BREASTFEEDING VS. FORMULA FEEDING: ETHICAL, MEDICAL, AND RELIGIOUS PERSPECTIVES IN INFANT NUTRITION DECISION-MAKING
Keywords:
Breastfeeding, Formula Feeding, Ethics, Parental Autonomy, Healthcare Responsibility, Religious Perspectives
Abstract
Background: Breastfeeding is globally recognized as the optimal form of infant nutrition due to its numerous health benefits. However, the decision between breastfeeding and formula feeding presents ethical dilemmas influenced by medical, socio-economic, cultural, and religious factors. The interplay between parental autonomy, healthcare professionals' responsibilities, and societal norms creates complexities in infant feeding choices.
Objective: This study aims to analyze the ethical considerations in breastfeeding and formula feeding decisions, emphasizing parental rights, healthcare responsibilities, and the influence of cultural and religious values.
Methods: A literature review was conducted to examine ethical principles, including autonomy, beneficence, and non-maleficence, in the context of infant feeding choices. The study also explored real-world cases where parents opted for formula feeding due to various constraints. Additionally, religious perspectives, particularly from Islamic teachings, were analyzed to understand their role in shaping breastfeeding practices.
Results: The findings highlight that while breastfeeding remains the gold standard, formula feeding is sometimes necessary due to medical, economic, or social reasons. Ethical dilemmas arise when parental autonomy conflicts with public health recommendations. Healthcare professionals play a crucial role in providing evidence-based information, supporting informed decision-making, and mitigating societal stigma associated with infant feeding choices.
Conclusion: Ethical considerations in infant feeding require a balanced approach that respects parental autonomy while promoting the best interests of the child. Healthcare professionals must ensure that parents receive accurate information and support to make informed decisions. Addressing societal and religious influences is essential in fostering an inclusive and supportive environment for all feeding choices.
References
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Amoo, T. and Lucas, R. (2022). Exclusive breastfeeding in african american women: a concept analysis. Journal of Advanced Nursing, 79(5), 1699-1713. https://doi.org/10.1111/jan.15301
Andrew, N. and Harvey, K. (2010). Infant feeding choices: experience, self-identity and lifestyle. Maternal and Child Nutrition, 7(1), 48-60. https://doi.org/10.1111/j.1740-8709.2009.00222.x
Anggraeni, M., Punthmatharith, B., & Petpichetchian, W. (2020). A causal model of breastfeeding duration among working muslim mothers in semarang city, central java province, indonesia. Walailak Journal of Science and Technology (Wjst), 17(9), 1010-1023. https://doi.org/10.48048/wjst.2020.5406
Bartle, N. and Harvey, K. (2017). Explaining infant feeding: the role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes. British Journal of Health Psychology, 22(4), 763-785. https://doi.org/10.1111/bjhp.12254
Bartle, N., & Harvey, K. (2017). Explaining infant feeding: the role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes. British Journal of Health Psychology, 22(4), 763-785. https://doi.org/10.1111/bjhp.12254
Binns, C. and Lee, S. (2017). The public health benefits of breastfeeding. Perspectives in Public Health, 137(6), 307-308. https://doi.org/10.1177/1757913917734139
Bonia, K., Twells, L., Halfyard, B., Ludlow, V., Newhook, L., & Murphy-Goodridge, J. (2013). A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in newfoundland and labrador, canada. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-645
Bonia, K., Twells, L., Halfyard, B., Ludlow, V., Newhook, L., & Murphy-Goodridge, J. (2013). A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in Newfoundland and Labrador, Canada. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-645
Brown, A. (2017). Breastfeeding as a public health responsibility: a review of the evidence. Journal of Human Nutrition and Dietetics, 30(6), 759-770. https://doi.org/10.1111/jhn.12496
Brown, A. (2017). Breastfeeding as a public health responsibility: a review of the evidence. Journal of Human Nutrition and Dietetics, 30(6), 759-770. https://doi.org/10.1111/jhn.12496
