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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

Linked opinion

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

Editor's Choice

Infant formula, the environment, and The BMJ

Rapid Response:

Re: Support for breastfeeding is an environmental imperative

We refer to the recent editorial by Joffe et al, ’Support for breastfeeding is an environmental imperative’ in which the authors presented the environmental impact of infant formula production and consumption as a reason for increasing investment in breastfeeding support.

It is crucial that we take action to minimise the impact of production of all foodstuffs, and that includes infant formula. However, the authors do not call on industry to improve their practices in this regard, rather they place the burden of reducing the environmental impact of infant formula into the laps (or indeed onto the breasts) of individual mothers.

As the authors state, many women who express a desire to exclusively breastfeed their babies ultimately find themselves using infant formula, either exclusively or in part. While a lack of breastfeeding support is part of that, many other factors also contribute – including the desire to share feeding with their partner or family, meet the demands of their other young children, or the need to return to work.

We appreciate that the intent of the editorial may have been to use growing concerns about the climate to persuade government to increase investment in breastfeeding support and services, but we are concerned it may only fuel a culture in which women are ultimately held responsible for mitigating against all risks, real, imagined or predicted. Nowhere is this more true than in relation to pregnancy and childrearing.

There is absolutely no doubt that we should do more to improve infant feeding support to all women. It should be noted that the current provision of breastfeeding support in the UK urgently needs review as research suggests the present delivery of the Baby Friendly Initiative may promote unrealistic expectations of breastfeeding, fail to meet women’s individual needs, and foster negative emotional experiences (Fallon et al, 2019), and in its present form therefore offers an inadequate response to the issue of low breastfeeding rates the authors are concerned about. However, even with the best possible breastfeeding support, infant formula will remain a legitimate product needed and used by families across the UK.

By focusing on the suggested environmental benefits of breastfeeding over the use of infant formula the authors fail to hold the correct people to account for the issue - the producers - and instead place the onus on consumers, who are predominantly women. The responsibility for reducing whatever global climate burden is posed by infant formula should not come at the expense of women’s reproductive rights, which are inclusive of how women use their breasts.

We suggest engagement with all food manufacturers, including infant formula companies, to reduce the carbon footprint of production systems without undermining a woman’s ability to make the decision that is right for her and her family about how she feeds her baby.


Fallon VM, Harrold JA and Chisholm A. (2019) The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review. Maternal & Child Nutrition 15:e12778.

Competing interests: No competing interests

08 October 2019
Erin J Williams
Co-Founder, Feed
Stephanie Maia, Feed; Rosie McNee, Feed; Kate Wishart, Feed; Clare Murphy, British Pregnancy Advisory Service (bpas); Dr Ellie Cannon, GP
Edinburgh, Scotland