So often, breastfeeding advocates are met with the assertion that they're just trying to "make women feel guilty" for formula-feeding. Is this truly the case? Is guilt even the appropriate term?
First of all, let's look at guilt. In order to be guilty of something, you have to have done something wrong. In order to feel guilt, you have to be aware of it. Guilt implies not just wrongdoing, but the choice to do wrong. I don't think that guilt applies universally to women who don't breastfeed. Often, they should *not* feel guilty for that; though sometimes, they should.
Analogies often help, so I'll try one. When I was growing up, people believed that the cholesterol and saturated fats in butter were really, really bad for you, so my parents used margarine (which has no cholesterol and less saturated fat) with us instead. They didn't want to give us all the cholesterol and saturated fats in lard, so they used vegetable shortening. Now, current evidence suggests that the trans-fats present in partially-hydrogenated oils -- what margarine and shortening are made of -- are far, far more harmful than the naturally-occuring (but still not exactly healthy) cholesterol and sat. fats in butter. So it turns out that in giving us margarine and shortening instead of butter, my parents were actually doing something harmful to us, more harmful than what they were trying to prevent.
Should they feel guilty? No. They were doing the best that they could based on what was known then. As far as they knew, they were making the healthier choice for us. Now we know differently, and it would be natural for them to feel badly for having made that choice, but they shouldn't for one minute feel guilty for doing so.
Here's another. Consider Pop-Tarts® and related snacks. They're certainly not health foods; indeed, they contain partially-hydrogenated fats, simple sugars that break down quickly and can contribute to insulin resistance; and when eaten to excess, take up room in the child's diet that would be far better filled with healthier choices. If there are healthier choices available to me and I give my children Pop-Tarts® every morning anyway, knowing that they are contributing to potential health problems, should I feel guilty? Absolutely! However, if there were a natural disaster and all I could find to give them -- if all we had to live on -- were Pop-Tarts®, I would not feel the least bit guilty about giving them to my children. In the absense of healthier choices, they would keep them alive, and given the natural disaster, I'd far rather have them kept alive on unhealthy foods than starving to death.
So it goes with breastfeeding and formula feeding. Breastfeeding is our biological norm -- it's what babies evolved to eat (or were created to eat, if that happens to be your persuasion). As mammals, our breasts are there to feed babies (fringe benefits aside), and our babies are meant to have breastmilk when they are infants. Breastmilk changes from day to day, month to month, so that it's specifically crafted not just for the age of the child and her needs, but it also responds to immunological factors. Breastmilk contains thousands of compounds that ensure proper brain development, healthy gut development and flora, jaw alignment, teeth placement, and hundreds of other factors that are only now being discovered. Many of these will never be replicated by artificial milk, no matter how ingenious the scientists who work on it are trying, unless we get involved with recombinant bacteria, and even then, the immune benefits will be absent. So clearly, anything less than breastmilk will tend to have health effects on the infant -- that's just a fact. Many babies will do "fine" on artificial breastmilk, or appear to do so, just as a child who eats only Pop-Tarts® can still grow and be relatively healthy. But clearly, there's no comparison.
However.
Artificial breastmilk was invented to save the lives of babies whose mothers could not otherwise feed them -- babies whose mothers died in childbirth, or physically could not breastfeed them, for whatever reason. While it has always been held up as an "ideal" feeding method, many doctors in the mid-1900s gave it little more than lip-service, often examining a beaker of the mother's expressed milk and declaring it "unsuitable" for their infant; or they pushed feeding schedules that made it impossible for the breastfeeding dyad to grow into their nursing relationship. (Infants were expected to go 4 hours between feedings, and if they did not -- as one would rightfully expect, given that breastmilk is digested in 2 hours or less -- the mother was told that her milk was inadequate and she should switch to formula.) So essentially, an entire generation was raised on formula, and the societal knowledge of the normalcy of breastfeeding was lost.
Should that generation of parents feel guilty? I don't think so. They were doing what they thought was best, even if we know now that wasn't the case. They were deluded by a medical establishment that felt it knew better than nature did. It would be normal for them to feel badly about depriving their babies of breastmilk, and indeed, one does find that many women of that generation become defensive about feeding formula -- "You/your mother/your father turned out just fine!" -- and attempt to denigrate current knowledge of feeding practices. However, many are also apologetic and congratulate our generation's efforts -- "I'm sorry I wasn't able to breastfeed you/your mother/your father -- good for you for breastfeeding!"
How does this relate to current parents? Well, any woman who has made a small effort to become informed about the baby she's about to have (and every childbearing woman should, in my opinion) will come upon two points: one, that breastfeeding is the ideal; and two, if she doesn't want to, she's got her choice of hundreds of different formulas. Her doctor will probably tell her that breastfeeding is best, but formula is "just as good", and she's left thinking that while breastfeeding is a nice thing to do, it's no big deal if she decides not to. This is a tragic holdover from the 1950s, and also of the mentality that no one should "make mothers feel guilty" if they decide not to breastfeed.
