I opened my talk at the Community Action Partnership annual conference this year with the observation that like that weird looking guy from the old “Hair Club for Men” commercials, I’m not just a spokesperson, I’m also a client. All foster children under 5 years receive WIC, the US program that provides SUPPLEMENTAL (this word will be important in a moment) food for pregnant and nursing women, and babies and children under five. We haven’t always used WIC for our foster children – a lot of the food it provides is industrial and not something we eat a lot of, but Baby Z. is formula fed, and the cost of that formula was nearly $200 per month, so we do use WIC.
I’ve come to think that being a WIC recipient, as well as someone who writes a lot about supplemental food programs, poverty and hunger, is a really good thing. Just as it is salutary for every doctor to experience the loss of control of being a patient, it is useful for someone like me to get the dirty looks and get to know the realities of being a recipient in an anti-poverty program.
The reason Z. is a formula-fed baby is that New York State has no program for foster breastfeeding. This is too bad, because I probably could have nursed Z. I ceased nursing Asher less than five years before Z. was born (relactation after less than five years is supposed to be pretty viable), and Z. had been breastfed by his mother in the hospital. His mother expressed a strong desire for me to nurse him, and I would have been glad to, including doing appropriate medical testing for HIV and other illnesses that can be transmitted through breastmilk. All in all, our family would have been a great candidate for foster nursing. Some counties in California and a few other states have programs for supporting foster nursing, but not ours – hopefully that will change eventually, but in them meantime, Z is on formula.
That word I emphasized, “supplemental’ is important here – WIC is a supplemental food program, designed to provide PART of a child’s food needs. The difficulty is that there is a wide-spread perception culturally among low income mothers that when choosing between infant formula and breastfeeding, there is no real financial difference for poor mothers, because “WIC pays for our formula.” Thus, despite WIC’s programming to encourage breastfeeding, the widespread availability of formula through WIC – but not enough formula – serves to do two things. First, it implicitly undermines incentives to nurse by seemingly promising to eliminate economic incentives for most mothers to breastfeed, and second, by providing only supplemental formula, it means that the lowest income families often run short – pushing families financially to the wall at the end of the month, and sometimes forcing them to water formula or supplement with less healthy liquids in the bottle.
WIC does pay for “our” formula – it distributes about 50% of all the formula used in the US. 53% of infants born in the US receive WIC. About 9 million households received WIC in 2011. That’s a lot of baby formula, and it enormously enriches the companies that make formula. Most states contract directly with one or another formula company, and without those contracts, formula makers would be doing a lot less well. States also get rebate money FROM the formula companies.
There is clearly a need for a minority of low-income households to receive subsidized formula – but the problem is that WIC functionally undermines breastfeeding – yes, it does offer breastfeeding information, but WIC recipients are LESS likely to nurse than comparable low income mothers who choose not to use the WIC program (remember, WIC also offers supplemental foods for nursing mothers, so not nursing wouldn’t mean you wouldn’t use WIC). A recent CDC study showed a that women who were on WIC were significantly less likely to nurse than their peers who aren’t on WIC. (66% initiation rate, 33% still nursing at 6 months, 17% nursing at 1 year, as opposed to their non-recipient peers with 77% initiation, 50% at 6 months and 30% at one year). The CDC acknowledges that there isn’t a clear indication of cause and effect, since race and other cultural factors are mixed in with this, but offering free formula clearly doesn’t ENCOURAGE women to nurse. A 2011 study in “Breastfeeding” found that nursing support was distributed inequitably as well – that there was more likely to be in-home nursing support in areas where the population was largely white or Hispanic, rather than African-American.
A _Pediatrics_ Study points out the costs (economic and otherwise) of not breastfeeding can be calculated at around 13 billion and 911 child deaths. While I suspect the study’s recommended end point of 90% of all mothers nursing for six months is probably unrealistic given the lack of other supports for nursing in our society, and our preference for externalizing costs, the very real costs of not nursing give us a sense of scale.
Moreover, the perception that WIC “gives our formula” makes for an ugly surprise when first-time mothers realize, at the end of the month when money is tightest, they are running out of formula. WIC Q and A boards abound with mothers asking in desperation how they can get more formula, and food pantries report infant formula is one of the most-in-demand items at most food pantries. But going through food pantries offers significant disadvantages, particularly for babies on specialized formulas. Even a brand change can cause digestive upset for a sensitive infant, but often a child who needs a specialized formula (dairy free, anti-reflux, etc…) won’t be getting it for the days in which WIC formula is not available. This may be true even when the parents can buy formula – a can of Nutramigen or other specialized formula is more than double the price of a can of regular formula, pushing lower income parents of children with special dietary needs not to meet them.
If WIC is going to, whether with or without intention, encourage low-income women not to breastfeed, it is morally incumbent upon the program to provide enough formula for a healthy infant, and not to recreate the boom-and-bust cycle of poverty. Better still, however, would be to truly support breast-feeding as a society – to provide the real support needed to enable low income women to nurse. That would include making formula less readily available, real in-home lactation support, and ultimately a national commitment to nursing That would most of all mean providing some measure of paid maternity leave nationally and requiring employers to provide breastfeeding support.
As much as I appreciate not having to buy several hundred dollars of specialized infant formula each month, I’m also concerned that what I see at WIC sets up low income women for a cycle of late-month desperation and frustration, and babies for watered-down bottles or worse. Moreover, in the longer term, this operates to provide an enormous subsidy to industrial food companies that produce infant formula by the state, and it also places families in difficult situations. Hurricane Sandy, for example, came at the end of a month, leaving many poor families in NYC and surrounding areas without enough formula to get their babies safely through the period afterwards where stores were closed and trucks unable to get into restock. During Hurricane Katrina in 2005, bottle fed infants suffered deeply due to lack of formula access. While not every mother can nurse by any means, it is in our collective interest to encourage, rather than discourage nursing.