“Formula, Fries and Froot Loops”? MAHA Forgot Breastfeeding

Jacqueline H. Wolf

On March 25, 2025, a story appeared in the New York Times under the headline, “Formula, Fries and Froot Loops: Washington Bends to Kennedy’s ‘MAHA’ Agenda.” The “Make America Healthy Again” (MAHA) agenda, devised by the recently appointed secretary of Health and Human Services, Robert F. Kennedy Jr., focuses in part on children’s diets. Kennedy has lauded the “MAHA Moms” who follow him on social media and adhere to his advice on everything from food to immunizations.

The New York Times article begins by describing Kennedy’s meeting with a group of mothers at the White House. The group included Karoline Leavitt, Trump’s press secretary, who brought her 8-month-old to the meeting. With her infant on her lap, Leavitt complained to Kennedy that infant formula made in the U.S. is not as healthy as formula manufactured by European companies. She’s right. A recent study confirmed that many American-made formulas contain added sugars while European-made formulas contain only lactose, a naturally occurring sugar in milk. The finding triggered Kennedy to meet with the nation’s formula makers and subsequently announce a MAHA initiative he dubbed “Operation Stork Speed” to push for “safe, reliable and nutritious infant formula” in the United States.

Yet despite their concern about infant formula, neither Kennedy nor Leavitt mentioned that unsanitary practices persist at the Abbott Laboratories formula factory that was forced to shut down in 2022, causing a massive formula shortage. The Food and Drug Administration (FDA) is responsible for inspecting baby formula factories and Kennedy is the Trump cabinet member who not only ordered mass layoffs at the FDA he also appointed a corporate lawyer who once defended Abbott Laboratories against a lawsuit, to head the FDA division that oversees the baby formula industry.

If Kennedy is serious about improving infant and child health, what are his plans to increase the nation’s breastfeeding rates? What are his plans for cleaning up formula factories and strengthening, rather than weakening, the FDA? Public health campaigns in the late 19^th and early 20^th centuries to “Save the Babies” focused first and foremost on breastfeeding but also on working with dairy farmers to clean up the cows’ milk that was essential to the creation of the food for infants who had no access to human milk.

History of “formula”

In 1900, 13 percent of babies died before their first birthday; most often the cause of death was dehydration from diarrhea. Public health officials estimated that 15 bottle-fed babies were dying for each one breastfed baby who died. This was an era before pure food laws, when dairy farmers shipped cows’ milk in large, uncovered vats, permitting the milk to be adulterated with chalk to whiten it and plaster to make skimmed milk appear to be rich cream. After traveling for up to two days in unrefrigerated railroad cars, these vats ended up in local food stores where suspicious customers taste-tested the milk using a communal dipper that allowed tuberculosis, diphtheria, typhoid, and scarlet fever, among many other illnesses, to become milk-borne diseases.

Consequently, public health officials and visiting nurses traversed urban neighborhoods explaining to mothers the importance of breastfeeding. They placed signs on tenement buildings containing slogans such as, “Mother’s Milk for Mother’s Babe Cow’s Milk for Calves,” accompanied by eye-catching illustrations. Their effort was two-pronged, however. Worried about the infants with no access to human milk, pediatricians also formed milk commissions to work with dairy farmers to create the “certified milk” movement. Certification indicated milk was pasteurized and produced by a conscientious dairy farmer who adhered to local milk commissions’ rules.

Use of the word “formula” to describe infant food stems from this era when Thomas Rotch, a Harvard University pediatrician, unveiled his “percentage feeding” method. Cows’ milk contains far more protein and far less lactose than human milk and Rotch sought to “humanize” cows’ milk using mathematical formulas. Mothers would bring a prescription (the “formula”) to a milk laboratory where a chemist would alter the protein, sugar, fat, and ash in cows’ milk according to the dictates of the math formula that a pediatrician had written to address the health needs of a particular baby. “Sugar digestion weak” and “duodenal jaundice” were just two of dozens of diagnoses to be corrected by an individualized “formula.”

Every sizable city in the late 19^th and early 20^th century United States housed at least one milk laboratory. The first appeared in Boston in 1891. The extraordinary cost of percentage feeding—at 45 to 50 cents daily—put milk laboratory products out of the reach of all but the most well-off urban families.

Milk commissions run by pediatricians took up the slack, assuring that clean milk was available at the certified milk stations that dotted American cities, either at cost or free of charge. Milk commissions did not ignore breastfeeding though. Milk stations doubled as infant-care education centers where mothers learned the difference between bovine and human milk and the importance of breastfeeding infants.

Breastfeeding Today

Kennedy is ignoring the lessons learned more than a century ago. While we have pure food laws today, and formula largely is clean, nutritious, and safe, it is still not, and never will be, the bioactive substance that mothers’ milk is. In 2000, David Satcher, the U.S. Surgeon General under President Bill Clinton, authored the HHS Blueprint for Action on Breastfeeding in which he characterized breastfeeding as “one of the most important contributors to infant health,” and the low breastfeeding rates in the United States as “a public health challenge.”

