When the breastfeeding versus formula-feeding debates rage, the conversation usually centers around varying ideologies and lifestyles. People want to talk about how breastfeeding is better for the baby's health, or about how it's a more "natural" way of feeding your child; on the other side of the argument, they want to talk about how bottle-feeding gives parents more flexible work schedules and feeding arrangements.
It’s certainly true that parents make infant feeding choices based on a wide variety of factors, from social norms in their community to their own personal comfort level. But there’s one aspect of the breastfeeding vs. bottle-feeding debate that I don’t see discussed nearly enough: income. In my case, I’m a breastfeeding mama by “choice," but honestly I couldn’t have afforded formula, even if I’d wanted to go down that road.
My family of three lives a little below the United States poverty line. Our budget is tight, with the bulk of our income going to rent and bills. I’d always planned to breastfeed, in part because I’d heard the mantra “breast is best” a thousand times and because I knew I'd just hate washing bottles. But I also knew that even if we got the cheapest formula possible and kept our costs down, formula-feeding our son would be incredibly difficult for us.
That changed, albeit temporarily, when my son was four weeks old. I was admitted to the hospital for gallbladder removal, and because much of my pumped milk was contaminated, I had no choice but to give him formula. My in-laws bought him the formula, and I was grateful to them for it. If it wasn’t for their generosity, my partner and I would have struggled to afford enough formula to get him through that week.
The social and economic issues that contribute to the breastfeeding/bottle-feeding divide are complex. While it's true that low-income parents are often more likely to rely on formula, because they’re less likely to be in a position to demand pumping time at work or to be able to take enough time off work to establish a good breastfeeding routine in the first place, many women like me breastfeed out of economic necessity, simply because formula is so damn expensive.
Formula prices vary widely. On Amazon, the price per fluid ounce for name brand formulas like Similac, Infamil and Earth's Best are between $0.27 and $0.29. These costs tend to add up. Babycenter, for instance, estimates that monthly formula costs run between $60 to $100. For lower-income families, these numbers are not insignificant, and of course, they don't factor in the matter of waste. What happens, for instance, when some of the formula goes bad and you have to throw it out?
'What do we do? Do we give him the formula with added sugar and ingredients we can't even pronounce simply because that's what we can afford?'
Emily, 29, struggled with breastfeeding due to tongue-tie issues with her son. For the first two weeks of his life, she relied solely on donated breast milk to feed him. "We live in one of the most expensive cities in the United States and any extra expense, such as formula, just isn't in our budget," she told Romper. So she pumped around the clock just to make sure she never ran out of breast milk.
When Emily's son was 9 months old, her supply dropped significantly, so she finally bit the bullet and bought formula for him. But it was a struggle to find a product that was both cost-effective and high-quality.
“'What do we do? Do we give him the formula with added sugar and ingredients we can't even pronounce simply because that's what we can afford?,'" she remembers asking herself. "'Or do we cut costs somewhere else to give him what we think is best for him?'" She said the struggle to decide how to feed her son was "mentally exhaust[ing]" — and because she couldn't physically breastfeed him, she felt like she had no other options.
Brook, another mom I spoke with, was only able to afford to feed her infant daughter because of assistance provided by Women, Infants and Children (WIC), the federal government's supplemental nutrition program, which provides nutritional resources for infants, children, and low-income pregnant, breastfeeding, and non-breastfeeding postpartum women.
While Brook always planned to breastfeed, in part because she knew it would be more cost-effective than formula-feeding, she lost her job after she gave birth, and her milk dried up shortly thereafter. Brook was at a loss for what to do next until she joined the WIC program. The program allowed her to buy formula, which she mixed with donated breast milk from one of her midwife's clients.
"I was so grateful," she told Romper. "I was on food stamps and unemployment at the time, too. We also decided to cloth diaper because we were given a bunch of them, and that worked out well because we could certainly have not afforded diapers, either.”
Programs like WIC can be a great help to moms like Brook, but WIC benefits vary from state to state, and aren't always accessible to everyone. I was fortunate: I didn't have to go on WIC, but I was able to find work I could do from home, which enabled me to continue regularly breastfeeding my child. While I enjoyed being able to feed him from my own body, it would be dishonest to say I never fantasized about having the money to formula-feed, especially because I noticed that my formula-feeding friends had the luxury of allowing their partners and/or co-parents handle some of the feedings.
When I ran out to get diapers from the drugstore around the corner from our apartment, my eyes glazed over the bottles of formula, which were all locked up in a glass case. When I glanced at the prices, I was so stunned I found myself looking away.
All in all, I'm glad that infant formula exists, because not every baby can be breastfed, but every baby does deserve a nutritious meal. The fact remains, however, that for many moms, the breastfeeding vs. bottle-feeding debate is not much of a debate at all, because the choice to breastfeed is not merely a matter of preference. It is literally what we can afford.