND | |
| RB = __________TND___________ | |
| Rel x 2,000,000 + 2,000,000 | |
| RB x 4,000,000 = Number Deaths if all B | |
Let’s apply this formula to congenital abnormalities. Clearly, feeding’s impact in this category could be significant, but there is not enough solid statistical evidence to say for sure. If we modestly assume a 50% higher death rate for the 50% of formula-fed infants, the number of breastfed infants who died would be 2,200. The number of formula-fed who died would be 3,300. If all of the infants had actually been breastfed, then the total number of deaths would be 4,400 -- a savings of 1,100 lives.
The relative risk for formula feeding in other categories was much more clearly defined by the studies. Conservative but appropriate rates were selected, as seen in the table below.
Calculating Formula’s Final Impact
| Cause of death | Actual U.S. infant deaths (1999) | Relative risk for formula-fed infants | Estimated IMR for breastfed babies | Deaths if all were breastfed | Deaths if all were formula-fed | Lives saved if all were breastfed |
| Congenital abnormality | 5500 | 1.5 | 1.1 | 4400 | 6600 | 1100 |
| Prematurity | 4500 | 2.5 | .643 | 2570 | 6430 | 1930 |
| SIDS | 2700 | 4 | .27 | 1080 | 4320 | 1620 |
| Complications of pregnancy & birth | 2400 | 1.25 | .533 | 2135 | 2670 | 270 |
| Respiratory distress & infections | 1750 | 4 | .175 | 700 | 2800 | 1050 |
| Accidents | 850 | 1 | .213 | 850 | 850 | 0 |
| Bacterial infection | 700 | 3 | .087 | 350 | 1050 | 350 |
| Circulatory problems | 650 | 1.5 | .13 | 520 | 780 | 130 |
| Necrotizing enterocolitis | 400 | 8 | .022 | 90 | 710 | 310 |
| Diarrhea | 300 | 2.5 | .043 | 170 | 430 | 130 |
| Meningitis | 100 | 3 | .014 | 55 | 170 | 45 |
| Cancer | 100 | 2 | .02 | 80 | 160 | 20 |
| SUBTOTALS | 19950 | 2.075 | 3.25 | 13000 | 26970 | 6955 |
| All other | 8050 | 2 | 1.6 | 6440 | 12880 | 1610 |
| TOTALS | 28000 | 2 | 4.7 | 18665 | 37335 IMR 9.4 | 9335 |
Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.
Based on the current U.S. infant death rate of 6.75 and an average breastfeeding rate of 50%, the American infant mortality rate would climb to 9.4 if all infants were formula-fed and would drop to 4.7 if all were breastfed. Twenty-two nations with high rates of breastfeeding have infant mortality rates below 5, while the U.S. ranks higher in infant death than 41 other nations.81 Clearly, lower rates for the United States are a possibility.
The ugly truth about formula
From the above statistics, we see that formula feeding costs American babies three or four additional lives per thousand. The final relative risk for formula feeding comes out to 2 – that’s double the risk of death for American infants who are fed with formula, compared with babies who are fed naturally.
A multitude of studies demonstrate that when breastfeeding is accompanied by formula supplementation, illness and death rates are much closer to those of babies who are fully formula-fed. Studies also reveal conclusively that the longer breastfeeding lasts, the greater the measurable difference in illness and death rates.
Answering the detractors
Criticisms are often spread about studies that find increased illness and death rates associated with formula feeding. For just this reason, each later study aggressively attempts to take into account any factors that have been purported as distorting previous study outcomes. These research papers address as many aspects as possible, from maternal education, to smoking, to income level, to day care usage and many more possibilities. The results continue to reveal the risks of formula feeding.
It’s commonly said that formula feeding does not risk lives in industrialized nations where education and medical advances prevent increased deaths. The evidence is quite to the contrary. Some insist that the blame for the United States’ relatively high infant death rate lies with underprivileged communities. Again, it has been shown that elevated death rates among U.S. blacks cannot be attributed to poverty. Hispanic Americans rank similarly to African-American populations for socio-economic factors, but they match non-Hispanic whites in their lower infant mortality rates. The difference is not socio-economic; rather, it’s in rates of formula use versus breastfeeding.82-84
A New York study sought to establish the connection between education, income and infant survival. It concluded strongly that the number of illnesses is increased by two to three times in formula-fed babies regardless of socioeconomic status or level of parental education.85 A later study in Israel confirmed the effects of formula feeding across all classes and education levels.86 The most recent analysis of this issue, again performed in the United States, reiterated that higher illness rates among formula-fed or formula-supplemented infants “did not differ among income groups.”87
And beyond the first year
While the extent of breast milk’s health protection declines with age, a great number of studies demonstrate the continued survival advantage of breastfeeding through the second year and beyond. A World Health Organization study of less-developed countries found a doubled risk of death in the second year of life for those weaned prematurely or never receiving breast milk.88 A study in The Netherlands found a strong correlation between the extent of breastfeeding and the number of illnesses in children. Significant protection from breastfeeding was noted during the first three years of life.89 Other studies show a sizeable increase in illnesses throughout all of childhood for those who were never breastfed or prematurely weaned.90-92 In fact, an increased risk of death throughout life has been well documented for people who were formula-fed. Higher blood pressure, more heart disease, obesity, diabetes and artery disease, a nearly doubled rate of Crohn’s disease and tripled rates of celiac disease have all been associated with early formula feeding.93-105
What your doctor doesn’t tell you
Pediatricians spend much time frightening parents with something like a 1 in 100,000 combined risk from vaccine-preventable diseases when parents question the utility and safety of vaccines. “Would you want to risk the life of your child?” they demand. Yet these very same professionals offer formula samples with the other hand – when the magnitude of health risks associated with the use of formula is 500 times greater.
Parenting is all about making choices and weighing risks and benefits. Many parents need to make the riskier choice of formula feeding in order to balance other factors that benefit the family. Yet some parents who have lost their children, possibly based on pediatric advice condoning or encouraging formula-feeding, would surely wish that they had been informed of the very real risks related to using formula.
Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal child nutrition and attachment parenting. After running a successful chiropractic practice focused on nutrition and women’s health for more than a decade, Linda’s life became transformed eight years ago by the birth of her son. Her research into his particular health challenges led her to write Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Extensively documented, this healthy parenting book presents the scientific evidence behind attachment parenting practices, supporting baby's immune system, preventing colic and sparing drug usage. You can visit Linda’s web site at www.babyreference.com.
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