Reframing Infant Feeding: Beyond the Breast is Best Narrative

As a psychotherapist with expertise in child development, I deeply appreciate the unique developmental needs of infants. The decision to breastfeed, use formula, or some combination of the two, is a very personal decision.  Yet, expectant mothers often face intense pressure from multiple sources—healthcare professionals, social expectations, and older family members—to exclusively breastfeed. This pressure to conform to a single feeding approach, regardless of individual circumstances, can significantly compromise maternal mental health outcomes. The discordance between breastfeeding expectations and lived experience has been identified as a particular risk factor for psychological distress (Farias-Antúnez et al., 2022), reinforcing the importance of tailoring support to individual maternal circumstances.

The stigma of not breastfeeding is a moral judgement of mothers reflecting a rigid belief system that extends far beyond peer pressure. Medical professionals, healthcare providers, and even well-meaning family and friends all too often promote an agenda that breastfeeding is the only choice a responsible and loving parent could make. Unfortunately, many that offer advise often lack a concrete understanding for the many challenges of breastfeeding that some families experience (Grattan et al., 2024).

The Gold-Standard Narrative

The medical community frequently promotes exclusive breastfeeding as the "gold standard" of infant nutrition, yet what does this mean for mothers who, regardless of the reason, are unable to breastfeed exclusively? When we establish exclusive breastfeeding as the singular "gold standard," we create a dangerous hierarchy that influences how mothers, children, and families are perceived—both by healthcare providers and by society at large (Coffey-Glover et al., 2023; Símonardóttir & Gíslason, 2018).

The "gold standard" language implicitly suggests that mothers who do not breastfeed are providing their child with a level of care that is less than optimal. This framework ignores decades of research showing that formula-fed children thrive, develop normally, and grow into healthy adults (Anderson & Burggren, 2018). While breast milk offers certain immunological advantages, particularly in the early months, the long-term health and developmental outcomes between breastfed and formula-fed children are far more nuanced than the "gold standard" rhetoric suggests. Research indicates that when variables such as socioeconomic status and maternal education are taken into account, the association between breastfeeding and improved cognitive outcomes becomes less significant, reinforcing that the moral imperative is a social construct and not a child-centered and data-driven decision (Pereyra-Elías et al., 2022; Jedrychowski et al., 2015). 

Stigma & Moral Judgment

The rhetoric around breastfeeding carries an implicit moral judgment. This persistent message that exclusive breastfeeding is best stigmatizes mothers who, for whatever reason, have made a different and hence inferior choice, and by extension, implies their children have received an inferior start in life. Not only does this messaging suggest that the child's nutrition is inferior, even though it’s not, it suggests a mother who does not exclusively breastfeed is taking the easy way out or is selfish, and simply doesn’t care enough (Ryan et al., 2010; Símonardóttir, 2016). Such rhetoric ignores that a mother with the insight to evaluate the needs of her family and make a thoughtful decision is, to the contrary, demonstrating considerable parental wisdom (Grattan et al., 2024).

A systematic review of breastfeeding and maternal mental health found that while breastfeeding itself can have positive effects on maternal wellbeing, breastfeeding challenges and a disparity between expectations and actual experience were associated with negative mental health outcomes (Farías-Antúnez et al., 2022). This finding underscores the importance of individualized care rather than blanket prescriptions.

The pressure to breastfeed exclusively makes families that don’t far more vulnerable.  When mothers struggle with breastfeeding—whether due to biological, logistical, or psychological factors—the insistence on exclusive breastfeeding can lead to maternal stress, anxiety, and feelings of inadequacy (Grattan et al., 2024; Mayers et al., 2024). Recent longitudinal research has demonstrated that perceived pressure to breastfeed is associated with increased anxiety, stress, and birth trauma symptoms four weeks postpartum because mothers experience difficulties living up to the "breast is best" ideal and view breastfeeding as integral to their success as mothers (Grattan et al., 2024). These emotional states can negatively impact the parent-infant bond and overall family wellbeing. The detrimental effects associated with the stigma of not breastfeeding can easily offset the potential gains, causing more harm than the benefits of breastfeeding (Farías-Antúnez et al., 2022).

How do we move forward?

Moving forward, we need a more honest and nuanced conversation about infant feeding that:

Acknowledges incremental benefits: While breastfeeding offers certain benefits, research indicates these advantages are incremental rather than transformative and must be weighed against individual family circumstances. Meta-analyses demonstrate modest but significant effects on outcomes such as childhood obesity and cognitive development, with effect sizes that are meaningful at the population level but small for individual children (Horta et al., 2015; Victora et al., 2016).

