“You’re not breastfeeding? Did something happen? It’s recommended for at least a year.”

That’s the question from a colleague who kindly asked me if I needed to pump about two weeks after I stopped giving Shanta breast milk and switched to formula. It was a time when I felt self-conscious about my decision, but also incredibly free. No more breast pump, no more waking up in the middle of the night to pump/feed, no more aching breasts, no more leakage. When I was done, I was done, it was the right decision for my mental and physical health, and my baby.

I felt ashamed after that question. I mumbled something and we moved on. I wish I could go back and stand confidently in that moment, so for that reason I’m writing this. It’s to all parents out there: however you feed your child, breastmilk or formula, it’s your decision and that’s okay.

Now, this whole post supposes that you have easy access to a clean water supply and funds to buy formula. The experience of low resourced countries without clean and running water is extremely different.

A lot of this stems from the Baby Friendly Hospital Initiative (BFHI). Beginning in the 1990s, the BFHI was a program endorsed by the WHO and UNICEF to provide resources and support to women to breastfeed. This is supported by data that suggests that more support/resources = more likely to breastfeed. This is great, because before it was hard to find support to do this super challenging thing that does take a lot of will and effort. I’m happy this is exists for women now. It’s also true that this can be a lovely bonding experience for some parents, and the first milk (colostrum) is jam PACKED with antibodies to help support baby’s immunity for the first weeks of life.

However, somewhere along the way we moralized the conversation. “Breast is best” became a thing. People started attributing all kinds of long term benefits to breast milk that were steeped in mediocre (at best) studies. On this Unfortunately, the BFHI became tied up with some mediocre studies that suggested that breastfed babies were less likely to develop obesity, high blood pressure, hospitalizations for infections, etc. Similarly, it suggested that mom’s that breastfeed were less likely to develop heart disease, diabetes, and even hip fractures! Praise all that is good, if this is true breast is milk is mana.

Of course this ignores the big, glaring difference in the women that breastfeed and the women that might not. Women that breastfeed in the US tend to be white or non-black minorities, wealthy, and with higher education. These are critical social determinants of health — the children of wealth and education tend to garner wealth and education.  It’s nearly impossible to “control” for these maternal factors in these observational studies (explained wonderfully by Dr. Emily Oster, PhD here).

So instead we can look at the largest randomized trial on breast milk vs not — the PROBIT trial. We learned about it in medical school — breastfeed promotion and resources is positively associated with increased rates of breastfeeding. This is excellent because resources = increased likelihood that parents that want to breastfeed will be able to. But, with regards to the additional findings, researchers followed the children out for years and looked at obesity, behavior issues, or IQ and found no notable differences between groups that were breastfed and those that weren’t.

So all of this to say — do what is best for you and your child, and rest easy with that decision. Whether you feed your child breast milk or formula made with clean water, what matters is your child is loved and fed, the rest comes out in the wash.