Income

For many low-income families, getting formula milk has always been a hassle

Christina Szalinsky

Kaiser Health News

Miracle Abbott got pregnant during her freshman year at the University of South Carolina in upstate.

She was working a low-wage job and mounting student debt, so the 19-year-old turned to the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC, to getting formula and food. But after giving birth, her baby had painful colic and reflux, and her pediatrician recommended a special formula not available through the program.

It took four months, three pediatrician appointments and two meetings at her local WIC office before the program provided her with a formula that worked for her daughter. She spent hundreds of dollars on the formula in the process. That was in 2020, years before an Abbott manufacturing plant in Michigan closed due to concerns about bacterial contamination. February shutdown and simultaneous recall catalyzed massive infant formula shortages in the United States

The continued shortage of infant formula has caused enormous stress for families across the country, especially those dependent on WIC. The federally funded subsidy program, administered by nearly 90 state, territorial and tribal governments, accounts for up to two-thirds of all formula purchases in the United States, according to the U.S. Department of Agriculture, who manages the WIC.

For nearly 50 years, WIC has provided food assistance to low-income mothers and children. About half of babies in the United States – 1.5 million – received WIC benefits in 2021. This purchasing power has resulted in significant savings on infant formula for the federal and state governments that run the program. . But the program’s massive purchases also limit choices for families and can make it difficult for mothers like Abbott to get a formula that’s right for their infants.

These limitations began in 1989 after WIC administrators opted for a policy in which formula preparation companies bid to become the sole supplier in each state. States then offer a limited assortment of formulas from the winning manufacturer.

Under the deal, the companies give state WIC programs deep discounts for the formula they buy. For every dollar WIC pays formula companies, it recoups up to 93 cents in rebates, said David Betson, an associate professor of economics and public policy at the University of Notre Dame who has studied the WIC program.

Rebate savings reduced annual program costs by $1.6 billion last year, according to the USDA. In a statement to KHN, he said the reimbursement system allows states to use their food subsidies more efficiently and offsets the cost of the formula so more participants can be served without increasing federal funding.

And because of WIC’s bidding policies, nearly half of all WIC-supported infants receive formula from just one brand: Similac, which is made by Abbott. As a result, more than half a million babies may have had to switch formulas after the February recall and plant shutdown.

Many babies do well with just about any formula, but some parents find that their baby seems to do better with a specific brand and type.

“Parents often have to experiment a bit and often end up trying three or more formulas to find the formula that keeps their baby comfortable,” said Bridget Young, an assistant professor who studies infant nutrition at the University of Rochester Medical Center.

When Jenny Murray, a mother of three in Florida, started on WIC benefits, the formula her baby was using was not among the WIC-approved options in her state. The formula WIC chose for her baby made her gassy. Officials at her WIC office told her she needed a doctor’s note to get a different formula, but her doctor said it was not medically necessary to change. She therefore stayed with this formula. Now, amid the shortage, she’s struggling because WIC only allows attendees to buy small boxes of formula, and she said those are the hardest to find. (Some state WIC programs are temporarily changing policies due to the shortage.)

“I didn’t even cook dinner tonight because I knew we were going to spend the rest of the evening going from store to store to store to store hoping to find some. [formula]”, Murray said. On a few occasions, she had to pay around $40 out of pocket for a large box of formula because that was all that was available.

Each state’s decision to compete with formula makers to serve the WIC program has driven prices up, Betson said. It found that wholesale formula prices in all areas had nearly doubled since WIC implemented its bidding process from 1989 to 2002. Another study found that formula prices had increased by an additional 30% from 2006 to 2015. Betson said formula companies take a hit on the formula they sell through WIC and compensate by charging higher prices to non-WIC customers.

Other economists, however, argue that formula companies instead benefit from increased sales after winning a WIC contract, and that prices for non-WIC customers have not been affected. (Store brand formulas, which are made by Perrigo Nutrition, a company that does not participate in WIC contracts, are about 40% less expensive than formula brands that participate in WIC and have nearly identical ingredients.)

And WIC spends more on formula than any other food because the majority of infants supported by WIC, about 88 percent, receive at least formula through the program. Low-income families are more likely to use formula because these mothers often face more barriers to breastfeeding. For example, about 25% of low-income people have to return to work about two weeks after giving birth, said Ifeyinwa Asiodu, an assistant professor at the University of California, San Francisco, whose research focuses on disparities in infant feeding. Those same parents may also work in jobs that don’t have breastfeeding accommodations, and they may be afraid to jeopardize their jobs to ask for them, she said.

Due to high rates of formula-fed infants from the federal program, WIC administrators have tried to encourage breastfeeding by giving more food to nursing mothers, and some states have tried to limit access to formula for mothers starting to breastfeed. Emeline Pratt, a mother of two who lives in Vermont, said her WIC office required her to meet with a lactation consultant to get formula, even though she explained she had already given up breastfeeding. The uncomfortable date left Pratt in tears.

Asiodu, who said she would like more policies that support breastfeeding and allow better access to breastmilk from milk banks, also sees a need for more flexibility in the WIC.

“I think it’s really important that we allow families to make the decisions that best suit their needs and that we also provide resources along the way,” regardless of the feeding option they have. choose, she said.

Miracle Abbott said she also wishes WIC had more options for formula-feeding moms. Despite having a colicky baby, going to school and coping with the issues of the pandemic, she said, “WIC is probably the most frustrating thing we’ve ever had to deal with. to face.

Kaiser Health News is an editorially independent news service. It is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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