Casaubon's Book

WIC, Formula and Nursing

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.

Comments

  1. #1 Denise
    February 7, 2013

    Small changes, step by step. Our facility’s nurse managed health center announced this week that it has prepared a lactation room at its center for use by students, staff, and instructors who are nursing. More employers/institutions need to implement this practice.

  2. #2 Brad K.
    Ponca City, OK
    February 8, 2013

    I am uncomfortable with making someone pay for someone else, even when it is an employer required to pay for vacation, maternity/paternity leave, etc., that the business doesn’t see as being in it’s own interest. While it does redistribute wealth, it denies both the employer and employee of the ability to make the best choices in their own interests.

    The answer cannot be paid maternity leave. A better answer would be alternate work, or better yet, more work in the informal economy with related adjustments to the lifestyle.

    My suspicion is that work that doesn’t accommodate children and family involved in the workplace won’t be found to be sustainable (local food security, local transport and residence practices and materials, etc.). It might just be that the issue of breastfeeding is showing us all a healthier direction, if we can figure out what that direction is.

  3. #3 KRowbot
    Grand Rapids, MI
    February 8, 2013

    While I understand Brad’s position, this puts women and babies (and therefore, FAMILIES) in a tight spot. (Granted, here in the US, the longest paid maternity leave I’ve heard of is 3 months and most docs/orgs recommend breastfeeding almost exclusively for the first 6 months so many moms will be in the bind I describe below during baby’s 4th through 6th months anyway, but that’s another story…)

    So, here’s the bind — if your employer DOESN’T offer paid maternity leave, I would be pretty surprised if they let you take your baby to work. Let’s assume then that mom has to leave baby with family, a friend, or at daycare. And we want mom to breastfeed, right? So that means she’s pumping and then giving that breastmilk to the folks who are taking care of baby while she’s at her 9 to 5 (or 3 to 3 like some of my nurse friends). Correct me if I’m wrong, but from what I understand about breastfeeding, if you want to make sure that you make enough milk to exclusively breastfeed, your supply is not going to just “turn off” when it’s inconvenient for you to dispense it. So that means mom’s going to need to pump during the day and somehow safely store that breastmilk until she goes home. Is her employer going to provide her with a place to privately pump and then store her milk? I assume Brad would be uncomfortable with that as well since it involves an employer being required to pay for something that it “doesn’t see as being in it’s [sic] own interest.” What’s mom supposed to do here? Like the situation Sharon describes in her post, this is ANOTHER situation that “encourages”/forces moms (of EVERY income level this time) to formula feed.

    Again, while I understand Brad’s position and agree with him that in the future “work that doesn’t accommodate children and family involved in the workplace won’t be found to be sustainable,” that’s not where we are now. And we might not be there for a little while. Given its effects on mom+baby+family and the realities of our current culture/economy, it feels irresponsible to oppose paid maternity leave and downright hypocritical to oppose paid maternity leave and give lip service to the importance of breastfeeding at the same time (not saying Brad necessarily did the latter).

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    February 8, 2013

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  5. #5 dean
    February 8, 2013

    ” it denies both the employer and employee of the ability to make the best choices in their own interests.”

    Yes, because having employees know that you value them as more than simply expendable cogs isn’t a wise choice for business.

    I am amazed that people still refer to “the wisdom of the market” when experience and data show there is no such thing: neither consumers nor suppliers are rational actors, and waiting for change based on the assumption that they are is waiting for change that will never come.

  6. #6 Rose Bartiss
    February 8, 2013

    I totally agree with you about encouraging mothers to nurse their kids. And that WIC pushing free formula makes women feel sort of obligated to use the formula.

    But what about breastfeeding being a huge pain in the ass? I think a lot of new moms don’t want to start breastfeeding or don’t stick with it because it’s uncomfortable, or inconvenient (like when you have to go back to work), or not shared by your partner (dad can’t breastfeed). Hauling a breast pump around so I could go to work or so my husband could feed the kid was a huge pain. Plus pumps are super expensive and the one the hospital gave me for free was as close to a torture device that I have ever been.

    I think there needs to be some realistic consideration of the hassle breastfeeding imposes when people go around trying to encourage it. It’s great to limit the amount of free formula available to encourage moms to try breastfeeding, but the LaLeche League needs to get realistic about the fact that not every mom has the same wonderful breastfeeding experience.

    Trust me, if I actually got any enjoyment out of breastfeeding, I would have stuck with it.

  7. #7 Greenpa
    http://littlebloginthebigwoods.blogspot.com/
    February 8, 2013

    Sounds to me like a job for La Leche.

    Why on earth should we not have the profession of “wet nurse” available anymore? Granted it has been considered a “low” occupation many time- it SHOULDN’T be. It ought to be a highly valued contribution to society- well paid and honored. And sure- tested and certified.

