What if formula killed as many babies as homebirth?

Powdered milk with baby bottle of milk on green background

Whenever homebirth advocates get around to acknowledging the increased death rate at homebirth, they invariably characterize it as “tiny.” They typically say things like: The risk of neonatal death in the hospital is tiny, so even if they homebirth death rate is several multiples higher, several times tiny is still tiny.

To put that “tiny” death rate in perspective, it might be useful to do a thought experiment: what if formula killed as many babies as homebirth?

I’ve chosen to use formula as an example, because homebirth advocates are almost always lactivists as well, fanatically in favor of breastfeeding and remarkably intolerant of women who choose to bottle feed. Indeed, they have pushed governments of first world countries like the US to spend millions of dollars on public health campaigns to convince women to breastfeed when there are only soft benefits (fewer colds) and most of those soft benefits aren’t even proven.

Can you imagine the field day they would have if they could actually point to deaths directly attributable to formula?

Let’s suppose that formula feeding had an excess death rate over breastfeeding similar to Oregon’s excess death rate at homebirth. I’ve chosen Oregon’s data because they are the most comprehensive statistics currently available. In Oregon, hospital birth for low risk women has a neonatal death rate of 0.6/1000 (“tiny”) and a neonatal death rate at homebirth with a licensed midwife of 5.6/1000 (9X “tiny”) for an excess death rate of 5/1000.

There are 4 million babies born in the US each year. It’s not a stretch to assume that 3 million receive formula at some point during their first year. A death rate of 5/1000 translates to 15,000/3,000,000. Spread over a year, that rate would lead to the death of 41 babies who died unexpectedly each and every day simply because their mothers chose bottle feeding over breastfeeding.

Homebirth advocates/lactivists would go nuts. They would push for even greater government spending on breastfeeding promotion and support. They would decry women who found bottle feeding more convenient and in better keeping with working outside the home. They would undoubtedly taunt mothers for literally risking their babies’ lives for no better reason than the mothers’ “experience.”

It would not end there, though. The FDA would be investigating formula manufacturers, pulling products from the market and funding research to make safer formula. There would be extensive evaluation to determine if some formulas were safer than others. If it were found that the excess death rate was due to improper manufacture or testing of formula, fines would be levied and formula executives might even go to jail. Factories that had the highest death rates would almost certainly be closed. Parents would be suing those formula manufacturers and they would be winning large judgments. In short, a “tiny” excess death rate would trigger a massive reaction, because such a death rate would be viewed as appalling and utterly unacceptable.

So here’s my question to homebirth advocates:

What would you think of mothers who chose formula feeding over breastfeeding, knowing that 41 babies would unexpectedly die each and every day for no other reason than their mothers’ refusal to breastfeed?

More importantly:

Why shouldn’t women who choose hospital birth think the same thing about you?