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding—no other food, not even water—for about six months after birth. The AAP further advises that as mothers introduce “appropriate complementary foods” breastfeeding continue “as long as mutually desired by mother and child for 2 years or beyond,” a recommendation consistent with that of the World Health Organization’s. Yet in 2022, the last year for which we have comprehensive infant feeding statistics collected by the Centers for Disease Control (CDC), only 62.6 percent of new mothers exclusively breastfed in the hospital before discharge, only 24.9 percent were still exclusively breastfeeding six months later, and only 35.9 percent were still breastfeeding at 12 months. There is no record of how many American mothers were still breastfeeding at 24 months.

The CDC has tracked breastfeeding rates for years because there is a direct relationship between human milk and human health. The AAP cites extensive data confirming that many acute illnesses, such as middle ear infections, diarrhea, and lower-respiratory illnesses can be prevented or lessened in severity by breastfeeding. And, especially given Kennedy’s interest in preventing chronic illness, he should take note that chronic conditions, such as inflammatory bowel disease, childhood leukemia, type 1 diabetes, obesity, and asthma occur less frequently among children and adults who were breastfed as infants.

To highlight only one way that human milk protects human babies, at each feeding breastfeeding mothers share their mature immune systems with their immunologically inexperienced infants because the plasma cells that populate every adult’s small intestine contain the immunological memory for how to eradicate every gastrointestinal pathogen ingested over a lifetime. The cells move from the small intestine only when a woman lactates, migrating to her mammary glands where they are passed on to a breastfed infant.

Mothers who breastfeed have health benefits too. They have lower risks of developing type 2 diabetes; breast, ovarian, and endometrial cancers; and hypertension—all chronic conditions targeted by Kennedy.

But there’s good reason American mothers have lower breastfeeding rates than their counterparts in other wealthy countries. Among 41 countries, only the United States has no government-mandated paid leave from work for new parents. Estonia is the most generous country with 86 weeks of paid leave, Japan is fourth with 65 weeks, Norway is ninth with 50 weeks, Canada is 23^rd with 25 weeks, while American mothers are on their own with no legally required paid leave even though in 2023, 68.9 percent of American mothers with children aged 5 and under worked outside the home. Although the United States has a weak Family and Medical Leave Act that allows some eligible workers to take up to 12 weeks of unpaid leave after the birth of a child, there has never been any attempt to associate paid leave from work for new mothers with the health needs of their infants, despite the obvious benefits to society such a requirement would confer.

In a country with no government-mandated paid maternity leave, most mothers must rely on infant formula at some point in their child’s life. Thank goodness we have formula that is far safer than it was 125 years ago. But, as physicians recognized in the late 19^th century, any effort to make artificial food for infants more nutritious should be coupled with efforts to encourage more mothers to breastfeed and to encourage breastfeeding mothers to breastfeed longer. And one of the best ways to do that in the early 21^st century—to literally make Americans healthier—is to champion legislation mandating lengthy, paid maternal leave. Rather than compare American infant formula with European infant formula, let’s compare the lack of governmental support for new mothers in the United States with the generous paid leaves from work that new mothers receive in other countries. And for the mothers and babies who need formula, let’s rehire the FDA workers who are so essential to food inspection. And let’s not give FDA director jobs to food industry insiders. How about that, Secretary Kennedy?

Jacqueline H. Wolf is professor emeritus of Social Medicine, Ohio University.

Sources:

Sheryl Gay Stolberg, “Formula, Fries and Froot Loops: Washington Bends to Kennedy’s ‘MAHA’ Agenda,” New York Times, March 25, 2025.

Audrey R. Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, Tera L. Fazzino, “US infant formulas contain primarily added sugars: An analysis of infant formulas on the US market,” Journal of Food Composition and Analysis 141: (May 2025).

Post on X by HHS.gov, March 18, 2025, Operation Stork Speed announced, accessed April 7, 2025.

Heather Vogell, “Unsanitary Practices Persist at Baby Formula Factory Whose Shutdown Led to Mass Shortages, Workers Say, ProPublica April 4, 2025, Unsanitary Practices Persist, accessed April 7, 2025.

Centers for Disease Control and Prevention, Breastfeeding Report Care United States 2022, Breastfeeding Report Card US 2022, accessed April 7, 2025.

Joan Younger Meek, Lawrence Noble, and American Academy of Pediatrics Section on Breastfeeding, “Policy Statement: Breastfeeding and the Use of Human Milk,” Pediatrics 150(1) July 2022, AAP Policy Statement on Breastfeeding, accessed April 7, 2025.

Jacqueline H. Wolf, Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19^th and 20^th Centuries (Ohio State University Press, 2001).

Jacqueline H. Wolf, “What Feminists Can Do for Breastfeeding and What Breastfeeding Can Do for Feminists,” Signs (2006).

Jacqueline H. Wolf, “‘They Lacked the Right Food’: A Brief History of Breastfeeding and the Quest for Social Justice,” Journal of Human Lactation (2018).

U.S. Department of Labor, Bureau of Labor Statistics, “Employment Characteristics of Families 2023,” Employment Characteristics of Families 2023, accessed April 7, 2025.

Gretchen Livingston and Deja Thomas, “Among 41 countries, only U.S. lacks paid parental leave,” Pew Research Center, December 16, 2019.