Intended for healthcare professionals

Editor's Choice

Infant formula, the environment, and The BMJ

BMJ 2019; 367 doi: (Published 04 October 2019) Cite this as: BMJ 2019;367:l5816
  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}

When we stopped taking advertisements for breast milk substitutes earlier this year, it was because of the many ways in which the producers of infant formula have undermined breastfeeding around the world (doi:10.1136/bmj.l1200). We hadn’t considered another compelling reason: the damage that infant formula does to the environment. This week Naomi Joffe and colleagues itemise how formula milk contributes to ecological degradation and climate change (doi:10.1136/bmj.l5646).

As well as the carbon, methane, and water footprints, there are the discarded cans going to landfill, the paper, postage, and plastic, the food miles, the palm oil and other ingredients, and the energy used to heat water for mixing the powdered milk. Joffe and colleagues say that in the UK alone carbon emissions saved by supporting mothers to breastfeed would equate to taking between 50 000 and 77 500 cars off the road each year.

Of course, many women can’t or don’t want to breastfeed, and some readers who responded to our decision on advertising saw it as yet another example of women being told what to do with their bodies. But Joffe and colleagues report that more than 85% of pregnant women do want to breastfeed. The fact that the UK has some of the lowest breastfeeding rates and one of the highest uses of formula per capita suggests we are getting things badly wrong. Given the widely recognised benefits of breastfeeding to mother and child, we have to do better for health and the environment.

What of The BMJ’s own environmental impact, and in particular the weekly print magazine? What of the paper, print, and distribution, and why still the plastic wrapper? Like many of you, we fret about these things and continually look for the most environmentally friendly options. First, the paper. It now comes from the offcuts of trees harvested from sustainably managed forests. The offcuts are otherwise unusable, so in the glibbest of terms, no trees have died to make this journal. The trees themselves are used by the Swedish construction industry instead of environmentally damaging materials such as concrete, so in purchasing the offcuts we also are helping to make sustainable construction more financially viable.

As for the wrapper, we have looked at a range of options to replace the current recyclable plastic. Potato starch looked promising, but not everyone can recycle it. So we plan to test two alternatives. From next month academics and hospital doctors will receive their magazine in a paper wrapping, and GPs and retired doctors will get theirs in a carbon neutral polymer wrapping derived from sugar cane.

Meanwhile, for those who prefer digital reading, our mobile app is available from the Apple App Store or from Google Play for Android users. Feedback on all of the above is, as always, welcome.