Why don't Gypsy and Traveller women breastfeed?

I came very late to the Channel 4 documentary series "My Big Fat Gypsy Wedding," having spent the last couple of months catching up on the two 2011-2012 series. The series itself was largely fluff--in the most literal sense, since it focused on traveler weddings and the enormous, puffy net-crinoline dresses that tend to be worn at these events--and much of the information on the program was wildly inaccurate, but it was still enough to get me interested in Britain's Travelers... and of course, to take a look at these groups through the lens of infant feeding politics.

(By the way, given the controversial nature of both Travelers and breastfeeding in popular culture, I'm wryly amused that I have somehow wound up discussing both issues together in the same article. Good job this post doesn't include discussion about pit bull terriers as well, otherwise it might just explode in an incendiary fireball of its own making....)

Britain's Travelers
The biggest nomadic groups in Britain today are Romani Gypsies and Irish Travelers. Romani gypsies (otherwise known as Romany, Rom or just plain "gypsies") trace their origins back to a group of nomads who left Northern India centuries ago and traveled through Europe, reaching Britain by about 1500. Irish travelers are the result of several waves of emigration from Ireland. Things get complex because the term "gypsy" is often used as a catch-all term covering both groups, while other people use "traveler" to mean Irish Traveler, as opposed to Romani Gypsy. In recent years, a new wave of "Roma" gypsies from Romania and Bulgaria--who come ultimately from the same roots as the English Romani--has arrived in Britain as well. Many people classified as Travelers, by the way, live in houses or other permanent accommodation and do not travel; others live on caravan sites but may travel for part of the year depending on work. Traveler men typically work in areas such as tarmacing, building, and scrap metal dealing. Women generally live within a carefully defined female sphere, marrying young (around 16-20), having quite large families and usually not working outside the home.

Travellers and breastfeeding
The word "gypsy" has a romantically Bohemian image, and indeed, a quick search for "gypsy breastfeeding" threw up a ton of results for whimsically-patterned baby carriers and cloth diapers. You could almost imagine yourself wandering around the hedgerows in a gypsy skirt and a gypsy baby-wearing wrap, breastfeeding your cloth-diapered gypsy baby and generally being at one with nature. All this is of course rather removed from the real lives of modern Romany Gypsies and Irish Travelers, who tend to go in for modern petrol-powered caravans, the swankiest prams they can afford, and cleaning everything with lots of bleach. They also almost always formula feed: in fact, Travelers have the lowest breastfeeding rates of any ethnic group in the UK. In a 2011 survey of Traveler women, breastfeeding rates were "2.7% at birth and 0% at six to eight weeks" (Pinkney, 2011 (*1)) while in "My Big Fat Gypsy Christening" (a babycare special that was broadcast in 2013), a midwife who had worked with Travelers for 30 years said that in that time she had only known a handful of women who nursed their babies. Low breastfeeding rates have been just one of several aspects of Traveller childrearing practices that have come in for criticism, the others including unhealthy diets, unsafe driving practices and the fact that many Traveler groups still remove children from schooling at around puberty. The MBFGW series and christening special certainly sparked off a lot of (mostly negative) online discussion (see here and here), though given the tendency for TV programs to sensationalize it is difficult to know how seriously to take the version of the Traveler lifestyle that the series portrayed.

Cultural taboos
Ethnological studies of Romani Gypsy and Irish Traveller women universally indicate quite negative attitudes towards breastfeeding among both men and women.

