I talk rather a lot about how great breastfeeding is. Helping mothers have the best breastfeeding experience possible is something that I’m passionate about. Today, though, I thought I’d switch things up a bit and discuss the history of infant formula, both good and bad. I hope you find it as interesting as I do.

Prior to the 20th century the overwhelming majority of infants were breastfed. There simply wasn’t a viable alternative. If a mother couldn’t breastfeed, or chose not to, she employed a wet nurse. Or, failing that, the infant was fed some sort of home-made substitute. The situation was dire for those who weren’t breastfed. In foundling homes (think orphanages), only one in three of those who were wet nursed survived to age 5. Those who were artificially fed had only a one in nine survival rate. Infants who were artificially fed at home had a fatality rate in excess of 99%.

Even using a wet nurse was not an ideal situation. The market was not controlled, and women were not screened for diseases. Neither were babies. Pathogens were sometimes transmitted from the baby to the wet nurse or vice versa. Women in slavery were forced into wet nursing. Their own babies suffered as a result. There is a very real history of impoverished wet nurses facing subjugation at the hands of wealthy families.

Henri Nestle was horrified by this situation. He was the 11th of 14 children, half of whom died in infancy. He decided to use his background as a pharmacist’s assistant to create an infant formula. In the 1860s and 1870s Nestle and his competitor Justus von Leibig developed and introduced the first powdered infant formulas. Although the products represented an advancement over existing breast milk substitutes, they were slow to catch on. By the 1910s, the manufacturers realized that developing a close relationship with the medical community would help them sell their product, and that helped grow their market.

The number of mothers using infant formulas increased slowly through the early part of the 20th century. Partly, this had to do with the norms of childbirth and infant care. In 1900, 95% of babies were born at home. By 1940 that number had dropped to 50%, and by the 1950s about 95% of babies were born in the hospital. Birth and baby care became highly medicalized. Doctors were men, and science was king. Formula feeding rates skyrocketed in the 1950s and 1960s, reflecting these prevailing attitudes.

Breastfeeding rates reached their all-time low in 1971 in the US, when fewer than 25% of mothers attempted to nurse their babies. In addition to societal attitudes more and more women were working outside the home, meaning mothers and babies were separated during the early months. Formula feeding was the norm, and few women even attempted to breastfeed. We developed the culture that still exists today where baby bottles and soothers are ubiquitous symbols of infancy. With the baby came the bottle and the formula, along with the diapers and the itty bitty clothes.

But then some things changed. Childbirth practices started to shift. Groups like Lamaze took hold and more women took prenatal classes and sought natural childbirth. Hospital policies evolved to promote early bonding, with practices such as keeping mothers and babies in the same room. These changes supported breastfeeding by keeping the mother-baby pair together and alert during the critical early days.

Formula companies also started to comme under attack in the 1970s for their marketing practices in the developing world. A brochure called The Baby Killer claimed that the use of infant formula in the third world was leading to infant death or illness. Infant formula is expensive. This can lead impoverished families to use less formula powder than they should when mixing it. Compounding that, many people in developing countries do not have reliable access to safe drinking water. Using this water to mix up formula for very small babies is a recipe for disaster. But once mothers have stopped nursing, re-establishing exclusive breastfeeding is very difficult or impossible, leaving them with few options.

The accusation was made that companies such as Nestle were deliberately marketing their products as ‘safe’ when they knew full well they weren’t. They encouraged families who weren’t in a position to use formula properly to switch, and then their babies paid the price. There was some backlash, and an ongoing boycott was launched against Nestle in 1977.

Today breastfeeding initiation in the United States is over 70% and climbing. Formula use is on the decline, and human milk banks are opening across North America. The trend is positive, but there is a lot of work left to be done. Our recent formula-feeding history remains strong, and many people don’t have access to good breastfeeding information and support. The result is that while many women try to breastfeed, the success rates are much lower than they should be. I wish that this wasn’t the case, but I am happy that a generally safe alternative to breastfeeding exists. Now I hope that we can restore a breastfeeding culture so that fewer women need to use it.