By By Dr. Linda Folden Palmer
This groundbreaking analysis from noted author, health educator
and advocate Dr. Linda Folden Palmer is the first time a health
expert has published an examination of the available scientific
research comparing the death rates of formula-fed and breastfed
babies. While the results hold no surprises for breastfeeding
educators and advocates, the study may prove to be a rude
awakening for the millions
of Americans who have
bought into the myth that
infant formula is a perfectly
safe breast milk substitute.
The following article was
summarized by editors of
Natural Family On-line.
Homebirth or hospital? Cloth or disposable?
Early exposure to large numbers of other children?
Extreme or relaxed sanitation? Pets in the house?
The answers to the swirl of questions surrounding the
birth of a baby are not simple. There are no overall right
or wrong answers. Parenting involves a huge number of
choices, starting from before conception and reaching
through childhood and beyond.
In many cases, we don’t have the time or energy to
investigate and choose from all the available options.
We opt for the status quo or simply what seems easiest
for our families. Other times, we do not have the luxury
of choice; circumstance prevails. Traveling in a car with
our children, for instance, is a risk that most of us take
because we have little choice.
Still, many major parenting decisions, including the
decision to breastfeed or use infant formula, remain
conscious choices for most parents. What’s often missing
from this decision are the facts. Sure, we’ve all heard
that “breast is best”—but what are the solid statistics?
Is infant formula the perfectly safe breast milk substitute
we’ve been led to believe?
The deadly influence of formula
Infant formula was designed to be a medical nutritional
tool for babies who are unable to breastfeed. Formula
does not fully meet the nutritional and immunity needs of
infants, leaving their immune systems flailing. An infant’s
immune system has three aspects: her own immature,
developing immune system; the small component of
Read the immunities that passes through the
placenta during natural childbirth
(and to a lesser degree with premature
births and cesarean sections);
and the most valuable, living portion
that is passed on through mother’s
milk on an ongoing basis. Remove
any of those components and you
take away a vital support structure.
This brings us face to face with
the safety and effectiveness of infant
formula as a breast milk substitute.
Is formula actually as safe as we
have been led to believe? In fact,
the answer is a resounding “no.”
In fact, the use of infant formula
doubles the risk of infant death for
American babies.
While the dangers of formula feeding
aren’t something you’re likely to hear
in your doctor’s office, the conclusions
can be derived through an examination
of the available scientific
research on infant mortality in the
United States and across the world.
There are studies showing artificial
feeding’s impact on overall infant
death rates in both developing
and undeveloped countries. While
studies offering comparative death
rates are not available for industrialized
regions, there are numerous
studies providing comparative occurrence
rates for many illnesses and
disorders in the United States and
other industrialized nations. Many
more reports are available extolling
superior survival rates and decreased
illness rates among breastfed
infants, but only those with solid
numbers are useful here. We can
assemble the statistics from these
studies to build a firm picture of
the ratio of infant deaths for U.S.
formula-fed babies against those
who are breastfed.
Why do U.S. babies die?
Total U.S. births
in 1999: 4,000,000
Total U.S. infant deaths
in 1999: 28,000
So how does formula play into these
deaths? Let’s look at some of the common
causes of infant death and see
what current research has to say on
the involvement of infant formula.
Sudden Infant Death Syndrome
(SIDS) Studies have found a five-fold
risk of infant death from SIDS for
American formula-fed babies.
Heart, circulatory and respiratory
failure Scientists worldwide have
documented higher blood pressure
among formula-fed infants, as well
as more apnea and episodes of
oxygen desaturation, inferior body
temperature regulation, less growth
and longer hospital stays.
Necrotizing enterocolitis
Researchers in the United Kingdom
have confirmed that formula-fed
infants develop necrotizing enterocolitis
six to 10 times more often than
breastfed babies.
Diarrhea A summary article for
industrialized nations demonstrated
an average of triple the risk of diarrhea
for formula-fed babies. The risk
in China and Israel is reported as
slightly less than triple; in Scotland,
the risk is five-fold; and a doubled
risk is measured in Canada.
Respiratory illnesses It is clear
that respiratory infections are at
least triple in the United States for
formula-fed infants. The death rate
is likely to be even higher, since
some of these studies note that both
the severity and extent of respiratory
illnesses are considerably higher
once they occur.
Cancer A joint study between
the United States and Canada on
neuroblastoma, a common childhood
cancer, revealed a doubled risk for
children who did not receive breast
milk for more than one year. This
study is consistent with several
other childhood cancer studies in
other nations.
Low birth-weight and pre-term
birth A U.S. study performed at
George Washington University
Hospital found 2.5 times the number
of infections among formula-fed
infants in the intensive care unit
than among those receiving human
milk. Another study at Georgetown
University Medical Center also found
more than double the number of
infections in very low birth-weight
infants not receiving human milk.
A San Diego study found twice as many infections in pre-term, formulafed
infants compared with infants
who received human milk.
It is worth noting that the eye
damage that can occur in very low
birth-weight infants, retinopathy of
prematurity, occurs only half as often
in infants who receive some breast
milk. Even a disorder as apparently
unrelated to feeding methods as
inguinal hernia has been discovered
to occur twice as often in artificially
fed infants and even more frequently
when compared with infants who
are exclusively breastfed.