"It is viewed with contempt by these women and also by their partners. One traveler woman described it as ‘weird just weird, what would I do that for?’ Another woman claimed that even if she had wanted to, there was no way her husband would have permitted her doing so. Breasts for these women were associated more with ones sexuality rather that performance of breastfeeding. All of the women claim that they were made aware of the benefits of breastfeeding, however none of them expressed any desire to do so, nor to encourage other family members to do so. One woman claims that if she were to have a family member do so –‘she would be an embarrassment and a lot of people wouldn't want her around their families if she was doing that sort of thing’." (*2)

 "The aversion to 'personal' matters may play a part in the very poor breastfeeding rates among Gypsy and Traveller women. Okely [10]  found social taboos to be the main reason women did not breastfeed: "We wouldn't let a man see. That's filthy'"(p208). None of the women interviewed breastfed any of their children and the taboo, perpetuated by oral tradition, impacts greatly on their health at all ages." (*3)

“I don’t like the thought of [breastfeeding] and I was not gonna get my bits [sic] out." (*4)

Why has breastfeeding become so taboo among British Traveler women? Travelers (Romani and Irish) have for centuries observed strict rules about bodily decency--including taboos on premarital sex, elaborate codes of cleanliness in which pets and toilets are kept separately from living quarters, and beliefs about the polluting nature of childbirth and menstruation. Modern British Traveler culture seems to have put breastfeeding into the same sort of category--a shaming and disgraceful display of the breasts.  And yet this can hardly be a truly traditional attitude--if one goes back a couple of generations or more breastfeeding surely must have been the norm among Gypsies and Irish Travelers, because until quite recently rearing a child "by hand" was something close to a death sentence (even without the vagaries of a traveling lifestyle). Indeed, among many Romani-related ethnic groups outside the UK (*5-*8) such as the Eastern European Roma, breastfeeding has remained the norm; in fact, Roma women from these countries are well-known for breastfeeding openly in public, even with toddlers.

I don't know when breastfeeding stopped being the norm among British Gypsies and Irish Travelers. I'm guessing that what happened is at some point in the 20th century, after bottle-feeding had become normalized among white working-class British women (who continue to this day to bottle-feed almost universally), the custom probably spread to Traveler women, and has since come to seen as a social norm and as an ethnic marker--hence the remarks in the ethnological literature about how "we Travelers don't breastfeed." Travelers have their own peer group norms and see themselves as being culturally distinct from settled people--a fact hinted at by the fact that most Irish Travelers retain their Irish accents generations after leaving Ireland.

I just want to emphasize this, because a lot of public conversation about breastfeeding--especially in the United States--tends to focus strongly on the idea of "everyone wants to breastfeed, but economic barriers get in their way, such as inability to afford time off work, lack of maternity leave and pumping rights, and lack of access to healthcare professionals." But Traveler women still generally choose formula even though they do not usually face work/mat. leave-related barriers and the majority (90%) of the women surveyed by Pinkney cheerfully agreed that breastfeeding was cheaper than formula feeding. Poor women and women from disadvantaged ethnic groups (just like relatively privileged women) aren't solely motivated by monetary considerations, nor are socio-economic barriers the only reason why they may not do certain things; cultural identity, desire for status, personal preferences and what their friends do may also be important factors. As the saying goes, "Culture matters."

(By the way, I'm strongly in favor of things like universal access to maternity leave, pumping rights and all the other things, for various reasons--but if US lactivists are under the impression that bringing these things in will result in breastfeeding becoming the norm across America, they are probably in for a big disappointment. Just saying.)

Which is easier--breast or bottle?
Given that most Traveler women don't work outside the home and may sometimes lack access to running water and electricity required for making up bottles, it's somewhat surprising to see that 65% of the women surveyed by Pinkney (strongly) agreed with the statement "Bottle feeding is easier than breastfeeding," while 60% (strongly) disagreed that "Breastfeeding is easier than bottle feeding."

It's still common in many Traveler communities for kids to be removed from schooling at around age 12 or so (having often attended only sporadically before that); girls are expected to take on much of the housework and babysitting work from an early age. Traveler sites where this is still the custom consequently tend to resemble the kind of villages you get everywhere in the world where mass schooling hasn't been developed yet--where kids keep an eye on their siblings and cousins, and every girl seems to have a baby/toddler on her hip. The thing about breastfeeding is, it's only more convenient if you are at home alone with your baby and you are responsible for most of the childcare yourself. If you always have a lot of childcare in the form of older kids, bottle-feeding does tend to be the easier option; you can easily leave the baby with anyone.