(No doctor would tell a woman that she shouldn't bother quitting smoking while she's pregnant, yet the health effects of not breastfeeding are often just as stark. Unfortunately, few doctors, used to dancing around the guilt issue, will tell a woman that she should keep trying to breastfeed if she runs into problems. Sometimes it can be just as difficult to persevere in breastfeeding through cracked nipples, thrush, mastitis, and lack of sleep, as it is to quit smoking; yet there is considerable societal pressure to quit smoking during pregnancy, and very little to keep breastfeeding. Something is very wrong with this picture.)
A woman who does a little more research soon finds that breastfeeding isn't just a nice thing to do, it's tremendously important to her infant's current and future health. Statistics will tell her that babies who are formula-fed are statistically more prone to dozens of conditions, from asthma to diabetes to Crohn's disease. She will learn that formula is frequently recalled for bacterial infestations, that women in third-world countries are essentially duped into using it and then having their babies die from the polluted water that's used to make it, and that pharmaceutical companies pour millions of dollars into marketing formula, including giving it out "free" at hospital discharge. (Of course, nothing is free, and that one sample can turn into a year-long committment to that brand of formula, at a cost of many thousands of dollars to the parents.) She will quickly come to understand that there really is no choice -- she can give her baby the breastmilk that is its birthright, or she can give an inferior substitute.
And then the baby comes, and she may begin to experience problems. Her baby may not know how to latch on correctly -- and the nurses at her hospital may have no idea how to help her. She may get a "lactation consultant" who has had a few courses on breastfeeding, but has never nursed herself, or who has the attitude of "just stick them on the tit!" Her family may tell her, as she struggles, "Just give the baby a bottle -- it's so much easier, and you turned out just fine!" Her doctor agrees, saying that her baby needs a happy mother more than he needs breastmilk. And so she listens to all of them and stops trying, and gives her baby the bottle.
Should she feel guilty? I don't think so. She's had no support, no loving circle of women doing all they can to help her do what feels like it should come naturally. She's healing from the birth, exhausted, post-partum, with a crying baby and no one to tell her what is normal for her baby and herself. She doubts her own abilites because everyone around her is basically saying that she should give up, and is it any wonder if she does? She could stick it out, but it would mean battling not just the problems she's facing, but her whole environment. She may feel some guilt for not fighting both, but she is not fully culpable.
And then there's the young woman whose entire family formula-feeds. All her siblings were bottle-fed growing up; all her cousins bottle-feed their babies. It's all she sees, and all she knows. She's 17, still living with her mother, separated from the baby's father. Even if, against all odds, she learns that formula isn't as good as breastmilk, she has very little chance of successfully breastfeeding, as her whole family will essentially be against her. Should she feel guilty? I don't think so. She's barely got a choice in the matter.
Or consider the woman who tries and tries and tries, but she genuinely does not make enough milk, whether because of a genetic condition, a retained placenta, or a breast reduction. Her baby is losing weight, dehydrated, lethargic. Clearly she has to give him formula, or he will die. Should she feel guilty? Of course not! Her baby needs to eat, and even if it's not ideal, artificial substitutes were created for this very condition. The same would go for an adopted baby -- relactation is a wonderful gift to give an adopted baby, but it's just not physically possible for many women, and in this case, formula is being used for the purpose it was invented.
Guilt implies choice. Choice implies knowledge. There is no choice when you are forced to do something, and no choice if a given condition is the only thing you know.
Are there women who should feel guilty for not breastfeeding? In my opinion, yes. If there is no medical barrier (disease, medication, or other conditions) barring her from breastfeeding; if she is otherwise capable of breastfeeding; and she knows that breastfeeding is what she ought to do... yet she still, knowingly, chooses to feed artificial milk... yes, she should feel guilty. Because in that case, there was a choice, a knowledgable choice not to do what she knows is best for her child. I think guilt is entirely appropriate in that case, especially (but not only) if harm results. I am also of the opinion that a woman who does not educate herself should feel guilty later on; if you're bringing a baby into the world, you owe it to that child to make choices for it that will lead to a healthy life. A choice to formula-feed, all other things being equal, is not entirely the woman's choice to make: she has, presumably, chosen to have that baby, and in doing so, she makes the choice to give the baby its birthright, the best she can provide.
But for the many women who try their hardest and are still unable to succeed, or are not provided with the support that we evolved with (older women teaching younger women how to breastfeed)... there is no shame, and should be no guilt, in that. It is natural for those women to feel badly that they could not breastfeed, just as my parents feel badly that we were raised on trans fats, but they need not feel guilty. Sadly, it is the women who genuinely tried who most often feel guilty, yet they are not the ones who should. Grieve for the lost nursing relationship, yes; worry about the health consequences if they exist (and they may not, as the effects of artificial substitutes are found more on the statistical level than on the individual, as any number of "my baby turned out just fine" anecdotes will tell you); but do not geel guilty if you gave it your best.
No one can make you feel guilty -- you have to do that yourself. And guilt implies choice; choice implies knowledge. If there is no choice, there should be no guilt.