News that U.S. officials tried to water down an international resolution promoting breastfeeding has sparked outrage and accusations that the Trump administration put the interests of baby formula manufacturers ahead of children’s health.

The New York Times reported Sunday that American officials bullied other countries at a Geneva World Health Assembly meeting in an unsuccessful attempt to remove references to ending the inappropriate promotion of breast-milk substitutes like infant formula.

President Donald Trump slammed the Times story as “fake news” in a tweet Monday, saying, “The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.” (The White House did not respond immediately to a request for comment about what Trump meant by the references to malnutrition and poverty.)

‘Rarely do we look at women’s personal financial interests’

But to some experts there’s a crucial piece missing from the debate: How much breastfeeding costs women. “There are a lot of financial interests at play and very rarely do we look at women’s personal financial interests,” said Phyllis Rappey, a University of Ottawa professor who studies the economics of breastfeeding. “It’s become the formula manufacturers’ interests versus the baby victims, and it’s a lot more complicated than that.”

Breastfeeding is considered more economical than formula feeding because in theory, it doesn’t require buying any products. Breastfeeding can save families up to $1,500 in formula costs during the first year of a baby’s life, according to the U.S. Surgeon General. But in reality, breastfeeding can come with its own costs: one author said she and her husband spent $2,000 in six months “to make nursing and pumping breast milk easier and less uncomfortable.”

And there are other longer-term costs associated with breastfeeding too, Rappey told MarketWatch. Women who breastfed for six months or longer were more likely to leave the workforce and had steeper and more prolonged declines in earnings than women who either didn’t breastfeed or only did it for a short time, Rappey and co-author Mary C. Noonan found in a 2012 study published in the American Sociological Review. “Breastfeeding for six months or longer is only free if a mother’s time is worth absolutely nothing,” Noonan said when the study was first published.

Breastfeeding is considered the gold standard

Of course, those costs must be weighed against the benefits of breastfeeding. Breast milk is considered the gold standard for feeding infants, and the American Academy of Pediatrics has long recommended that babies consume only breast milk for the first six months of life. Breastfeeding has been shown to protect the health of both babies and mothers, which in turn leads to women taking fewer sick days at work, the AAP notes on its website.

A 2016 study published in The Lancet found that the world loses $300 billion a year because of the lower cognitive ability associated with not breastfeeding. If breastfeeding rates improved, about 820,000 child deaths a year would be prevented, the study found.

‘These women should not be stigmatized’

A Department of Health and Human Services spokeswoman said Monday that HHS officials wanted to reword the World Health Assembly resolution because it “placed unnecessary hurdles for mothers seeking to provide nutrition to their children.”

“The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies,” HHS spokeswoman Caitlin Oakley said in an email to MarketWatch. “Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies.”

But to advocates like Lucy Sullivan, executive director of 1,000 Days, a Washington, D.C.-based nonprofit that advocates for children’s health, the resolution up for approval in Geneva was simply a “run-of-the-mill” document. It was designed to reiterate the importance of breastfeeding and call on countries to bolster efforts to support mothers who want to breastfeed. So it was shocking when the U.S. wanted to change it, she said.

Sullivan said the attempted rewording was the latest evidence of the power of infant formula manufacturers. “This revealed what we’re up against,” Sullivan said. “The Trump Administration is willing to pull out the big guns when needed and go to bat for the infant formula industry.”

Formula makers are fighting a changing market

The issue dates back to the 1970s, when Nestlé NESN, -0.03% was criticized for aggressively marketing baby formula in sub-Saharan Africa with misleading tactics that ultimately lead to infant deaths.

That dark chapter led the World Health Assembly to adopt an international code in 1981 regulating how baby formula can be marketed, Sullivan said. Formula makers consulted in the wording of that code, and, according to Sullivan, Nestlé voiced opposition about the World Health Assembly’s breastfeeding resolution this year. (Nestlé did not respond to a request for comment.)

Nestlé and other formula makers have been retooling their products in response to changing trends. Infant formula manufacturing revenues hit $2.3 billion in 2017, according to an industry analysis by research firm IBISWorld, Inc.. But as breastfeeding has grown in popularity, demand for formula has dropped, IBISWorld found.

Manufacturers have responded by creating new products designed to feed children as they grow out of infancy. The World Health Organization is convening a meeting in November where regulations for those products will be discussed, and Sullivan’s group will keep a close eye on the proceedings. “Our concern is that we’ll see a repeat of what we saw in Geneva at the World Health Assembly,” Sullivan said.

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