Coca, K., Lee, E., Chien, L., Souza, A., Kittikul, P., Hong, S., … & Chang, Y. (2022). Postnatal women’s breastfeeding beliefs, practices, and support during the covid-19 pandemic: a cross-sectional comparative study across five countries. International Breastfeeding Journal, 17(1). https://doi.org/10.1186/s13006-022-00497-2
Daud, N., Ismail, H., Ariffin, S., Embong, R., Nordin, N., & Bichi, A. (2019). Benefits of breast milk for health care analysis from the islamic perspective. Indian Journal of Public Health Research & Development, 10(9), 1846. https://doi.org/10.5958/0976-5506.2019.02723.2
Dubik, S., Yirkyio, E., & Ebenezer, K. (2021). Breastfeeding in primary healthcare setting: evaluation of nurses and midwives competencies, training, barriers and satisfaction of breastfeeding educational experiences in northern ghana. Clinical Medicine Insights Pediatrics, 15. https://doi.org/10.1177/11795565211010704
Dyson, L., Green, J., Renfrew, M., McMillan, B., & Woolridge, M. (2010). Factors influencing the infant feeding decision for socioeconomically deprived pregnant teenagers: the moral dimension. Birth, 37(2), 141-149. https://doi.org/10.1111/j.1523-536x.2010.00394.x
Flaherman, V., Aby, J., Burgos, A., Lee, K., Cabana, M., & Newman, T. (2013). Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an rct. Pediatrics, 131(6), 1059-1065. https://doi.org/10.1542/peds.2012-2809
Gribble, K. and Palmquist, A. (2021). ‘we make a mistake with shoes [that's no problem] but… not with baby milk’: facilitators of good and poor practice in distribution of infant formula in the 2014–2016 refugee crisis in europe. Maternal and Child Nutrition, 18(1). https://doi.org/10.1111/mcn.13282
Grummer‐Strawn, L., Zehner, E., Stahlhofer, M., Lutter, C., Clark, D., Sterken, E., … & NetCode, U. (2017). New world health organization guidance helps protect breastfeeding as a human right. Maternal and Child Nutrition, 13(4). https://doi.org/10.1111/mcn.12491
Hamnøy, I. (2023). A balancing act—midwives' and public health nurses' experiences with breastfeeding counselling. Scandinavian Journal of Caring Sciences, 38(1), 92-103. https://doi.org/10.1111/scs.13198
Kamoun, C. and Spatz, D. (2017). Influence of islamic traditions on breastfeeding beliefs and practices among african american muslims in west philadelphia: a mixed-methods study. Journal of Human Lactation, 34(1), 164-175. https://doi.org/10.1177/0890334417705856
Kiyaeimolasaraei, S., Torkzahrani, S., Janati, P., & Nasiri, M. (2022). Paternal breastfeeding self-efficacy and infant and young child feeding practice three months postpartum. Journal of Comprehensive Pediatrics, 13(3). https://doi.org/10.5812/compreped-126395
Knaak, S. (2010). Contextualising risk, constructing choice: breastfeeding and good mothering in risk society. Health Risk & Society, 12(4), 345-355. https://doi.org/10.1080/13698571003789666
Low, L., Purvis, R., Cunningham, T., Chughati, A., Garner, R., & McElfish, P. (2019). Ethical dilemmas encountered by health care providers caring for marshallese migrants in northwest arkansas. Narrative Inquiry in Bioethics, 9(1), 53-62. https://doi.org/10.1353/nib.2019.0018
Lubold, A. (2019). Historical-qualitative analysis of breastfeeding trends in three oecd countries. International Breastfeeding Journal, 14(1). https://doi.org/10.1186/s13006-019-0230-0
Mäkelä, H., Axelin, A., Kolari, T., Kuivalainen, T., & Niela‐Vilén, H. (2021). Healthcare professionals’ breastfeeding attitudes and hospital practices during delivery and in neonatal intensive care units: pre and post implementing the baby-friendly hospital initiative. Journal of Human Lactation, 38(3), 537-547. https://doi.org/10.1177/08903344211058373
Mehrpisheh, S., Memarian, A., Ameri, M., & Isfeedvajani, M. (2020). The importance of breastfeeding based on islamic rules and qur’an. Hospital Practices and Research, 5(2), 37-41. https://doi.org/10.34172/hpr.2020.08
Moland, K., Esterik, P., Sellen, D., Paoli, M., Leshabari, S., & Blystad, A. (2010). Ways ahead: protecting, promoting and supporting breastfeeding in the context of hiv. International Breastfeeding Journal, 5(1), 19. https://doi.org/10.1186/1746-4358-5-19
Moriarty, C. M., & Davies, B. (2023). Feeding Infants: Choice-Specific Considerations, Parental Obligation, and Pragmatic Satisficing. Ethical Theory and Moral Practice. https://doi.org/10.1007/s10677-023-10400-5
