"A multitude of studies demonstrate that when breastfeeding is 
accompanied by formula supplementation, illness and death rates are 
much closer to those of babies who are fully formula-fed..."

My friend Darillyn voiced her concerns about this paragraph, and 
wondered if adoptive breastfeeding mothers might become discouraged if 
they learned that breastfeeding combined with supplements did not have 
the power that exclusive breastfeeding has.  However, I would like to 
argue for keeping the message unchanged, because I think more good can 
come from solving the problem than from trying to avoid it.

It’s true that Americans in general struggle with the concept of risk.  
If formula-feeding were associated with 100% fatality, we would have no 
trouble convincing people of the importance of breastfeeding.  Certain 
death is a concept most of us understand.  But because the outcome of 
not breastfeeding is much more variable than that, it is hard for many 
to understand that there is any risk at all.  How many times have we 
heard someone say, “But I wasn’t breastfed, and I’m fine,” meaning “I 
wasn’t breastfed, and yet I am alive.  Since I can see that there isn’t 
100% mortality, there must be no risk at all.”

In a culture where most moms hear that breastmilk is only marginally 
better than a can of dried milk from a cow, the concept of comparative 
risk may be even harder to communicate.  That adoptive breastfeeding 
mothers may initially be discouraged is a real possibility, when they 
learn that all their efforts are impacted by the health effects of the 
supplements they use.  However, this group has faced great adversity to 
choose what they know to be the lowest risk for their children.  The 
fact that they are maximizing their children’s chances for health has 
not changed.  If this is not immediately obvious, then it is an 
opportunity to educate the public about relative risk.

A mom who is making every effort to maximize her milk production is 
doing everything in her power to reduce risk even if she has to 
supplement what she makes.  On the other hand, a mom who can easily 
meet 100% of her baby's needs through endogenous production has the 
right to know that she is choosing to increase risk if she chooses to 
supplement.

I believe that with sufficient knowledge, empowerment will be the end 
result, rather than discouragement.  Today, many adoptive breastfeeding 
mothers rely on supplemental formula.  We can hope that accurate 
information about the risks of artificial baby milk will help to 
empower all mothers to demand access to safe and affordable donor human 
milk when needed.

All that any of us can hope for is to have enough knowledge and control 
over our lives to be able to act to decrease risk--not eliminate it.  
All of our lives are filled with risk.  The safest course lies in 
having accurate information about risk,  so that we can reduce our 
exposure to it.


Arly Helm, MS, IBCLC

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