By Dr. Linda Folden Palmer
First published on Natural Family Online

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.

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 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 these 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.

The relative risks of formula

It is clear that feeding infants artificial formula instead of breastfeeding increases their relative risk of death. A number of studies point to this fact. Table 1 shows figures from two studies measuring infant mortality risks during certain age ranges. A risk number of 3 in the chart represents three times the risk of infant death for infants who are artificially fed.

While the numbers in the charts reflect any amount of breastfeeding during the study period (and not necessarily exclusive breastfeeding), nearly all studies mention that during the first six months, exclusive breastfeeding produces much higher survival rates than partial breastfeeding. No studies refute this assertion. Figures for each age range listed here do not include children who died prior to reaching that age group. Figures reflect infants who received no breast milk or had weaned prior to reaching the reported age group versus those who received any breastfeeding through that age.

Table 1 clearly demonstrates that the disadvantages of formula are most devastating in the earliest months. Significant disadvantages for formula continue throughout the year-long study period.

Suggested Relative Risks for Infant Deaths

No Breastfeeding or Any Breastfeeding Ending Before Designated Age Ranges vs. Breastfeeding Through Designated Age Ranges (1,2)

A relative risk of 13 here means that a child who was not breastfed through the time period has thirteen times the risk of dying during his first year as a child who had received any breast milk through that period.

The studies cited in the next table compare no breastfeeding with 12 months of breastfeeding, each deriving a relative risk of death over the full first year.

Suggested Relative Risks for Infant Deaths

No Breastfeeding vs. Any Breastfeeding for 12 Months (3-7)

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age. A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying as an infant who is partially or completely breastfed.

* These values are calculated from numbers provided in the studies, with averages weighted by percentages of total deaths occurring in each age range. More than two-thirds of deaths occur during the first month.

While the United States has a current infant mortality rate of 6.75 per thousand, many countries have rates approaching 100, with 16 of 225 reporting nations suffering well over 100 infant deaths for every 1,000 children born.(8) The nations in the above table with lower infant mortality rates can thus be seen as somewhat comparable to the United States.

Factors influencing high infant death rates include malnourished mothers, high numbers of births per mother with short spacing between births, poor weaning foods, the early use of cow's milk, inadequate medical attention and supplies, poor sanitation leading to high infection rates and a rapid spread of infectious disease, and limited education about methods of limiting infection and the spread of disease.

Why do U.S. babies die?

Below are the percentages and total numbers of U.S. infants who die from various leading causes, according to the 1999 National Vital Statistics Reports. (9,10)

Numbers account for 70 percent of total infant deaths

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)

Sudden Infant Death Syndrome (SIDS) accounts for a full 10 percent of U.S. infant deaths. Several studies performed in the United States and other industrialized nations reveal increased risks of SIDS among babies who receive formula instead of breast milk. In the table below, the 2002 Scandinavian study takes into account variables thought to have affected the 2000 U.S. study, finding even stronger risks associated with formula.

The most recent U.S. study (2003) takes advantage of the lessons from these earlier studies to raise confidence in its final results. Its finding of five times the risk of infant death from SIDS for formula-fed infants seems to be the most powerful statistic yet.

Studies Demonstrating Relative Risks of Infant Death from SIDS
Formula-Fed vs. Breastfed (11-17)

A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying from SIDS as an infant who is breastfed.

Heart, Circulatory and Respiratory Failure

Premature infants and those with circulatory abnormalities often display one or more warning signs of potential death, including inadequate oxygenation of the blood, apnea (episodes where breathing stops) and high blood pressure. Studies illustrate the dangers of formula for these infants. One study observed better body temperature and superior oxygenation in pre-term infants receiving breast milk. Formula-fed infants demonstrated many episodes of inadequate oxygenation and some apnea, both of which were not seen among the breastfed infants. A Scottish study found significantly better blood pressure among naturally fed infants.

Three U.S. studies are available examining feeding methods for infants with early circulatory problems. One study reported that more than half of infants with congenital heart disease lost oxygenation during bottle feedings, while none did so while breastfeeding. Another study also dealing with heart disease found infants' growth to be significantly inferior and their hospitalizations to be longer when they were fed formula. A third study of very low birth-weight infants found twice as many episodes of inadequate oxygenation among formula-fed infants as in those who received breast milk.

Heart and Circulatory Disease in Formula-Fed vs. Breastfed (18-22)

Necrotizing Enterocolitis

Necrotizing enterocolitis is a severe intestinal inflammatory disorder that affects around 4 percent of low birth-weight babies and 1 percent of full-term infants. About one-third of low birth-weight infants and 20 percent of full-term infants who contract this disorder die. While necrotizing enterocolitis is reported to be responsible for 1.4 percent of infant deaths, many more unconfirmed cases are likely to be responsible for some portion of infant deaths reported as caused by prematurity.

In the United Kingdom, it was discovered that confirmed cases of necrotizing enterocolitis occurred in three times as many infants who received no breast milk as in those who received both breast milk and formula. For infants who exclusively received breast milk, necrotizing enterocolitis occurred six to 10 times less often than among wholly formula-fed infants.

Necrotizing Enterocolitis (23)

Diarrhea

A World Health Organization (WHO) study revealed a risk of diarrhea for formula-fed babies in developing nations averaging more than six times that of breastfed babies. 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 (2.8); in Scotland, the risk is five-fold; and a doubled risk is measured in Canada.

While one study noted nearly twice the risk of developing diarrhea for artificially fed infants in Brazil, other studies have demonstrated that the risk of actually dying from diarrhea was an astounding 14 to 15 times greater. The latter studies demonstrated not only that the artificially fed infants suffer higher rates of illness, but also that the severity and duration of their illnesses are even greater when they do occur and result in proportionately more deaths. This same assertion is demonstrated in a study from India, where formula-fed infants suffer six times the death rate, once diarrhea occurs, as breastfed infants with diarrhea.

Four separate studies in the United States all deduce a doubled risk of diarrhea for formula-fed babies. The U.S. studies also reiterate the well-established factor of greater severity and extent of illness once diarrhea does occur among formula-fed babies. Death rates for formula-fed U.S. infants who get diarrhea may be three times higher or more than their breastfed contemporaries.

The table below collates the reported risks of diarrhea for formula-fed infants from many studies.

Diarrhea Risks for Formula-Fed vs. Breastfed (24-40)

Respiratory Illnesses

Numerous studies document higher numbers of respiratory infections among formula-fed infants than among those who are breastfed. 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.

Respiratory Illness Risks for Formula-Fed vs. Breastfed (41-50)

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, with results ranging from 1.45 to 4 times the risk for developing various common childhood cancers for formula-fed babies.

Childhood Cancer Risks for Formula-fed vs. Breastfed (51-56)

Continued Next Issue ...

Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal child nutrition and attachment parenting. After running a successful chiropractic practice focused on nutrition and women's health for more than a decade, Linda's life became transformed eight years ago by the birth of her son. Her research into his particular health challenges led her to write Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Extensively documented, this healthy parenting book presents the scientific evidence behind attachment parenting practices, supporting baby's immune system, preventing colic and sparing drug usage. You can visit Linda's Web site at www.babyreference.com.