Cans of infant formula on a conveyor belt.

Bottled Milk: A Mother’s Reach for Infant Health

By Ashley Chang ~

For millennia, mothers around the world have made great sacrifices to ensure the survival of their children. These efforts have changed over centuries as civilizations around the world made strides towards improving infant survival. After its development, infant formula (or bottled milk) was a symbol of exactly that to many mothers—a tool of modern ways and advanced nutrition. If women of social and financial stature were buying infant formula, what could possibly go wrong?

As an intern at NLM, I have been watching medical videos for a copyright research project. Videos with no copyright restrictions can eventually be released to the public for anyone to study and enjoy, and my job was to discern the copyright status of nearly 400 titles. One video titled Bottle Babies: A Film (available for viewing onsite at NLM) focused on bottle-feeding in Nairobi, Kenya, during the 1970s,  a practice that, according to the film, medical professionals soon correlated with an alarming number of dying babies. Infants arrived at hospitals emaciated, with diarrhea and infections. “What they have in common,” says the narrator of the film, “is that they have been bottle-fed.” The bottle—a sign of civilization, prosperity, and modern living—had appeared to be a desirable option for feeding these babies, but it introduced risks as well. Bottle-feeding was expensive and, in some cases, the formula cost one-third or even one-half of the family’s income. To make it last longer, some mothers had diluted the formula, often mixing it with unsanitary water and leaving the infant open to malnutrition and infection. In fact, lack of access to clean water is the main reason formula can be dangerous to babies, according to a 2018 working paper from the National Bureau of Economic Research titled Mortality from Nestle’s Marketing of Infant Formula in Low and Middle-Income Countries.

In considering bottle-feeding preferable, the mothers shown in Bottle Babies were following a trend seen in more-developed countries. In the West, the active marketing of formula took place alongside other societal developments, including increased sexualization of the breast. The perception of the female breast as a source of sexual pleasure grew, while public (and even private) breastfeeding began to be seen as primitive and less nutritious for the infant than a scientifically-developed product. In Western countries, rates of breastfeeding significantly declined post World War II as use of the new products grew.  When rates of breastfeeding began to climb again in the 1970s formula manufacturers sought new markets for their product in developing countries to fill the gap.

Nestlé and other producers of infant formula aggressively advertised their product. They plastered the walls of hospitals and other public areas with posters depicting happy, healthy babies, all holding onto bottles of formula. Nestlé sales representatives would dress in traditional nurse’s uniforms to talk to mothers about powdered milk, making mothers more susceptible to their advice. Employees gave free samples to the new mothers. This was a slippery slope; oftentimes, a mother’s milk would dry up within a few weeks of birth if infants were not breastfeeding. Use of the samples, then, ensured a dependable, long-term demand for powdered milk products. These practices were notorious in developing countries, where bottled milk often came at a huge financial expense to the mother.

Bottle Babies featured footage of women in Nairobi feeding their babies formula. I did further research into the history of bottled milk and the requirements for safe preparation. Films held at NLM dating from the 1930s-1960s, such as Clocking a Champion (1939) and Baby’s First Four Months (1967), make clear that sterilization of powdered milk and bottles was a lengthy, labor-intensive process. The bottles had to be cleansed thoroughly with soap and water before being placed in a sterilizer to be boiled for several minutes. Meanwhile, the milk was mixed, boiled, and placed into the bottles to be boiled and sterilized a second time. Once the formula was ready, it had to be warm to the touch, not too hot or cold for infant consumption, and any milk not used had to be refrigerated or discarded. This entire process from start to finish required the use of clean running water, a stove, and a refrigerator—resources that many bottle-feeding mothers still do not have. For many mothers in developing countries, breastfeeding is the least risky way to provide their babies with clean, reliable, and nutritious milk.

In the United States, the rate of breastfeeding has been steadily increasing in recent decades. I discovered many films at NLM on the benefits of breastfeeding published within the past forty years or so. These including Breastfeeding for the Joy of It (1977), Breastfeeding: A Practical Guide (1982), and The Benefits of Breastfeeding (1999). Scientific research linking infant health to breast milk is plentiful. Despite this, few U.S. mothers breastfeed for the first two years of life as the World Health Organization recommends (Breastfeeding in the 21st Century, PDF). Indeed, the video I watched about bottle-feeding in Nairobi feels familiar: of all mothers in the United States, women with lower income and education are the least likely to breastfeed their babies. Many of these women are aided by federal assistance programs that give out free formula samples. As with the mothers and infants in Bottle Babies, early consumption of free formula often dries up breast milk, meaning that infant formula becomes a permanent reality. Unfortunately, socioeconomic disparity and bottle-feeding correlate in many places around the world.

Today in the Philippines, only 29 percent of mothers exclusively breastfeed in the first six months. To these lower-income mothers, the promise of happy, prosperous babies in infant formula advertisements is particularly enticing. Free samples and aggressive advertising continue to be a problem in the Philippines and around the world.

The good news is that the benefits of breastfeeding are now widely known and researched among medical professionals, and internationally influential agencies such as the World Health Organization and UNICEF have taken to advocating for prolonged breastfeeding around the globe.

A series of three illustrations of women in work settings breastfeeding their babies.
Career is no Barrier to Breast Feeding, ca. 1960
National Library of Medicine #101454973

The realization that vigorous promotion of formula over breast has had unintended health consequences has resulted in regulation of infant formula advertising in developing countries. Unfortunately, this critical information does not always reach new  mothers. Increased and exclusive breastfeeding is a goal that requires continuous effort, here in the United States and around the globe.

An informal portrait of Ashley Chan.Ashley Chang is a senior at Millsaps College in Jackson, Mississippi. She is a history major and music minor. Ashley has worked for the ACLU of Mississippi as an archival intern, and for the Mississippi Department of Archives and History as a communications intern. She also serves as a Global Ambassador for the Millsaps Office of International Initiatives. She interned in the NLM Historical Audiovisuals Program during summer 2019.

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