For Fatema, feeding her three-month-old son has become a choice between buying formula milk and meeting the family’s other basic needs.
The young mother from Dumki upazila of Patuakhali is receiving treatment at Sher-e-Bangla Medical College Hospital in Barisal while caring for her son, Mohammad. Family members said Fatema was married young and became physically weak after childbirth.
Three days after birth, Mohammad began breastfeeding less than usual. He gradually lost weight, fell sick repeatedly and was eventually hospitalized for severe malnutrition for about 18 days.
After returning home, the family began feeding him Lactogen formula milk.
“One tin costs about Tk850 and we have to buy it regularly. We are a poor family, but we still buy it for the baby. Sometimes we have to cut other household expenses to afford the milk,” Mohammad’s aunt said.
Fatema has had no contact with her husband for six months and now lives with her parents.
“Sometimes we do not know whether to buy milk or medicine,” Mohammad’s grandmother said.
A similar situation was found at Patuakhali Medical College Hospital, where nine-month-old Tabassum was being treated for malnutrition.
Her mother, Tanjila Begum, said health problems after childbirth prevented her from breastfeeding properly. Following advice from others, the family began feeding Tabassum “Cute Baby” formula milk.
“I thought formula milk would help her gain weight, but it did not,” Tanjila said.
Hospital sources said Tabassum’s weight was below normal for her age. The family also tried feeding her khichuri from four months, but she refused it. She now eats only one meal of rice a day.
The two cases highlight the links between maternal health, breastfeeding support, child nutrition and poverty.
A 350-gram tin of Lactogen costs around Tk650-Tk850, while Nan Optipro costs roughly Tk900-Tk1,100 and Similac often exceeds Tk1,200. Depending on age and feeding patterns, families may spend Tk3,000-Tk6,000 or more on formula each month.
For low-income households, that burden can mean cutting spending on food, medicine and other essentials.
According to UNICEF Bangladesh, 56.6% of infants under six months are exclusively breastfed. Yet 24% of children under five are stunted, 12.9% suffer from acute malnutrition and 23% are underweight.
Experts say maternal illness, teenage motherhood, inadequate breastfeeding knowledge, work-related difficulties and formula marketing can contribute to early dependence on formula.
Research has found that around 51% of parents and pregnant women in Bangladesh have been exposed to formula milk promotion, while nearly 60% of mothers report receiving formula recommendations from health workers or medical professionals.
Anjana Basu, a senior staff nurse at Patuakhali Medical College Hospital, said misconceptions about breastfeeding were common.
“Some mothers think their babies cry because breast milk is not enough. Others believe that if the mother is weak, she cannot produce sufficient milk. As a result, many families start using formula milk without medical advice,” she said.
Mothers may naturally produce small amounts of milk during the first few days after childbirth, Basu said, while frequent breastfeeding usually helps increase milk production.
Dr Mariam Akter Jolly, a pediatric doctor at the hospital, said formula should not be introduced without a medical reason.
“If there is no medical reason, breast milk alone is enough for the first six months. Formula milk is expensive, and if it is prepared incorrectly, it can increase the risk of diarrhea, infections and malnutrition,” she said.
Financial pressure can also lead families to dilute formula or use unsafe water and unsterilized feeding bottles, experts said. Such practices can reduce nutritional value and increase the risk of diarrhea, infection and malnutrition.
Formula milk can be necessary in certain circumstances, including some serious maternal illnesses or specific medical conditions. However, health experts stress that it should not routinely replace breastfeeding when there is no medical need.
Dr Dilruba Yasmin Liza, superintendent of Patuakhali Medical College Hospital, said child malnutrition was closely linked to maternal health, family income, education and social conditions.
“We often see mothers who are themselves malnourished or anemic. As a result, both mother and child are at risk,” she said.
Shahnaz Begum, nutrition officer for the Barisal and Khulna divisions, said most mothers wanted to breastfeed, but social pressure, misinformation, lack of confidence and aggressive marketing could make them believe their milk was insufficient.
“For low-income families, buying formula milk regularly is extremely expensive. Many families reduce spending on food, healthcare or other necessities to afford it. In many cases, the solution becomes a new problem,” she said.
UNICEF reports that 22.3% of women aged 20-24 in Bangladesh had their first child before age 18. Early motherhood can increase the risk of anemia, poor maternal nutrition and physical weakness, potentially affecting both mother and child.
WHO and UNICEF recommend initiating breastfeeding within one hour of birth, exclusive breastfeeding for the first six months, and continued breastfeeding alongside complementary foods for at least two years.
Experts say tackling child malnutrition requires more than promoting breastfeeding. It also requires stronger maternal healthcare, better nutrition counseling, improved breastfeeding support, accurate information and greater efforts to prevent early motherhood.
For families like Fatema’s and Tanjila’s, formula milk can represent both hope and hardship: a product bought to help a child grow stronger, but one that can deepen the financial vulnerability of households already struggling to meet basic needs.