Murad, A., Renfrew, M., Symon, A., & Whitford, H. (2021). Understanding factors affecting breastfeeding practices in one city in the kingdom of saudi arabia: an interpretative phenomenological study. International Breastfeeding Journal, 16(1). https://doi.org/10.1186/s13006-020-00350-4
Navarro, I., Castillo, J., & Laredo, S. (2021). Applying systematic review search methods to the grey literature: a review of education and training courses on breastfeeding support for health professionals. International Breastfeeding Journal, 16(1). https://doi.org/10.1186/s13006-021-00373-5
Rosenberg, K., Stull, J., Adler, M., Kasehagen, L., & Crivelli-Kovach, A. (2008). Impact of hospital policies on breastfeeding outcomes. Breastfeeding Medicine, 3(2), 110-116. https://doi.org/10.1089/bfm.2007.0039
Salamuddin, S. and Suraya, R. (2022). The challenges and obstacles to exclusive breastfeeding to muslim families in an islamic and health perspective. Contagion Scientific Periodical Journal of Public Health and Coastal Health, 4(2), 324. https://doi.org/10.30829/contagion.v4i2.15340
Shaikh, U. and Ahmed, O. (2006). Islam and infant feeding. Breastfeeding Medicine, 1(3), 164-167. https://doi.org/10.1089/bfm.2006.1.164
Spagnoletti, B., Bennett, L., Kermode, M., & Wilopo, S. (2018). Moralising rhetoric and imperfect realities: breastfeeding promotions and the experiences of recently delivered mothers in urban yogyakarta, indonesia. Asian Studies Review, 42(1), 17-38. https://doi.org/10.1080/10357823.2017.1407291
Subramani S, Vinay R, März JW, Hefti M, Biller-Andorno N. Ethical Issues in Breastfeeding and Lactation Interventions: A Scoping Review. Journal of Human Lactation. 2024;40(1):150-163. doi:10.1177/08903344231215073
Subramani, S. (2023). Beyond Public Health and Private Choice: Breastfeeding, Embodiment and Public Health Ethics. Asian Bioethics Review. https://doi.org/10.1007/s41649-023-00259-0
Thomson, G., Ebisch-Burton, K., & Flacking, R. (2014). Shame if you do – shame if you don't: women's experiences of infant feeding. Maternal and Child Nutrition, 11(1), 33-46. https://doi.org/10.1111/mcn.12148
Tomori, C., Palmquist, A., & Dowling, S. (2016). Contested moral landscapes: negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the u.s. and the u.k.. Social Science & Medicine, 168, 178-185. https://doi.org/10.1016/j.socscimed.2016.09.014
Umer, A. and Edwards, R. (2013). Expanding public health professionals’ roles in promoting and supporting breastfeeding as optimal infant feeding: a pilot study with online tutorial implications. Open Journal of Preventive Medicine, 03(02), 184-190. https://doi.org/10.4236/ojpm.2013.32025
Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., ... & Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7
World Health Organization (WHO). (2021). Infant and young child feeding. Retrieved from https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
Zaidi, F. (2014). Challenges and practices in infant feeding in islam. British Journal of Midwifery, 22(3), 167-172. https://doi.org/10.12968/bjom.2014.22.3.167
Alnasser, Y., Almasoud, N., Aljohni, D., Almisned, R., Alsuwaine, B., Alohali, R.,& Alhezayen, R. (2018). Impact of attitude and knowledge on intention to breastfeed: can mhealth based education influence decision to breastfeed exclusively?. Annals of Medicine and Surgery, 35, 6-12. https://doi.org/10.1016/j.amsu.2018.09.007
Amoo, T. and Lucas, R. (2022). Exclusive breastfeeding in african american women: a concept analysis. Journal of Advanced Nursing, 79(5), 1699-1713. https://doi.org/10.1111/jan.15301
Andrew, N. and Harvey, K. (2010). Infant feeding choices: experience, self-identity and lifestyle. Maternal and Child Nutrition, 7(1), 48-60. https://doi.org/10.1111/j.1740-8709.2009.00222.x
Anggraeni, M., Punthmatharith, B., & Petpichetchian, W. (2020). A causal model of breastfeeding duration among working muslim mothers in semarang city, central java province, indonesia. Walailak Journal of Science and Technology (Wjst), 17(9), 1010-1023. https://doi.org/10.48048/wjst.2020.5406
Bartle, N. and Harvey, K. (2017). Explaining infant feeding: the role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes. British Journal of Health Psychology, 22(4), 763-785. https://doi.org/10.1111/bjhp.12254
Bartle, N., & Harvey, K. (2017). Explaining infant feeding: the role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes. British Journal of Health Psychology, 22(4), 763-785. https://doi.org/10.1111/bjhp.12254