We have loads of people come round and the baby would have starved cos I wouldn’t have fed it with people there or husband. That’s wrong.

I just couldn’t try it. I know it's good for the baby but we don’t do things like that and we have so many family coming round... the men would have had to stay out of the house.

Virtually all women who breastfeed are adamant that the first few weeks of breastfeeding, well, suck. You sit there hour after hour, your breasts hurt, and many women find books and web surfing are a lifesaver for getting through this difficult period (I maintain that the arrival of the World Wide Web has been a huge factor behind the increases in breastfeeding rates in most developed countries in the last couple of decades). Conversely, low levels of reading ability among many Traveler women make it harder to use the Net as a place to get advice and encouragement or simply to have someone to talk to when you've been by yourself for hours on end. Combine this with cultural taboos that make women embarrassed to nurse around other people, and it's no wonder the few women in the Pinkney survey who did initiate breastfeeding dropped it after a few weeks.

Health Promotion England (2000) acknowledges that many families initially find breastfeeding difficult however it tends to improve and becomes easier with time, patience and perseverance. It is therefore possible that Gypsy and Traveller women which have historically initiated breastfeeding may have stopped due to early difficulties and then verbalised their problems associated with early breastfeeding to other Gypsy and Traveller women. Research by Dion (2008) highlights that in the Gypsy and Travelling community there is a “strong oral tradition” (p33) and information is readily passed verbally from one generation to the next. This process if negative would therefore reinforce the belief amongst the Gypsy and Traveller community that breastfeeding is difficult. (*1)

It's one of the curious paradoxes of infant feeding culture that breastfeeding (generally seen as "natural") has seen a revival in modern times at least partly as a result of the technological revolution of the internet, while bottle-feeding has most likely remained strongly entrenched among Travelers at least in part because Travelers remain one of the few modern peoples who maintain a strongly oral culture.

A way forward
Pinkney's survey concludes that "In general the attitude scores provided evidence that the community [i.e. Travelers] would benefit from receiving more information on the health benefits of breastfeeding" and suggests that providing more information on this might result in more Traveler women initiating and persisting with breastfeeding. I confess to being a little skeptical about this. For one thing, other discussions about infant feeding among Travelers (see the Bromley paper linked below) suggest Traveler women are already getting plenty of information on this score, with many receiving considerable pressure to breastfeed from National Health Service (NHS) nurses.

"They kept on at you about that. They tried to push you into it. I didn't want to. They kept on about it." (*4)

"I would rather they let you have the choice but they make as if you have to. They made me feel bad and they wouldn't even tell me where the formula was kept." (*4)

Meanwhile, in Pinkney's survey a full 45% of women agreed with the statement that "Breastfed babies are healthier than bottle fed babies," while 50% agreed that "Breast milk is more easily digested than bottle milk."

Thing is, though, there's a big jump between "knowing that XYZ is, all things being equal, a little better," and "being determined to actually do XYZ no matter what it takes." I know perfectly well that (for example) having babies in one's twenties is better than doing so in one's thirties, yet I delayed childbearing till 32 and would do the same again if I had the chance to do things over. I wouldn't have wanted to become a mother in my twenties (I had too much traveling to get out of my system, for a start) and quite honestly, no amount of well-meaning "education" from healthcare workers would have changed my mind about something I felt this strongly about. Culture matters. Of course, the interesting thing is in terms of the age at which they first get pregnant, Traveler women (who typically start their families at around 19 or 20) are actually far closer to the medical ideal and biological norm that the average British woman, who probably doesn't get started till 30 or so. Let's face it though--popular culture and the healthcare profession tend to be a lot more forgiving about "slightly-less-than-100%-optimal" mothering decisions that are popular among educated women (such as delaying motherhood until later in life) while tongue-lashing mothering decisions that are attended with a similar level of risk which happen to be common among young working-class mothers or (shall we say) less-than-popular ethnic groups.

