Robert F. Kennedy Jr. is going after infant formula. The project called “Operation Stork Speed” will review infant formula and make it “as close to mother’s milk as we can get.” What they come up with remains to be seen, but for parents the science on the bottle-versus-breast debate is already in and not nearly as controversial as some people believe.

First, professional societies all recommend that newborns be breastfed. There are subtle differences in recommended duration but everyone agrees breastfeeding serves the nutritional needs of babies until they are ready to start taking solid food.

But not all women can breastfeed for a variety of reasons including infection, pain, low milk supply, fatigue or an underlying medical illness. Also some babies, especially preterm infants, may require specific nutritional formulations. So infant formula serves an important medical need.

The problem and the origin of the Breast is Best campaign go back to the 1970s when breastfeeding had hit historic lows with only about one-quarter of babies being breastfed at all. Public Health efforts to reverse this trend have been largely successful and now close to 90 per cent of babies in Canada are at least partially breastfed. However, duration of breastfeeding is still below targets with less than half of babies exclusively breastfed for four months and only a quarter breast fed for the recommended six months. Still the increase has been meaningful and gone a long way to reversing the downward slide seen in the early part of the 20th century.

But this focus on breastfeeding has been stressful for mothers who can’t breastfeed or who for a variety of reasons choose not to. One of the biggest trigger points is the debate about whether bottle feeding is bad for your baby. The data here is more mixed than most people realize. There is some evidence that breastfeeding helps with pain control in babies independent of skin-to-skin (a.k.a. kangaroo) care, where the infant is held close to the chest. There is pretty good evidence that donor milk is better than formula in preterm infants for preventing necrotizing enterocolitis, a severe condition in preterm infants were the bowel wall becomes inflamed and dies.

The WHO’s evidence review has found that breastfeeding provides a number of benefits. Short term, there is a reduction in both diarrhea and respiratory infections as well as the associated hospitalizations and deaths. The mechanism here is probably multifactorial. Breastfeeding allows the transfer of antibodies from mother to baby and prevents malnutrition and dehydration. Breastfed infants are also not going to get sick if local drinking water is contaminated.

However, the further out you go, the less concrete the benefits are. Claims that breastfeeding reduces childhood obesity are shaky. It will likely help mothers with post-pregnancy weight loss, but probably won’t boost your child’s IQ, prevent cavities or limit the development of allergies.

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Most important, breast milk is free. In resource limited areas where refrigeration and clean drinking water may not be readily available, it solves many problems of early childcare and nutrition.

While the MAHA movement may be hyper focused on high-fructose corn syrup and fat intake, it is worth remembering that most infant formulas contain lactose, just like breast milk. Some special brands for preemies or lactose-intolerant babies do contain other sugars, though it’s worth remembering that corn syrup solids are not the same as high-fructose corn syrup. Some recent and prominent product recalls may have spooked people, but what we need is better quality control — not a wholesale reconstitution of infant formula.

In this often heated and emotional debate we need to be able to walk and chew gum at the same time. We can acknowledge and promote the health benefits of breastfeeding without overhyping unfounded claims and stigmatizing women who can’t breastfeed. Breast is best, but you shouldn’t feel bad if you can’t and you shouldn’t be afraid of formula either.

© Montreal Gazette