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Tiny Feet, Large Footprint Features
Merel van Goor den Held
Photo: Destiny Tillery

A baby has tiny feet, but infant formula leaves a large footprint.

First published in Dutch, August 2015, in Down to Earth Magazine (Friends of the Earth, Netherlands) and translated into English by its author for Breastfeeeding Today.

The ecological footprint of infant formula is enormous and, what is more, it’s unnecessary according to The International Baby Food Action Network, (IBFAN). The choice between formula-feeding and breastfeeding, however, is hard-fought. In this discussion, the environment is rarely considered.

When you have just given birth, the environment might be the last thing on your mind. Hormones cause your world to revolve around your baby. Sometimes deliberately, sometimes involuntarily, many mothers choose to use infant formula. Worldwide, over 60% of all babies are being fed with artificial milk. Quietly, this decision has an enormous impact on the environment. While breast milk can be considered carbon neutral, infant formula possesses a very large carbon footprint.

Features_TinyFeetBigFootprint_FormulaForDisasterLast autumn IBFAN published a report on the effects of breast milk substitutes on the environment, “Formula for Disaster.” IBFAN argues that formula production uses a huge and unnecessary amount of precious resources and energy. The report evaluates what impact this billion-dollar industry has on the earth. And with a yearly production of 1.8 billion kilograms of infant formula (2010) this is not to be underestimated.

There are several varieties of infant formula. The most widespread is industrially processed cow’s milk with added nutrients. The infant formula industry is a part of the problems caused by large-scale dairy farming: deforestation, environmental degradation, and greenhouse gas emissions.

Carbon emissions

The production of one kilogram of powdered milk requires approximately ten liters of milk. IBFAN calculates on average that annually for the production of that single kilogram of powdered milk, 21.8 kg CO₂ is emitted. Multiplied by the annual worldwide production of formula, this amounts to 39.24 million tons of CO₂. To put this into perspective: that is more than 15 times the CO₂ cumulatively stored in the Dutch forests, or as much as the emission of 42.19 million flights from Amsterdam to New York.

“However, an exact figure for global CO₂ emissions resulting from the infant formula industry is not known,” says Alison Linnecar, author of the report, “partly because the CO₂ emissions per liter vary between countries. And although the composition of infant formula is established by law, it is impossible to determine what the actual percentage of powdered milk is that a kilogram of infant formula contains.” Infant formula consists of more than powdered cow’s milk alone, and the fats, sugars, and micronutrients that are added to the mix have their own environmental footprint as well. For example, soybean and palm oil are two main ingredients often used in infant formula, both of which potentially have a considerable impact on the environment. In addition, the number of food miles is high, as production takes place in only 40 to 50 plants in milk-producing countries.

The use of infant formula has an impact of its own as well, says IBFAN, sometimes in unexpected ways. First of all, you need clean water, fuel, a feeding-bottle, a teat. Less obvious is that the menstrual cycle of mothers who feed their baby with formula gets back on track quickly. Negligible? Not when you envision a supply of tampons and sanitary towels for more than one year multiplied by 136 million young mothers.

Child mortality

According to IBFAN, this impact is largely unnecessary. Is that true? If you ask the World Health Organization (WHO) and UNICEF, the answer is simple: yes. Besides a short list of medical conditions with which a breast milk substitute may be required, breast milk is always preferable to powdered milk. However, this has nothing to do with the environment, but with a different statistic: infant mortality.

According to UNICEF, breastfeeding is the first and foremost important preventive measure for reducing the mortality rate of children under five, of which presently nearly seven million die annually. The risk of dying in the first six months of life for babies who receive infant formula is 14 times higher. Both UNICEF and WHO emphasize that worldwide (not just in poor countries) at least 800,000 babies die each year as a result of  suboptimal breastfeeding management. They also argue that almost every mother can successfully breastfeed. The reality, however, looks quite different.

Enough milk?

TNO, a Dutch research institute, calculated that 80% of all mothers in the Netherlands start off by breastfeeding their babies. In the first few weeks, however, already two out of every eight mothers quit nursing, evaluated the institute this spring. Doubts about producing enough breast milk and problems with latching on play a large role in the sharp decrease of this number, says Patricia Schutte, spokesperson for The Netherlands Nutrition Centre (Voedingscentrum). “These doubts are unjustified,” says Schutte. “These problems can almost always be remedied with expert guidance,” she continues. The Netherlands Nutrition Centre is—in line with international health organizations—an advocate of breastfeeding. But surely there are also women that cannot produce milk? International Board Certified Lactation Consultant Gonneke van Veldhuizen-Staas explains: “There are no exact figures. The two percent that is often mentioned, is derived from biology and zoology. In addition, there are women who cannot or can only partially lactate as a result of breast surgery. Overall, this will remain under ten percent.” That is a lot less than the 60% worldwide currently choosing infant formula.