That said, I don't want to be completely gung-ho about Traveler women's preference for bottle-feeding. For one thing, while the benefits of breastfeeding are probably modest in developed country environments, some Traveler women effectively live in the twilight zone between developed and developing world due to intermittent access to running water and electricity (*9). Indeed, it's surprising that things like gastroenteritis are not more of a problem (though Travelers' famously high standards of cleaning are probably helpful in warding off the worst problems). Infant mortality rates among Traveler infants certainly are strikingly high (*10), though it appears that much of this is due to congenital problems caused by high rates of consanguinity. But there is also substantial evidence of sub-optimal bottle-feeding practices in Traveler families, such as feeding young babies cow's milk, or allowing toddlers to walk around sip-feeding off bottles all day long, sometimes filled with sweet drinks and other inappropriate substances, which can cause serious dental and nutritional issues (*11).

It might be more practical for NHS healthcare workers to put their focus on giving young Traveler mothers clearer information about sound bottle-feeding practices (not giving babies cow's milk at too young an age, making up formula correct as per the manufacturer's directions, not filling bottles with sweet drinks or putting children down to sleep with bottles, and bottle-weaning at appropriate ages). Although breastfeeding might in many ways be a more logical choice for women who do not work outside the home and sometimes lack access to the things that make bottle-feeding safe and feasible, the reality is that cultural practices are hard to change, especially when they have become an ethnic marker for a particular group. Putting strong pressure on Traveler women to breastfeed effectively presents them with a choice between maternal guilt and social isolation, increasing the vulnerability of a group of women who already struggle with low social and economic status. Resentment inspired by such pressure could also make Traveler mothers less receptive to taking on advice about more urgent matters such as vaccines, well-baby checks, hearing tests and optimal bottle-feeding practices themselves. Given the sometimes fraught relations that have long existed between Britain's Travelers and the settled community, a pragmatic approach is surely best for safeguarding Traveler children's welfare.


Further reading

*1: The infant feeding practice of Gypsy and Traveller women in Western Cheshire Primary. Care Trust and their attitudes towards breast and formula feeding

*2: Irish Traveller women (Ellen D'Arcy)
*3: Gypsies and travellers: cultural influences on health
*4: The Experience of Maternal Health services by the Bromley Gypsy Traveller Community
*5: Taboo and shame (Ladž) in traditional Roma communities
*6: Social exclusion at the crossroads of gender, ethnicity and class. A view through Roma women's reproductive health
*7: Risk factors for childhood malnutrition in Roma settlements in Serbia
*8: Purity and impurity in the traditional Romani family
Gypsies and Travellers: Their lifestyle, history and culture
*9: The big fat truth about Gypsy life (Guardian)
*10: Traveller infant mortality is persistently higher than the general population in the All Ireland Traveller Birth Cohort study
*11: Child Poverty Relating to Gypsy and Traveller Children and Young People in Sussex 

It didn't seem to fit anywhere into this discussion, but I was interested to stumble across the somewhat random fact that the condition known as galactosemia (where the baby cannot digest lactose and must be fed with a soy formula) is particularly common among Traveler infants, probably as a result of consanguinity. See here: http://en.wikipedia.org/wiki/Galactosemia

Homemade formula and the Weston A. Price bust-up

It's always kind of interesting when crunchy people fall out with each other (you know, like elimination communication fans vs. let-your-child-sit-in-diapers-till-they're five-if-they-want-to people... that kind of thing). The latest bust-up--if you'll pardon the pun--concerns the Weston A. Price Foundation (WAPF) vs. breastfeeding advocates.