Congenital abnormalities Twenty
percent of U.S. infant deaths are
attributed to birth defects. While
death certificates often list the initial
abnormality as the cause of death,
infection is actually the final factor
in many of these deaths. We have
already seen how drastically infection
rates and deaths are reduced
by breastfeeding. It is clear that
the youngest and weakest infants
are the ones who are most strongly
endangered by infant formula’s
inadequacies.
For example, infants born with
phenylketonuria (PKU), a defect in
handling a certain protein in the diet,
need specialized supplementation to
breast milk in order to prevent mental
retardation and other difficulties.
Yet a study demonstrated that infants
who had been breastfed before being
diagnosed with PKU fared far better
than those who had been fed on
formula. The greatest complications
for infants with cystic fibrosis are
lung infection, decreased oxygenation
and malnutrition—all of which are
recognized to be complicated by
formula feeding.
Complications of pregnancy and
birth Complications of pregnancy and
birth produce a wide range of injuries
and problems for babies. Infection,
insufficient neurological recovery
and inadequate oxygenation lead to
many infant deaths. Artificial feeding
certainly has some degree of impact
on mortality in these cases.
Accidents It seems logical that
accidents happen equally among
artificially and naturally fed infants.
Figures bear this out. One paper
actually measured accidental injuries
between breast- and formula-fed
infants, finding an equal number
in both.
The big picture
The relative risk for formula feeding
in many categories was clearly
defined by studies. We are able to
select conservative but appropriate
rates, as seen in the table below.
Relative risk for
formula-fed infants
Estimated IMR for
breastfed babies
Deaths if all
were breastfed
Deaths if all
were formula-fed
Lives saved if
all were breastfed
Calculating Formula’s Final Impact
Congenital abnormality 5500 1.5 1.1 4400 6600 1100
Prematurity 4500 2.5 .643 2570 6430 1930
SIDS 2700 4 .27 1080 4320 1620
Complications of
pregnancy & birth 2400 1.25 .533 2135 2670 270
Respiratory distress
& infections 1750 4 .175 700 2800 1050
Accidents 850 1 .213 850 850 0
Bacterial infection 700 3 .087 350 1050 350
Circulatory problems 650 1.5 .13 520 780 130
Necrotizing enterocolitis 400 8 .022 90 710 310
Diarrhea 300 2.5 .043 170 430 130
Meningitis 100 3 .014 55 170 45
Cancer 100 2 .02 80 160 20
SUBTOTALS 19950 2.075 3.25 13000 26970 6955
All other 8050 2 1.6 6440 12880 1610
TOTALS 28000 2 4.7 18665 37335 IMR 9.4 9335
Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.
Cause of death
The Deadly Influence of Formula in America continued from page 13
Actual U.
Based on the current U.S. infant
death rate of 6.7 and an average
breastfeeding rate of 50%, the
American infant mortality rate would
climb to 9.4 if all infants were formulafed
and would drop to 4.7 if all were
breastfed. Twenty-two nations with
high rates of breastfeeding have
infant mortality rates below 5, while
the United States ranks higher in
infant death than 41 other nations.
Clearly, lower rates for the United
States are a possibility.
The ugly truth about formula
From the above statistics, we see
that formula feeding costs American
babies more than four additional
lives per thousand. The final relative
risk for formula feeding comes out
to 2—that’s double the risk of death
for American infants who are fed with
formula, compared with babies who
are fed naturally.
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. Studies also
reveal conclusively that the longer
breastfeeding lasts, the greater the
measurable difference in illness and
death rates.
Answering the detractors
Criticisms are often spread about
studies that find increased illness
and death rates associated with
formula feeding. For just this reason,
each later study aggressively
attempts to take into account any
factors that have been purported as
distorting previous study outcomes.
These research papers address
as many aspects as possible, from
maternal education, to smoking,
to income level, to day care usage
and many more possibilities. The
results continue to reveal the risks
of formula feeding.
It’s commonly said that formula feeding
does not risk lives in industrialized
nations where education and medical
advances prevent increased deaths.
The evidence is quite to the contrary.
Some insist that the blame for the
United States’ relatively high infant
death rate lies with underprivileged
communities. Again, it has been
shown that elevated death rates
among U.S. blacks cannot be attributed
to poverty. Hispanic Americans rank
similarly to African-American populations
for socio-economic factors, but
they match non-Hispanic whites in
their lower infant mortality rates.
The difference is not socio-economic;
rather, the difference is in rates of
formula use versus breastfeeding.
A New York study sought to establish
the connection between education,
income and infant survival. It concluded
strongly that the number of
illnesses is increased by two to three
times in formula-fed babies regardless
of socioeconomic status or level
of parental education. A later study
in Israel confirmed the effects of
formula feeding across all classes
and education levels. The most
recent analysis of this issue, again
performed in the United States,
reiterated that higher illness rates
among formula-fed or formula-supplemented
infants “did not differ
among income groups.”
Beyond the first year
While the extent of breast milk’s
health protection declines with
age, a great number of studies
demonstrate the continued survival
advantage of breastfeeding through
the second year and beyond. A World
Health Organization study of lessdeveloped
countries found a doubled
risk of death in the second year of
life for those weaned prematurely or
never receiving breast milk. A study
in The Netherlands found a strong
correlation between the extent of
breastfeeding and the number of
illnesses in children. Significant protection
from breastfeeding was noted
during the first three years of life.
