"There's a dichotomy of 'good mothers breast feed, bad mothers formula feed', " says journalist Madeleine Morris, who is writing a book about the topic.
In many unserved rural areas, people still fetch water for drinking and mix it with infant formula to feed their babies.
"If you feed formula to your child, and a healthy loving home, and your baby was full term and healthy weight, then there are going to be minimal differences in the outcome of child, " she says.
At one week of age, 10% of the formula group was still using formula in some way as part of their feeding strategy compared to 47% of the group originally assigned to breast-feed but who added formula.
Mothers who come in intending to breast feed and decide they want some formula will be subject to an educational talk (read: a "breast is best" lecture), and hospital staff will have to document a medical reason before they sign it out.
Lieberman says that the findings may have been affected by the attitude of the women themselves, who said they wanted to exclusively breast-feed but were also open to using formula.
The pro-breastfeeding campaign has drawn the ire of some women who argue it stigmatizes infant formula and interferes with a mother's choice of what to feed her child.
Via email and telephone, many women I talked to rattled off stories about going into New York City hospitals saying they wanted to breast feed exclusively and then having nurses bully them into using formula as a supplement because they were having difficulties nursing.
The first two recalled baby formula containing high amounts of aflatoxin, a fungal carcinogen probably introduced via the feed for cows.
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And if we're going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can't sustain them -- with 4 million births a year, that's 200, 000 moms who need extra help.
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