WAPF is a kind of nutritionist movement that's been around for decades, and which advocates for "traditional foods"--organic everything, lots of animal products and lots of fermented/home-processed foods, from konbucha to bone broth to a yohurt-like product called kefir. It also advocates making homemade formula. Some breastfeeding advocates have become suspicious of WAPF in recent times, claiming that WAPF proponents are too quick to push homemade formula recipes on struggling mothers, rather than getting to grips with their latch issues, tongue ties, lack of support and so on. In the most extreme form, some WAPF advocates have stated that WAPF homemade formula can be better than breastmilk... if the mother eats an imperfect diet, and especially if she's vegan. WAPF doesn't actually sell its formula, obviously (this formula has to be made freshly), but it does encourage followers to purchase ingredients from a sponsor company called Radiant Life, which sells $170-$400 kits containing one to six months' worth of the supplements and powders needed to make the formula at home.

I don't always agree with Best For Babes but I think their piece on the WAPF thing got it more or less right. Full-on malnutrition can affect breastmilk quantity and quality, but this is rare in developed countries. In spite of its hippy image, woo/crunchy stuff/pseudoscience is often big business, and WAPF may well be subtly encouraging homemade formula use because it's in its business interests to do so, no different to Similac or Cow & Gate. Women who want to breastfeed would therefore be advised to be wary. Incidentally, this is not really about whether we think formula is wonderful, evil or something in between; it's because it behoves us to maintain a proper degree of skepticism concerning the advice given by anyone who is trying to sell us stuff. I mean, I use disposable diapers and wouldn't want to live in a world where they didn't exist; however, I have no intention of getting my toilet-training advice from a Pampers helpline. After all, businesses are businesses, not charities; it ought to be possible for us all to take advantage of their products appropriately and take what they say with a good pinch of salt.

However, amid all this talk, there's actually been very little discussion of the homemade formulas themselves. So I thought I 'd talk about that.

How to make formula (quick explanation)
Bit of background: You can't give straight cow's milk to young babies as a main drink because it's pretty different from human milk. Too much protein, for a start. Also, there are two types of protein in all animal milks: casein and whey protein. Human milk is about 30:70 casein-to-whey, while cow's milk is more like 80:20. All that casein's hard for a baby's belly to digest. The resultant stress on the intestines causes microscopic bleeding, which can add up to quite a lot of blood loss. Now, there's hardly any iron in cow's milk, which tends to cause anemia, and that gradually accumulating blood loss makes things even worse. Cow's milk also has too much sodium, and not enough carbohydrates. (It's a similar story for goat's milk, by the way, despite the urban legends about how it's supposedly similar to mother's milk)

Formula companies therefore process cow's milk and add things and take things away to make it more similar to breastmilk. Not the same, mind you; many nutrients are better absorbed and more useable ("bioavailable") in breastmilk than they are in formula, and the storage and preparation of formula may cause loss of some nutrients. So in order for the formula-fed baby to get the same amount of, say, calcium as the breastfed baby, you may actually have to create a formula with more calcium in it than breastmilk.

Now, the WAPF formulas purport to do the same thing--just on a homegrown scale. The website lists three types of formula--cow's milk-based, goat's milk-based, and liver-based--and explains the ingredients and preparation method for each. There is also a nutritional chart comparing what's in them (maddeningly, however, it uses ounces which makes it difficult to compare with scientific data on formula composition).

Protein
Now, the WAPF cow's milk and goat's milk formulas are certainly better than the crude recipes your grandma might have used--the sort where you just watered down evaporated milk and then bunged in a bit of sugar. Like commercial formula, the WAPF recipes get you to "rebalance" the casein-whey ratio, by making a separate batch of curds-and-whey (remember Little Miss Muffet?) and then adding some of that whey into your formula mixture. The actual amounts of protein also turned out to be comparable with commercial formulas, when I checked. So far, so good.
UPDATE: I've had a chance to read through some of the materials linked to me by Becky (the commenter below) on cow's milk in the first year. Cow's milk protein in the first year irritates the intestines and causes occult enteric blood loss in babies, meaning that their stools contain unusually large amounts of blood when examined. This over time can add up to substantial blood loss, greatly increasing the risk of iron deficiency anemia, which is strongly linked with mild cognitive problems later on in life. In commercial formulas, these milk proteins are heat-treated, making them easier to digest and minimizing blood loss. As I discuss below, the WAPF milk-based formulas are already low in iron; the fact that they contain elements which could cause the baby to loose what little iron they have must be considered a further strike against using such concoctions. And I think this also ties in with what I talk about in the final section--that when it comes to infant formula, processing is generally a good thing.

