Intended for healthcare professionals

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Support for breastfeeding is an environmental imperative

BMJ 2019; 367 doi: (Published 02 October 2019) Cite this as: BMJ 2019;367:l5646

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Conflict of interest and the infant formula industry—a call to action

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Infant formula, the environment, and The BMJ

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Re: Support for breastfeeding is an environmental imperative

Shenker et al. look only at the environmental benefits of breastfeeding, ignoring both costs and risks.

Consider that breastmilk supplies the same calories per ounce as formula and those calories have to come from food consumed by the mother. In contrast to cows, who need only to consume grass to make milk, women need meat (often produced by industrial farming), vegetables and fruits (often produced by industrial agriculture) and fish (often caught by practices that are harming oceans).

Moreover, how green is a plastic breast pump? How green is the electricity and batteries used to power them? How green are nursing bras made with synthetic fibers, special clothing, breastfeeding pillows and other breastfeeding accessories? Shenker et al. don’t tell us.

Several decades after predicting that increased breastfeeding rates would lead to decreases in infant mortality, severe morbidity and healthcare spending, none of those things has come to pass. To the extent that increased breastfeeding has caused any measurable change for term babies, it has only made things worse: exclusive breastfeeding is now the leading risk factor for newborn re-hospitalization in the US (1), leading to tens of thousands of readmissions per year at a cost of hundreds of millions of dollars (2).

What is the environmental impact of tens of thousands of newborn re-hospitalizations, including neonatal incubators (made largely of plastic), IV tubing, blood drawing needles, etc?

By refusing to consider the environmental impact of breastfeeding itself and the increased risk of hospitalization, Shenker et al. haven’t made the environmental case for breastfeeding. Unfortunately, they have shifted responsibility for addressing climate change from corporations (which could fix it) and instead blame mothers. Ultimately, Shenker et al. exert even more pressure on women.

Recent research has noted how pressure to breastfeed has harmed women’s mental health (3). Diez-Sampedro et al. recommend:

“Health care providers also need to be supportive of women who choose to supplement with formula or who eschew breastfeeding altogether. It is not possible for health care providers to be aware of all the factors that play a role in forming a woman’s infant feeding intentions, but so long as a woman is provided appropriate education to make informed decisions, clinicians must trust that a woman will choose to do what is best, even if the woman’s definition of best is different than that of the health care provider.”

In short, Shenker et al. fail to make the case that breastfeeding is an environmental imperative, implicate individual women in a problem that is largely due to corporate activity, and add more pressure to women already struggling with overwhelming pressure to breastfeed.


1. Wilson, J. L., & Wilson, B. H. (2018). Is the" breast is best" mantra an oversimplification?. The Journal of family practice, 67(6), E1-E9.

2. Flaherman, V., Schaefer, E. W., Kuzniewicz, M. W., Li, S. X., Walsh, E. M., & Paul, I. M. (2018). Health care utilization in the first month after birth and its relationship to newborn weight loss and method of feeding. Academic pediatrics, 18(6), 677-684.

3. Diez-Sampedro, A., Flowers, M., Olenick, M., Maltseva, T., & Valdes, G. (2019). Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being. Nursing for women's health.

Competing interests: No competing interests

03 October 2019
Amy B. Tuteur
Boston, MA