Binns, C. and Lee, S. (2017). The public health benefits of breastfeeding. Perspectives in Public Health, 137(6), 307-308. https://doi.org/10.1177/1757913917734139
Bonia, K., Twells, L., Halfyard, B., Ludlow, V., Newhook, L., & Murphy-Goodridge, J. (2013). A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in newfoundland and labrador, canada. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-645
Bonia, K., Twells, L., Halfyard, B., Ludlow, V., Newhook, L., & Murphy-Goodridge, J. (2013). A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in Newfoundland and Labrador, Canada. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-645
Brown, A. (2017). Breastfeeding as a public health responsibility: a review of the evidence. Journal of Human Nutrition and Dietetics, 30(6), 759-770. https://doi.org/10.1111/jhn.12496
Brown, A. (2017). Breastfeeding as a public health responsibility: a review of the evidence. Journal of Human Nutrition and Dietetics, 30(6), 759-770. https://doi.org/10.1111/jhn.12496
Coca, K., Lee, E., Chien, L., Souza, A., Kittikul, P., Hong, S., … & Chang, Y. (2022). Postnatal women’s breastfeeding beliefs, practices, and support during the covid-19 pandemic: a cross-sectional comparative study across five countries. International Breastfeeding Journal, 17(1). https://doi.org/10.1186/s13006-022-00497-2
Daud, N., Ismail, H., Ariffin, S., Embong, R., Nordin, N., & Bichi, A. (2019). Benefits of breast milk for health care analysis from the islamic perspective. Indian Journal of Public Health Research & Development, 10(9), 1846. https://doi.org/10.5958/0976-5506.2019.02723.2
Dubik, S., Yirkyio, E., & Ebenezer, K. (2021). Breastfeeding in primary healthcare setting: evaluation of nurses and midwives competencies, training, barriers and satisfaction of breastfeeding educational experiences in northern ghana. Clinical Medicine Insights Pediatrics, 15. https://doi.org/10.1177/11795565211010704
Dyson, L., Green, J., Renfrew, M., McMillan, B., & Woolridge, M. (2010). Factors influencing the infant feeding decision for socioeconomically deprived pregnant teenagers: the moral dimension. Birth, 37(2), 141-149. https://doi.org/10.1111/j.1523-536x.2010.00394.x
Flaherman, V., Aby, J., Burgos, A., Lee, K., Cabana, M., & Newman, T. (2013). Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an rct. Pediatrics, 131(6), 1059-1065. https://doi.org/10.1542/peds.2012-2809
Gribble, K. and Palmquist, A. (2021). ‘we make a mistake with shoes [that's no problem] but… not with baby milk’: facilitators of good and poor practice in distribution of infant formula in the 2014–2016 refugee crisis in europe. Maternal and Child Nutrition, 18(1). https://doi.org/10.1111/mcn.13282
Grummer‐Strawn, L., Zehner, E., Stahlhofer, M., Lutter, C., Clark, D., Sterken, E., … & NetCode, U. (2017). New world health organization guidance helps protect breastfeeding as a human right. Maternal and Child Nutrition, 13(4). https://doi.org/10.1111/mcn.12491
Hamnøy, I. (2023). A balancing act—midwives' and public health nurses' experiences with breastfeeding counselling. Scandinavian Journal of Caring Sciences, 38(1), 92-103. https://doi.org/10.1111/scs.13198
Kamoun, C. and Spatz, D. (2017). Influence of islamic traditions on breastfeeding beliefs and practices among african american muslims in west philadelphia: a mixed-methods study. Journal of Human Lactation, 34(1), 164-175. https://doi.org/10.1177/0890334417705856
Kiyaeimolasaraei, S., Torkzahrani, S., Janati, P., & Nasiri, M. (2022). Paternal breastfeeding self-efficacy and infant and young child feeding practice three months postpartum. Journal of Comprehensive Pediatrics, 13(3). https://doi.org/10.5812/compreped-126395
Knaak, S. (2010). Contextualising risk, constructing choice: breastfeeding and good mothering in risk society. Health Risk & Society, 12(4), 345-355. https://doi.org/10.1080/13698571003789666
Low, L., Purvis, R., Cunningham, T., Chughati, A., Garner, R., & McElfish, P. (2019). Ethical dilemmas encountered by health care providers caring for marshallese migrants in northwest arkansas. Narrative Inquiry in Bioethics, 9(1), 53-62. https://doi.org/10.1353/nib.2019.0018
Lubold, A. (2019). Historical-qualitative analysis of breastfeeding trends in three oecd countries. International Breastfeeding Journal, 14(1). https://doi.org/10.1186/s13006-019-0230-0