Raw milk
It is concerning, however, to see that WAPF is advocating raw (unpasteurized) milk for babies. When a person consumes raw milk, there is a small but real risk of infection which can have very serious consequences including organ failure, as the Real Raw Milk Facts website explains--no matter how clean the milking barn is. And most adults who drink raw milk are only having the odd glass. A baby is getting many bottles of milk a day--the chances of coming across a bad batch sooner or later are going to add up fast.

Sodium
One reason you shouldn't feed straight cow's/goat's milk in lieu of formula/breastmilk is their high sodium levels--about 430mg per 36oz (compared to breastmilk's 180mg). Commercial formulas, when I did the calculations, ranged from 180-360mg per 36oz. So the sodium levels in WAPF's milk-based formulas--308-320mg--seem to be fine.

Iron
Breastmilk iron is unusually bioavailable--there doesn't need to be a lot of it. Formulas need more iron in order for baby to get enough. Commercial ones usually have around 3.5mg per 36oz in the case of low-iron formulas, and up to 14.5 mg in the high-iron types. WAPF's cow's milk and goat's milk formulas, however, contain only 1.4mg and 2.2mg per 36oz, respectively, which looks rather low to me. The WAPF does emphasize that parents should start egg yolk feeding at 4mo, which will certainly help, but I wonder how the baby is supposed to manage till then--or what happens if your baby just can't take a spoon at 4mo.

Vitamin A
Perhaps mindful of the low iron levels in its other formulas, WAPF have come up with a third formula--"Liver based." You make this one by grating raw liver into meat broth, plus vegetable oils and other things. This formula has more iron in it (and it's haem iron, which is well absorbed).

Unfortunately, the liver means it has potentially toxic levels of Vitamin A as well. 20,000iu of Vitamin A per 682 calories means 2,933iu per 100kcal; meanwhile, "Toxic manifestations have been reported in infants when the daily intake was 2,100 iu/100 kcal or higher." I can't really imagine that very many people are actually going to bring themselves to feed their baby a pureed liver concoction all day long, but I do think it's a bit scary to think that if you followed WAPF s instructions to the letter, you could risk poisoning your child. Of course, a few decades ago, mega vitamin doses were very much the thing; I remember my mum's Adelle Davis books recommending that readers take some truly scary amounts of Vitamin This and That. Since then, the pendulum has swung very much towards recommending low doses of vitamins only; high doses of Vitamin A in particular have come out very badly in recent times, including concerns about teratogenicity (birth defects) in pregnant women; that's why pregnant women are supposed to take prenatals (with special low Vitamin A) rather than normal vitamins.

Other nutrients
Most of the micronutrients in the formula seemed to be higher than comparable amounts in commercial formula, when I did a comparison. One or two--like Vitamin E--were lower. Other than the scary liver-Vitamin A thing, I can't see anything here that would cause acute toxicity.  Still, from a long-term perspective, I think I'd rather feed my baby something where the levels of all these nutrients have been balanced reliably and consistently to just the right levels, based on research by dietitians.

The advantage of manufacturing formula using artificial vitamin and mineral drops and powders is that if you want to add exactly such-and-such amount of, say, manganese, you can go ahead and do just that. When you use natural materials, anything you add tends to come packaged with other nutrients, which then throws the mixture's balance off. Like... okay, one can boost the iron content of a formula by adding liver. But that iron comes bundled up with way too much Vitamin A. Or, perhaps we could bump up the rather low vitamin E level by adding more vegetable oil? But then the mixture might face composition/texture problems such as excessive oil separation. We could add something else to deal with the separation issue... but then you're inadvertently adding other nutrients. And so on. And the more steps and ingredients you have, the more opportunities for errors. I just think it's going to be really, really difficult to produce a well-balanced and foolproof formula on a home-kitchen scale.