Recognizes maternal mental health: Maternal mental health, family cohesion, and parental confidence are equally important factors in child development—and rigid adherence to breastfeeding goals can sometimes undermine these elements. Given that maternal mental health is a critical predictor of healthy child development, interventions that increase stress and anxiety may ultimately be counterproductive (Dias & Figueiredo, 2015; Grattan et al., 2024).

Respects parental autonomy: Parents deserve respect for making informed decisions based on their unique situations, free from moral judgment or suggestions that choosing formula reflects inadequate parental love or commitment. The sociological literature demonstrates that the "breast is best" discourse places unrealistic demands on mothers while obscuring structural barriers to successful breastfeeding (Wolf, 2011; Hausman, 2013).

Shifts to 'fed is best': Rather than "breast is best," we should emphasize that the goal is nourishing healthy babies, supported by confident, mentally healthy parents. This reframing recognizes that optimal infant feeding practices exist on a continuum and that multiple pathways can lead to positive outcomes (Smith et al., 2012).

References

Anderson, J. W., & Burggren, W. (2018). Cognitive and neurodevelopmental benefits of extended formula-feeding in infants: Re: Deoni et al. 2013. NeuroImage, 178, 487-492. https://doi.org/10.1016/j.neuroimage.2018.05.061

Anderson, J. W., Johnstone, B. M., & Remley, D. T. (2013). Breast-feeding and cognitive development: A meta-analysis. The American Journal of Clinical Nutrition, 70(4), 525-535.

Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., Bahl, R., & Martines, J. (2015). Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatrica, 104(S467), 96-113. https://doi.org/10.1111/apa.13102

Coffey-Glover, L., Hanson, S., & Callaghan, J. E. M. (2023). 'At the breast is best?' A corpus-informed feminist critical discourse analysis of the marginalisation of expressing human milk in online infant feeding promotional discourse. Discourse & Communication, 17(5), 539-562. https://doi.org/10.1177/17504813231170127

Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: A systematic review of the literature. Journal of Affective Disorders, 171, 142-154.

Farías-Antúnez, S., Santos, I. S., Matijasevich, A., & Barros, A. J. D. (2022). The effects of breastfeeding on maternal mental health: A systematic review. Journal of Women's Health, 31(6), 787-797. https://doi.org/10.1089/jwh.2021.0504

Grattan, R. E., London, S. M., & Bueno, G. E. (2024). Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time. Frontiers in Public Health, 12, 1357965. https://doi.org/10.3389/fpubh.2024.1357965

Hausman, B. L. (2013). Mother's milk: Breastfeeding controversies in American culture. Routledge.

Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatrica, 104(S467), 30-37. https://doi.org/10.1111/apa.13133

Jedrychowski, W., Perera, F., Jankowski, J., Butscher, M., Mroz, E., Flak, E., Kaim, I., Lisowska-Miszczyk, I., Skarupa, A., & Sowa, A. (2015). Effect of exclusive breastfeeding on the development of children's cognitive function in the Krakow prospective birth cohort study. European Journal of Pediatrics, 174(1), 151-158.

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Mayers, A., Gallimore, L., & Barnes, S. (2024). Perceived pressures and mental health of breastfeeding mothers: A qualitative descriptive study. Healthcare, 12(17), 1794. https://doi.org/10.3390/healthcare12171794

Pereyra-Elías, R., Quigley, M. A., & Carson, C. (2022). Associations of breastfeeding duration with verbal and spatial abilities at age 11 and 14 in the UK Millennium Cohort Study. PLOS ONE, 17(5), e0267326. https://doi.org/10.1371/journal.pone.0267326

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Símonardóttir, S., & Gíslason, I. V. (2018). When breast is not best: Opposing dominant discourses on breastfeeding. The Sociological Review, 66(3), 665-681. https://doi.org/10.1177/0038026117751342

Smith, P. H., Hausman, B. L., & Labbok, M. (Eds.). (2012). Beyond health, beyond choice: Breastfeeding constraints and realities. Rutgers University Press.

Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., Rollins, N. C., & Lancet Breastfeeding Series Group. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7

Wolf, J. H. (2011). Is breast best? Taking on the breastfeeding experts and the new high stakes of motherhood. NYU Press.