Throughout history, mothers who could not breastfeed their babies either employed a wet nurse or, less frequently, prepared food for their babies, a process known as “dry nursing”.Baby food composition varied according to region and economic status. In Europe and America during the early 19th century, the prevalence of wet nursing began to decrease, while the practice of feeding babies mixtures based on animal milk rose in popularity.
This trend was driven by cultural changes as well as increased sanitation measures, and it continued throughout the 19th and much of the 20th century, with a notable increase after Elijah Pratt invented and patented the India-rubber nipple in 1845. As early as 1846, scientists and nutritionists noted an increase in medical problems and infant mortality was associated with dry nursing. In an attempt to improve the quality of manufactured baby foods, in 1867, Justus von Liebig developed the world’s first commercial infant formula, Liebig’s Soluble Food for Babies. The success of this product quickly gave rise to competitors such as Mellin’s Infant Food, Ridge’s Food for Infants and Nestlé’s Milk.
Raw milk formulas
As physicians became increasingly concerned about the quality of such foods, medical recommendations such as Thomas Morgan Rotchs “percentage method” (published in 1890) began to be distributed, and gained widespread popularity by 1907. These complex formulas recommended that parents mix cow’s milk, water, cream, and sugar or honey in specific ratios to achieve the nutritional balance believed to approximate human milk reformulated in such a way as to accommodate the believed digestive capability of the infant.
At the dawn of the 20th century in the United States, most infants were breastfed, although many received some formula feeding as well. Home-made “percentage method” formulas were more commonly used than commercial formulas in both Europe and the United States.They were less expensive and were widely believed to be healthier. However, formula-fed babies exhibited more diet-associated medical problems, such as scurvy, rickets and bacterial infections than breastfed babies. By 1920, the incidence of scurvy and rickets in formula-fed babies had greatly decreased through the addition of orange juice and cod live oilto home-made formulas. Bacterial infections associated with formula remained a problem more prevalent in the United States than in Europe, where milk was usually boiled prior to use in formulas.
Evaporated milk formulas
In the 1920s and 1930s, evaporated milk began to be widely commercially available at low prices, and several clinical studies suggested that babies fed evaporated milk formula thrive as well as breastfed babies
These findings are not supported by modern research. These studies, accompanied by the affordable price of evaporated milk and the availability of the home icebox initiated a tremendous rise in the use of evaporated milk formulas. By the late 1930s, the use of evaporated milk formulas in the United States surpassed all commercial formulas, and by 1950 over half of all babies in the United States were reared on such formulas.
Commercial baby formulas
In parallel with the enormous shift (in industrialized nations) away from breastfeeding to home-made formulas, nutrition scientists continued to analyze human milk and attempted to make infant formulas that more closely matched its composition.Maltose and dextrins were believed nutritionally important, and in 1912, the Mead Johnson Company released a milk additive called Dextri-Maltose. This formula was made available to mothers only by physicians. In 1919, milkfats were replaced with a blend of animal and vegetable fats as part of the continued drive to closer simulate human milk. This formula was called SMA for “simulated milk adapted.”
In the late 1920s, Alfred Bosworth released Similac (for “similar to lactation”), and Mead Johnson released Sobee. Several other formulas were released over the next few decades, but commercial formulas did not begin to seriously compete with evaporated milk formulas until the 1950s. The reformulation and concentration of Similac in 1951, and the introduction (by Mead Johnson) of Enfamil in 1959 were accompanied by marketing campaigns that provided inexpensive formula to hospitals and pediatricians. By the early 1960s, commercial formulas were more commonly used than evaporated milk formulas in the United States, which all but vanished in the 1970s. By the early 1970s, over 75% of American babies were fed on formulas, almost entirely commercially produced.
When birth rates in industrial nations tapered off during the 1960s, infant formula companies heightened marketing campaigns in non-industrialized countries. Unfortunately, poor sanitation led to steeply increased mortality rates among infants fed formula prepared with contaminated (drinking) water. Organized protests, the most famous of which was the Nestlé boycott of 1977, called for an end to unethical marketing. This boycott is ongoing, as the current coordinators maintain that Nestlé engages in marketing practices which violate the International Code of Marketing of Breast-milk Substitutes.
Generic brand baby formulas
In additional to commercially marketed brands, generic brands (or store brands) of infant formula were introduced in the United States in 1997, first by PBM Products. These private label formulas are sold by many leading food and drug retailers such as Wal-Mart, Target, Kroger, Loblaws, and Walgreens. All infant formula brands in the United States are required to adhere to the Food and Drug Administration (FDA) guidelines. As reported by the May Clinic: “as with most consumer products, brand-name infant formulas cost more than generic brands. But that doesn’t mean that brand-name [Similac, Nestle, Enfamil] formulas are better. Although manufacturers may vary somewhat in their formula recipes, the FDA requires that all formulas contain the same nutrient density.”
Similarly, in Canada all infant formulas regardless of brand are required to meet standards set by Health Canada.
Follow-on and toddler formulas
In the 1980s and 1990s, some companies introduced formula versions for older children, generally marketed for use from age 12 months up to about 2 or 3 years, under such terms as “follow-on formula” and “toddler formula”. This was done partly because the market for infant formula (generally up to age 6 or 12 months, when infants are typically breastfeed) was considered largely saturated, and in conjunction with regulations on infant formula advertising. Critics have argued that follow-on and toddler formulas were introduced partly to circumvent these regulations and have resulted in confusing advertising.
An early example of follow-on formula was introduced by Wyeth in the Philippines in 1987, following the introduction in this country of regulations on infant formula advertising, but which did not address follow-on formulas (products that did not exist at the time of their drafting).Similarly, while infant formula advertising is illegal in the United Kingdom, follow-on formula advertising is legal, and the similar packaging and market results in follow-on advertisements frequently being interpreted as advertisements for formula. (See also industry and marketing, below.)
These products have also recently fallen under criticism for contributing to the childhood obesity epidemic in some developed countries due to their marketing and flavoring practices.
Usage since 1970s
Since the early 1970s, industrial countries have witnessed a resurgence in breastfeeding among newborns and infants to 6 months of age. This upswing in breastfeeding has been accompanied by a deferment in the average age of introduction of other foods (such as cow’s milk), resulting in increased use of both breastfeeding and infant formula between the ages of 3–12 months.
The global infant formula market has been estimated at $7.9 billion,with North America and Western Europe accounting for 33% of the market and considered largely saturated, and Asia representing 53% of the market.South East Asia is a particularly large fraction of the world market relative to its population. Infant formula is the largest segment of the baby food market,with the fraction given as between 40% and 70%.
Leading health organizations (e.g. WHO, U.S. Center for Disease Control and Department of Health and Human Services) are attempting to reduce the use of infant formula and increase the prevalence of breastfeeding from birth through 12 to 24 months of age through public health awareness campaigns. The specific goals and approaches of these breastfeedingpromotion programs, and the policy environment surrounding their implementation, vary by country. As a policy basic framework, the International Code of Marketing of Breast-milk Substitutes, adopted by the WHO’s World Health Assembly in 1981, requires infant formula companies to preface their product information with statements that breastfeeding is the best way of feeding babies and that a substitute should only be used after consultation with health professionals. The Baby Friendly Hospital Initiative also restricts use by hospitals of free formula or other infant care aids provided by formula companies. (See also Policy section below.)