Working mothers in the Netherlands

There are more reasons than just biological ones to opt for powdered milk. In the Netherlands, mothers mention the problems associated with combining breastfeeding and work, for example. Regulations for feeding infants during working hours are defined in the Working Conditions Act and the Working Hours Act. Notwithstanding these regulations, we are not there yet. Mothers also mention concerns about remaining independent, dividing care equally with the father, and reluctance to feed in public, proving that many social and cultural barriers still exist.

The IBFAN report mentions that the information provided on infant nutrition in the media is often incomplete or distorted, being regularly provided by the manufacturer. Health workers are often influenced by the industry and frequently provide inadequate information, says IBFAN.

Milk nurses

Through the ages, the choice whether or not to breastfeed your baby yourself has been a matter of status, beauty ideals, and social developments in the labor market. Around 1850, historian Paul Doolan explains, technology became a third factor. The invention of powdered milk, baby bottles, and rubber teats coincided with a significant growth in dairy production, and the market expanded rapidly from foundlings and orphans to the democratization of the choice whether or not to breastfeed. Around 1960, newborns in America and England were fed for the most part with formula and mothers took lactation inhibitors, Doolan writes. Changes like urbanization and working indoors, further contributed to the booming success of infant formula.

Then the market expanded to poorer parts of the world, and not always in a decent manner, Palmer writes in The Politics of Breastfeeding: When Breasts Are Bad for Business. The “milk nurses” from manufacturers like Nestlé, Bristol Myers, and Dumex are a notorious example. They were saleswomen dressed as nurses, who in hospitals or at home advised young mothers. This proved to be very effective, because when a baby is fed with infant formula shortly after birth, milk production is not initiated adequately, resulting in dependency on a breast milk substitute. As a result of this practice, in 1970, 87% of Nigerian mothers used infant formula because they were under the impression that health professionals had advised them to do so. The consequence was a sharp increase in infant mortality.

These practices prompted WHO and its Member States in 1981 to establish the International Code of Marketing of Breast-milk Substitutes. The code has the status of an international recommendation. In addition, the Baby-Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, when international policy agreements were translated into ten recommendations for health care, including the directive that babies should not be given infant formula as a default principle. Yet these practices still prevail. Recently, in July 2015, Mead Johnson paid $12 million to settle allegations about bribery and influencing Chinese staff in government hospitals.


In the Netherlands, parts of the code are implemented in the Commodities Act on Infant Formulas, but for the remaining parts of the code, self-regulation is relied upon. The Food Safety Authority monitors compliance. Obviously formula companies continue to market their products albeit less conspicuously. Research grants, health advice, gifts, conferences, and training events are sponsored by the industry, Reaching the boundaries of the Commodities Act and the Code of Conduct, and sometimes crossing them. “We gather violations via a form on our website and report them to the Nederlandse Voedsel- en Warenautoriteit ” says Anke Tijtsma, Stichting Babyvoeding, Dutch IBFAN member. “We get five to eight cases per month.”

How intertwined the medical community and the industry still are in the Netherlands in 2015 is shown by the sponsored conferences for professionals. For example, a two-day Dutch conference, Oranjewoudconferentie offers “scientific quality supplementary education” targeting young doctors who work with infants and toddlers (0-4). The commission organizing this event: five doctors and a representative of Hero Baby. Another remarkable example is the Dutch Day of Maternity care: “On this day, the maternity carer can earn a good number of accreditation points.” Main sponsor: Nutricia. “These are also examples of code violations,” says Tijtsma. What’s more, babies are still sometimes fed with infant formula in Dutch hospitals, without the parents being consulted, while support with breastfeeding is seriously lacking, even in BFHI accredited hospitals.

What do the manufacturers say, confronted with this critique? “We welcome the existence of the code,” said Nutricia spokesperson Anja Timmermans. “We support breastfeeding, we find it important and we inform mothers about it.” Hugo Stienstra, corporate communication manager of Nestlé, wants to stay in conversation with IBFAN and writes that Nestlé supports mothers “by providing information and advising them in the daily care and nutrition decisions during pregnancy until the baby has grown into a toddler.” Both spokespersons indicate that they fully endorse the WHO recommendations. “However”, Timmermans states that formula can be a good alternative, adding that there is a need for “freedom of choice.”

