Breastfeeding in crisis: The hidden impact of early formula use in Kenya

When Samira Aziz gave birth to her youngest child at a busy public hospital, she felt both joy and anxiety. Like many new mothers, she imagined the first cries, the first cuddles, and the first breastfeeding attempts would come naturally. But her experience was very different.

In the moments after delivery, Samira held her newborn daughter to her chest and tried to breastfeed. The baby rooted instinctively—her tiny mouth searching and suckling—but no milk came out.

"I thought maybe it just needed time,” Samira recalls. “She was trying so hard, but no milk was coming. I kept thinking, ‘It’s going to come any minute now.’”

But time passed. Minutes turned into hours. Her baby's cries grew louder and more desperate. Eventually, nurses took the baby to the nursery, saying she needed rest and that trying to breastfeed without success was agitating her.

“They said my baby was getting sore in the mouth from trying so hard,” Samira says. “One nurse told me she was probably sucking in gas from all the air. That she might be in pain.”

Back in her hospital bed, Samira felt helpless. Her body wasn’t doing what she thought it was supposed to. She asked what to do next. The answer was simple: give the baby formula.

But there was a problem—Samira didn’t have any. She hadn’t brought formula with her because she never planned to use it. No one had discussed the possibility with her before. There was no lactation consultant, no support, no guidance—just a quiet suggestion to stop trying and switch.

“I didn’t know what else to do. The baby was crying, and I had no milk. I had nothing,” she says. “So we gave her warm water, just to calm her down until my mother could arrive with some formula. That was all we could do.”

Warm water wasn’t ideal—Samira was warned it might upset her baby’s digestion. But in that moment, calming the baby took priority.

When the formula finally arrived, Samira felt a rush of relief. Her baby fed, fell asleep, and stopped crying. But with that relief came something else: guilt, doubt, and a quiet sense of defeat.

“They said not to worry, that formula was just as good as breast milk. So, I stopped trying. I thought maybe this was better. I believed them.”

Back then, formula wasn’t affordable or easy to find. Each tin was expensive, but Samira often had no choice. Breastfeeding felt like something she was failing at, something she didn’t know how to restart.

“There were days when I just sat and cried,” she says. “Nothing I tried seemed to work. I wanted to feed my baby myself, but I didn’t know how to fix it. No one showed me. I didn’t even know who to ask.”

Sometimes she relied on donated formula. Other times, she stretched what little she had, measuring scoops carefully to make it last. The stress of not knowing where the next tin would come from haunted her daily.

“It wasn’t just the feeding,” she adds. “It was the guilt. The feeling that I was failing as a mother every time I gave her a bottle.”

Samira’s story reflects a broader crisis—one shaped by poverty, limited access, misinformation, and the emotional toll of feeding decisions made under pressure.

Across the world, more mothers are turning to formula, not because they can’t breastfeed, but because they feel unsupported, rushed, or emotionally drained. And many, like Samira, are told—subtly or directly—that formula is “just as good.”

That belief is no accident. It's the product of a global, multi-billion-dollar formula industry that has spent decades marketing its products as modern, scientific, and even superior to breast milk.

Despite health campaigns promoting exclusive breastfeeding for the first six months, many mothers still receive mixed—and sometimes misleading—messages.

In Kenya, the widespread belief that formula equals breast milk is not only inaccurate but also harmful. It undermines confidence, disrupts early bonding, and threatens infant health outcomes.

“Formula may contain some nutritional value,” says Professor Grace Irimu, a paediatric nephrologist and child health advocate, “but it can never replicate the complex, living composition of a mother’s milk.”

Despite strong scientific support for breastfeeding, many women stop early, often influenced by hospital routines, aggressive marketing, or the false belief they’re not producing enough milk.

“What many don’t realise,” Professor Irimu explains, “is that milk production is stimulated through continued suckling—the more a baby breastfeeds, the more milk the mother produces.”

A major barrier, she adds, is the early separation of mother and baby after delivery.

“The baby can be placed on the mother’s chest and allowed to crawl to the breast to feed—especially when there are no complications,” she says. “Early initiation of breastfeeding is critical.”

According to Irimu, babies should be exclusively breastfed for the first six months, then gradually introduced to complementary foods while continuing to breastfeed for two years or more.

“Breastfeeding builds immunity, helps fight disease, and significantly reduces infant mortality.”

It’s also one of the most affordable and effective ways to save lives, reducing child deaths by up to 13 per cent, and lowering the risk of diarrhoea and pneumonia by up to 50 per cent.

Yet in Kenya, only 61 per cent of infants are exclusively breastfed, below the global target of 70 per cent. That leaves over 500,000 children missing out on the full benefits.

UNICEF data shows that 60–75 per cent of under-five deaths occur in the first year. Kenya’s neonatal mortality rate is 22 per 1,000, and infant mortality is 35 per 1,000 live births. Improving breastfeeding practices could save thousands of lives, reduce hospital crowding, and help meet health goals such as “one cot, one baby.”

Scaling up exclusive breastfeeding to 80 per cent could save tens of thousands of Kenyan infants each year.

A landmark study, “In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed,” explored how formula use in hospitals affects breastfeeding outcomes. The study followed 393 mothers over 60 days postpartum.

The results were striking. Infants who received formula in the hospital were far more likely to stop breastfeeding early, even among mothers who had planned to exclusively breastfeed.

By day 60, 68 per cent of babies who got in-hospital formula were no longer fully breastfed, compared to 37 per cent of those exclusively breastfed from the start. Worse, 33 per cent of the formula group had stopped breastfeeding altogether, versus just 11 per cent in the other group.

These findings remained consistent even after adjusting for factors like age, education, delivery method, and maternal confidence. The odds of stopping breastfeeding were more than four times higher in the formula group.

The reasons for supplementation also mattered.

Babies given formula due to low milk supply, pain, or difficulty feeding were at greater risk of early weaning. However, when the formula was used due to temporary maternal illness or medication, the risk wasn’t significant.

The study also found a dose-response effect: the more formula feeds given in the hospital, the higher the risk of stopping breastfeeding. The use of bottles and syringes further compounded the problem.

This research underscores a vital truth: even small amounts of formula given in the early days can derail breastfeeding success.