Mäkelä, H., Axelin, A., Kolari, T., Kuivalainen, T., & Niela‐Vilén, H. (2021). Healthcare professionals’ breastfeeding attitudes and hospital practices during delivery and in neonatal intensive care units: pre and post implementing the baby-friendly hospital initiative. Journal of Human Lactation, 38(3), 537-547. https://doi.org/10.1177/08903344211058373
Mehrpisheh, S., Memarian, A., Ameri, M., & Isfeedvajani, M. (2020). The importance of breastfeeding based on islamic rules and qur’an. Hospital Practices and Research, 5(2), 37-41. https://doi.org/10.34172/hpr.2020.08
Moland, K., Esterik, P., Sellen, D., Paoli, M., Leshabari, S., & Blystad, A. (2010). Ways ahead: protecting, promoting and supporting breastfeeding in the context of hiv. International Breastfeeding Journal, 5(1), 19. https://doi.org/10.1186/1746-4358-5-19
Moriarty, C. M., & Davies, B. (2023). Feeding Infants: Choice-Specific Considerations, Parental Obligation, and Pragmatic Satisficing. Ethical Theory and Moral Practice. https://doi.org/10.1007/s10677-023-10400-5
Murad, A., Renfrew, M., Symon, A., & Whitford, H. (2021). Understanding factors affecting breastfeeding practices in one city in the kingdom of saudi arabia: an interpretative phenomenological study. International Breastfeeding Journal, 16(1). https://doi.org/10.1186/s13006-020-00350-4
Navarro, I., Castillo, J., & Laredo, S. (2021). Applying systematic review search methods to the grey literature: a review of education and training courses on breastfeeding support for health professionals. International Breastfeeding Journal, 16(1). https://doi.org/10.1186/s13006-021-00373-5
Rosenberg, K., Stull, J., Adler, M., Kasehagen, L., & Crivelli-Kovach, A. (2008). Impact of hospital policies on breastfeeding outcomes. Breastfeeding Medicine, 3(2), 110-116. https://doi.org/10.1089/bfm.2007.0039
Salamuddin, S. and Suraya, R. (2022). The challenges and obstacles to exclusive breastfeeding to muslim families in an islamic and health perspective. Contagion Scientific Periodical Journal of Public Health and Coastal Health, 4(2), 324. https://doi.org/10.30829/contagion.v4i2.15340
Shaikh, U. and Ahmed, O. (2006). Islam and infant feeding. Breastfeeding Medicine, 1(3), 164-167. https://doi.org/10.1089/bfm.2006.1.164
Spagnoletti, B., Bennett, L., Kermode, M., & Wilopo, S. (2018). Moralising rhetoric and imperfect realities: breastfeeding promotions and the experiences of recently delivered mothers in urban yogyakarta, indonesia. Asian Studies Review, 42(1), 17-38. https://doi.org/10.1080/10357823.2017.1407291
Subramani S, Vinay R, März JW, Hefti M, Biller-Andorno N. Ethical Issues in Breastfeeding and Lactation Interventions: A Scoping Review. Journal of Human Lactation. 2024;40(1):150-163. doi:10.1177/08903344231215073
Subramani, S. (2023). Beyond Public Health and Private Choice: Breastfeeding, Embodiment and Public Health Ethics. Asian Bioethics Review. https://doi.org/10.1007/s41649-023-00259-0
Thomson, G., Ebisch-Burton, K., & Flacking, R. (2014). Shame if you do – shame if you don't: women's experiences of infant feeding. Maternal and Child Nutrition, 11(1), 33-46. https://doi.org/10.1111/mcn.12148
Tomori, C., Palmquist, A., & Dowling, S. (2016). Contested moral landscapes: negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the u.s. and the u.k.. Social Science & Medicine, 168, 178-185. https://doi.org/10.1016/j.socscimed.2016.09.014
Umer, A. and Edwards, R. (2013). Expanding public health professionals’ roles in promoting and supporting breastfeeding as optimal infant feeding: a pilot study with online tutorial implications. Open Journal of Preventive Medicine, 03(02), 184-190. https://doi.org/10.4236/ojpm.2013.32025
Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., ... & Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7
World Health Organization (WHO). (2021). Infant and young child feeding. Retrieved from https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
Zaidi, F. (2014). Challenges and practices in infant feeding in islam. British Journal of Midwifery, 22(3), 167-172. https://doi.org/10.12968/bjom.2014.22.3.167
Published
2025-02-27
How to Cite
Syarfaini, surahmawati, S., Amansyah, M., Nildawati, & Indar. (2025). BREASTFEEDING VS. FORMULA FEEDING: ETHICAL, MEDICAL, AND RELIGIOUS PERSPECTIVES IN INFANT NUTRITION DECISION-MAKING. Homes Journal: Hospital Management Studies Journal, 6(1), 27-35. https://doi.org/10.24252/hmsj.v6i1.55855
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