Infant formula

 ( Milk ) 

• Mother's health: The mother is infected with HIV or has active tuberculosis. She is extremely ill or has had certain kinds of breast surgery, which may have removed or disconnected all milk-producing parts of the breast. She is taking any kind of drug that could harm the baby, including both prescription drugs such as Chemotherapy for cancer treatments, as well as illicit drugs.
• One of the main global risks posed by breast milk specifically is the transmission of HIV and other infectious diseases. Breastfeeding by an HIV-infected mother poses a 5–20% chance of transmitting HIV to the baby.WHO, UNICEF, UNFPA, UNAIDS. HIV transmission through breastfeeding: A review of available evidence. Geneva: World Health Organization, 2004. However, if a mother has HIV, she is more likely to transmit it to her child during the pregnancy or birth than during breastfeeding. A 2012 study conducted by researchers from the University of North Carolina School of Medicine showed reduced HIV-1 transmission in humanized mice, due to components in the breast milk. Cytomegalovirus infection poses potentially dangerous consequences for pre-term babies. Other risks include mother's infection with HTLV-1 or HTLV-2 (viruses that could cause T-cell leukemia in the baby), herpes simplex when lesions are present on the breasts, and chickenpox in the newborn when the disease manifested in the mother within a few days of birth. In some cases these risks can be mitigated by using heat-treated milk and nursing for a briefer time (e.g. 6 months, rather than 18–24 months), and can be avoided by using an uninfected woman's milk, as via a wet-nurse or milk bank, or by using infant formula and/or treated milk.
• In balancing the risks, such as cases where the mother is infected with HIV, a decision to use infant formula versus exclusive breastfeeding may be made based on alternatives that satisfy the "AFASS" (Acceptable, Feasible, Affordable, Sustainable and Safe) principles.de Paoli MD, Manongi RM, Klepp KI. Infant Feeding Options Recommended for Mothers with HIV: Are they acceptable, feasible, affordable, sustainable and safe? Int Conf AIDS. 2004 Jul 11–16; 15.
• Baby is unable to breastfeed: The child has a birth defect or inborn error of metabolism such as galactosemia that makes breastfeeding difficult or impossible.
• Baby is considered at risk for malnutrition: In certain circumstances infants may be at risk for malnutrition, such as due to iron deficiency, vitamin deficiencies (e.g. vitamin D which may be less present in breast milk than needed at high latitudes where there is less sun exposure), or inadequate nutrition during transition to solid foods. Risks can often be mitigated with improved diet and education of mothers and caregivers, including availability of macro and micronutrients. For example, in Canada, marketed infant formulas are fortified with vitamin D, but Health Canada also recommends breastfed infants receive extra vitamin D in the form of a supplement.

Other reasons for not breastfeeding include:

• Personal preferences, beliefs, and experiences: The mother may dislike breast-feeding or find it inconvenient. In addition, breastfeeding can be difficult for victims of rape or sexual abuse; for example, it may be a trigger for posttraumatic stress disorder. Many families bottle feed to increase the father's role in parenting his child.
• Mental health: The pressure to breastfeed in many cultures can be so much that the mother's mental health may take a sharp decline. This can have physical effects such as poor latching, as well as milk depletion and a lack of connection to the child. In some cases, the child should be formula-fed so that a better bond can be made between mother and child, rather than the 'special bond' that comes from breastfeeding being tainted by negative breastfeeding experiences. The pressure to breastfeed in many cultures can increase the likelihood of postpartum depression.
• Absence of the mother: The child is adopted, , abandoned, or in the sole child custody of a man or male LGBT adoption. The mother is separated from her child by being in prison or a mental hospital. The mother has left the child in the care of another person for an extended period of time, such as while traveling or working abroad.
• Food allergies: The mother eats foods that may provoke an allergic reaction in the infant.
• Financial pressures: Maternity leave is unpaid, insufficient, or lacking. The mother's employment interferes with breastfeeding. Mothers who breastfeed may experience a loss of earning power.
• Societal structure: Breastfeeding may be forbidden, discouraged, or difficult at the mother's job, school, place of worship, or in other public places, or the mother may feel that breastfeeding in these places or around other people is immodest, unsanitary, or inappropriate.
• Social pressures: Family members, such as the mother's husband or boyfriend, or friends or other members of society, may encourage the use of infant formula. For example, they may believe that breastfeeding will decrease the mother's energy, health, or attractiveness. Conversely, societal pressures to breastfeed can also lead to mental health issues. A sense of shame from not being able to or struggling to do so equalling being a failure, has a connection to Postpartum Depression
• Lack of training and education: The mother lacks education and training from medical providers or community members.
• Lactation insufficiency: The mother is unable to produce sufficient milk. In studies that do not account for lactation failure with obvious causes (such as use of formula and/or breast pumps), chronic lactation insufficiency affects around 10–15% of women. For about 5–8% of women, milk coming in (i.e., lactogenesis II) may not occur at all, and only drops are produced. Alternatively, despite a healthy supply, the woman or her family may incorrectly believe that her breast milk is of low quality or in low supply. These women may choose infant formula either exclusively or as a supplement to breastfeeding. New research is showing that mothers who report problems with milk production have physical markers indicating low milk production, calling into question the assumption (called "perceived insufficient milk supply" or PIMS) that mothers are incorrect about the quantity of milk they are producing.
• Fear of exposure to environmental contaminants: Certain environmental pollutants, such as polychlorinated biphenyls, can bioaccumulate in the food chain and may be found in humans, including mothers' breast milk.
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• However, studies have shown that the greatest risk period for adverse effects from environmental exposures is prenatally. Other studies have further found that the levels of most persistent organohalogen compounds in human milk decreased significantly over the past three decades and equally did their exposure through breastfeeding.
• Research on risks from chemical pollution is generally inconclusive in terms of outweighing the benefits of breastfeeding. Studies supported by the WHO and others have found that neurological benefits of breast milk remain, regardless of dioxin exposure.– cited in NRDCBrouwer, A., et al. Report of the WHO Working Group on the Assessment of Health Risks for Human Infants from Exposure to PCDDs, PCDFs and PCBs, Chemosphere 1998; 37(9–12): pp. 1627–1643. – cited in NDRC
• In developing countries, environmental contaminants associated with increased health risks from use of infant formula, particularly diarrhoea due to unclean water and lack of sterile conditions – both prerequisites to the safe use of formula – often outweigh any risks from breastfeeding.
• Lack of other sources of breast milk:
• Lack of wet nurses: Wet nursing is illegal and stigmatized in some countries, and may not be available. It may also be socially unsupported, expensive, or health screening of wet nurses may not be available. The mother, her doctor, "Breast-feeding and Guilt: Interview with a Mayo Clinic Specialist" or family may not know that wet nursing is possible, or may believe that nursing by a relative or paid wet-nurse is unhygienic.
• Lack of milk banks: may not be available, as few exist, and many countries cannot provide the necessary screening for diseases and refrigeration.