Donor milk

The WHO,  meanwhile, mentions a different primary alternative to nursing: donor milk. Since the advance of formula, the official milk banks have closed their doors. But in recent years, milk donation is on the rise again, with 203 milk banks established in Europe, mainly in Scandinavia. Donor milk has its risks too, which can be obviated by screening donors and testing them for transmittable diseases. The milk is microbiologically tested, and often pasteurized. In conditions where testing of blood is impossible, for instance in remote areas in Africa, there is the ‘Pretoria’ or ‘Flash’ pasteurization. With this heating method, an HIV-infected mother can feed her baby with her own milk.

For some years now, the Mother’s Milk Network (Moedermelknetwerk) has been active in the Netherlands. This network connects donors to those in need of mother’s milk. “We try to make it as safe as possible by screening mothers and by offering a blood test. We have also developed a protocol for the treatment of the donor milk,” network founder Chella Verhoeven says. Within a short time this non-profit initiative was extended to 50 countries.

Could donor milk make infant formula obsolete? “We have noticed a large donor readiness. Yet milk banks and health workers expect that there would be a deficit,” Verhoeven says. What could help? “The blood test now costs 95 euros. If we were able to offer those more cheaply, or if health insurance would cover these costs, the threshold would become much lower.” The Netherlands Nutrition Centre finds that the focus should be to reduce the percentage of nursing mothers that quit breastfeeding in the first weeks. Ironically, a milk bank does exist in the Netherlands. This Breast Milk Bank of VU University Medical Center, however, clearly demonstrates the various interests and forces at play. “This is not actually a milk bank, but a research project. Only premature babies who participate in the survey have access,” Verhoeven says. “The incidence of sepsis and necrotizing enterocolitis, a life-threatening intestinal inflammation, of donor milk-fed infants is compared with infant formula-fed babies. But long ago it has already been concluded that these disorders occur less often with donor milk-fed babies. Incidentally, the donor milk in the study has also been enriched with a product based on cow’s milk.” Financer of the study: Infant formula producer Mead Johnson Nutrition. According to Stichting Babyvoeding, this is a violation of the WHO code, but under the Commodities Act it is allowed.

Impact on health and environment

Compliance with the code not only impacts public health, but also affects the environment. Although the IBFAN report is not the first publication on this subject, the size of the impact of infant formula is generally unknown. Google ‘Greenpeace’ and ‘babyvoeding’ and you will find a successful campaign to stop Nutricia packing their baby milk powder in paper from the destructive company Asia Pulp & Paper: an entire campaign without talking about the impact on deforestation of the milk powder itself. Milieu Centraal, a Dutch environmental research institute, talks about the impact of diapers, but not about the footprint of powdered milk. Friends of the Earth focus on improving dairy farming in general.

At the same time, breastfeeding organizations do not focus on the environmental aspects around breastfeeding. Simone de Kok, chairman of La Leche League Netherlands: “We help mothers with breastfeeding, the environmental aspect does not play a direct role.” “The environment is currently no argument for us,” says Karen van Drongelen, Secretary Platform Breastfeeding in the Netherlands Nutrition Center. Consequently, many mothers have no notion of the environmental aspect.

According to research on milk feeding of infants by Dutch research institute TNO, the environment does not occur on the list of most common reasons to breastfeed. Who does want us to know that they care about the environment? Nestlé and Nutricia. In their answer to our questions, these companies say they work towards sustainability in their production chain. Nutricia spokesman Timmermans adds that “the use of formula is inevitable and consequently there is some impact on the environment.” Stienstra, Nestlé, says, when asked about their use of palm oil: “At the end of 2014, 82% of our global volume could be traced back to the factory in the country of origin, 32% was grown and harvested in a responsible manner. That means that the oil comes from a plantation that at least meets the criteria of the Responsible Sourcing Guideline or that is at least committed to a continuous improvement.” And yes, there is even such a thing as carbon neutral, biodynamic formula. The Swiss producer Holle says it is the only producer of infant formula that offsets carbon dioxide emissions. The question of course remains whether certification of raw materials or carbon credits are solutions to problems created by an industry we can largely do without.

IBFAN indicates its intention to campaign at the climate summit in December. According to the activist group, it is critical that decision makers are aware of every factor that contributes to climate change. Are there plans to go to Paris from the Netherlands? Most breastfeeding organizations have very small budgets. Sometimes they consist entirely of volunteers. Stichting Babyvoeding has no finances to attend. “But,” as Tijtsma suggests, “it would be good to work together with environmental clubs to generate media attention in the run up to the summit.”


Baby Milk Marketing. Who Needs Who?

Green Breastfeeding

IBFAN: Report on carbon footprint due to milk formula April 22 2016

Merel van Goor den Held wrote “Tiny Feet, Large Footprint” both in Dutch, as a freelance journalist for Friends of the Earth Netherlands, and in English for Breastfeeding Today. She is the mother of two little girls and has been a La Leche League Leader since 2013.

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