Margin for error
Honestly, though, in a way the recipes themselves are less scary than the comments below. People saying stuff like "We have been using the cows milk formula and have replaced the yeast with vitamin b and maple syrup..." "My bottle of yeast flakes was crushed entirely in my check-in luggage; is yeast flakes absolutely required for this recipe or can I do without it for 3 weeks?" "I have been feeding our adopted newborn the goat milk formula since he was 3 weeks old. I did not realize that I was supposed to wait on giving him the cod liver oil until he was 3 months old. Have I done something dangerous to his health?" "I increased the cream by a tablespoon because he is a big boy..." "How about coconut nectar from the company called coconut secret? Just ideas....." "I noticed that it had curdled almost, more like became gelatinous...is this suppose[d] to happen?" Seriously, people, why are you even asking these questions? This is your baby's lifeblood we are talking about, not a fun baking experiment. The newborn period is a time when most of us feel like we deserve a round of applause just for getting a simple meal cooked. Creating formula using all these elaborate rules when you are sleep deprived seems like an invitation to disaster (especially when one considers how many parents make errors even with commercial infant formula preparation).

The food that breaks the rules
Formula breaks all the rules of normal food. We all know these rules: "Cook food at home," "Use real produce," "Eat fresh food," "Try to eat foods with as short an ingredients list as possible" and so on. But formula is a food with a unique job to do: it's got to mimic a natural food (breastmilk) as closely as possible. So the processing that commercial formula undergoes and the long list of ingredients on the package are good things; they make the formula more like breastmilk and less like cow's milk. A simple homemade formula using fresh materials is likely to behave less like breastmilk, and is therefore less suitable for a baby.

To be fair, the WAPF's milk-based formulas (as opposed to the scary liver puree thing) don't look to me like they could induce toxicity in an infant, which fits in with the fact that many people do use these formulas and their babies seem perfectly alright...although to be honest, the impression I get from the comments on the WAPF page is that the greater part of parents using homemade formula are doing so as a supplement for a predominantly breastfed infant rather than as a full-time thing, which would greatly reduce the risks. In a situation where commercial formula and donor milk weren't available (and yes, this can happen: after the earthquake in Japan around the time I gave birth, formula started disappearing from the shops due to distribution problems and panic-buying) I have no doubt that something like the WAPF cow's milk formula, with pasteurized milk, would keep baby ticking over OK until supplies resumed. However, I'd really question the utility of using homemade formula by choice in peacetime conditions.

The optimal milk drink for a baby is breastmilk, but if a mother can't nurse or prefers not to, I think the next best thing is a commercial infant formula correctly made up. Buy a tin and follow the instructions on the label. Done. This is one of those pleasantly hedonistic moments in childrearing where the easiest approach is actually the best and safest too. Making your own formula falls into that interesting category known as "Putting a lot of effort into actually making your parenting worse." It's complicated, there's no evidence it's any better, and there's at least some indications that it may be less well balanced and riskier.


Further reading

*Best For Babes's take on the WAPF bust-up
http://www.bestforbabes.org/from-karo-syrup-to-goat-milk-the-formulas-may-change-but-the-booby-traps-remain-the-same

*More discussion at Unlatched
http://unlatched.wordpress.com/2013/04/02/the-weston-a-price-foundations-dangerous-breastfeeding-advice-should-not-be-ignored/

*Vitamin A toxicity
http://www.medceu.com/index/index.php?page=get_course&courseID=3903&nocheck

*Commercial formula composition
http://www.espghan.med.up.pt/position_papers/con_23.pdf

*Real Raw Milk Facts website
http://www.realrawmilkfacts.com/raw-milk-hot-topics

*Cow's milk induced intestinal bleeding in infancy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1029246/pdf/archdisch00547-0084.pdf