Hesperian Health Guides

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Alternatives to breastfeeding

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HealthWiki > A Book for Midwives > Chapter 16: Breastfeeding > Alternatives to breastfeeding


Breastfeeding is best, but there are a few times when it is not possible. If a mother is infected with HIV, if she is very sick, or if she adopts a child, she may not be able to or may choose not to breastfeed.

For some families, formula may be a safe alternative to breast milk.

Formula is only safe when:

  • the family has enough clean water to make plenty of formula to feed the baby.
  • the family has enough fuel to boil bottles.
One can of formula may not seem expensive, but formula for many months costs a great deal.
  • the family can afford to buy all the formula the baby needs (and will not dilute it with too much water, to save money).


Families who give formula must follow the directions on the package exactly. Do not thin the formula by adding extra water or by using less milk or powder. Dirty bottles and nipples or watered-down formula can kill a baby.

a woman handing a baby to a woman with a small child.
Someone else may be able to breastfeed the baby.

Families who cannot afford formula have tried some other ways to feed their babies. These ways are not possible for every mother, but may be for some.

  • A relative or friend who does not have HIV can breastfeed the child.
  • Animal milks can be fed to a baby. Animal milks have more fat and less sugar than human milk, so they must be mixed with water and sugar to be fed to a baby. People do not agree on one recipe that will make animal milk most healthy for a baby. Here are 2 ways to make it, depending on the kind of animal milk you have.


To feed a baby with animal milk
from cow milk, goat milk, or camel milk:
  • mix 100 ml fresh milk with 50 ml clean water and 10 g (2 tsp) sugar
from sheep milk or buffalo milk:
  • mix 50 ml fresh milk with 50 ml clean water and 5 g (1 tsp) sugar
Bring the formula to a boil and then remove it from the heat. Let it cool and then feed immediately.

Animal milks do not have all the vitamins a growing baby needs — so the baby should be given a wide variety of vegetables, fruits, and other foods starting at about 6 months of age.


When a family gives formula or animal milk they must keep everything very clean. The cup, spoon, bottle, rubber nipples, and any containers used for milk or formula should be washed thoroughly and boiled for 20 minutes before each use.

Prepared formula, tinned milk that has been opened, and animal milks should never be left at room temperature for more than 2 hours. They will spoil and could make the baby very sick. Formula can sit in a cold refrigerator for up to 12 hours.


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