    A little rebranding might be in order; the term wet nurse is probably not the best marketing we could do. For example, “LLP” would be better. Licensed lactation provider.

    Good grief- the benefits to the children are known; and enormous. Your situation, Sharon, gives you a powerful voice on this subject I think. Speak up! Yell, if you have to.

    :-)

  8. #8 Yvonne Rowse
    Sheffield, UK
    February 9, 2013

    Rose, I don’t think Sharon is suggesting any compulsion to breastfeed, just to take away the encouragement not to. You talk about the inconvenience of breastfeeding but I would have found bottle-feeding to be very inconvenient. I really struggled to breastfeed my first child for the first three weeks but persevered because I just didn’t want to do the whole sterilisation and making up bottles thing. With some help, my baby and I eventually learned how to breastfeed and then I could feed him whenever, wherever with minimal inconvenience. I found when I was feeding I woke up at the baby’s first stirring and could feed and be back to sleep very quickly whereas if my husband had had to bottle-feed during the night it would have been a much greater disturbance and I wouldn’t have slept through it anyway.
    What I’m saying is that we take the inconvenience of bottle-feeding for granted and don’t really see it. The key is effective help for mother and baby and no compulsion on either.

  9. #9 Susan
    Arizona
    February 9, 2013

    I was 17 when I got pregnant with my oldest son, and I received WIC after he was born. I think it must have changed a great deal since I was that young, or I was just so focused on breastfeeding that I didn’t know they pushed (by default) formula feeding, because I used the WIC coupon to buy foods allowed for me. Even in the early 80′s food stamps didn’t provide enough dollar value for high quality nutrition like a mother should have when breastfeeding, the WIC contribution really helped.

  10. #10 Lynn
    February 11, 2013

    You mentioned how you came to think of being a WIC recipient as being a good thing. I always had mixed emotions about being on WIC, but I rarely thought of being a WIC recipient as being good for me. Tolerable, at times, but never a situation I’d prefer to be in.

    All the dirty looks and judgmental attitudes just made me want to cry and stop using the program. It wasn’t that I was ashamed to be on WIC. I think if someone qualifies for it and it would benefit them, they should take advantage of it if they want to. I wasn’t ashamed, but I was shamed. Others thrust shame upon me because of their attitudes toward those types of programs. They were the ones shaming me.

    I suppose I toughened up in the process, and that can be a good thing, but I would have preferred that society would simply stop judging individuals. If they have a problem with the program or how it’s run, they should take that up with their elected officials, not with the recipients in the grocery store.

  11. #11 Greenpa
    February 12, 2013

    Astonishingly, Sharon, the NYT has a relevant article today- and it’s even reasonably intelligent:

    http://well.blogs.nytimes.com/2013/02/11/picking-source-of-babys-milk/

  12. #12 Lisa
    February 13, 2013

    The claims you make for breast feeding are wildly inflated. Also, the idea that women should be compelled to nurse their infants by failing to offer alternative adequate food support is appalling. Where is the autonomy inherent in that brilliant idea?

    Many women would not nurse their children even if given two years off to do so, and many many women prefer to go to work—without breast pump!—and send the infant to daycare while they continue to to work somewhat more productive than wiping infant bottoms and shoving puréed peas in mouths. I for one would have been a newspaper statistic had I stayed home with my children. I know others as well.

  13. #13 Sharon Astyk
    United States
    February 13, 2013

    Lisa, I can always count on someone to play Mommy Wars here, and bring out the old canard that caring for your kids in more deadening than any other work – glad you stopped by to make sure we didn’t miss this chance. Note that I said nothing of the sort – that I said that a society that offered subsidized formula has a moral obligation to provide enough to feed the children, but a better option would be better support for nursing. But don’t let that get in the way. Feel free also to offer comparably credible peer-reviewed studies that show my statistics to be wildly overinflated – the links to the ones I cited for my statistics are in the text. I don’t see yours.

    Rose, I don’t think that breastfeeding is a comparative pain in the ass, actually – bottle feeding has plenty of enormous hassles that accompany it. Consider, for example, the fact that for night care, bottle feeding is enormously more time consuming – instead of lying down and simply attaching child to breast, mother must get up, mix formula, sit up with the child. Bottle washing feels like it occupies many of my evenings, when boob washing really only took the time of my shower ;-).

    That said, different women experience things differently – but there is no reason to offer DIS-incentives to nurse – the statistics on the differences between breastfeeding initiation with WIC and without it are quite clear, and adjusted for other differences.

    Brad, I am uncomfortable with employers getting the benefits of externalizing all the costs of preparing their future labor force on to individual families, as though they don’t benefit.

    Sharon

  14. #14 Lisa
    February 14, 2013

    If a mom wants to nurse her child, fine. But while you may not be on the “force mom to breast feed” bandwagon, plenty are. Look for example at the “baby-friendly” hospital movement, where exhausted mothers can’t take baby to the nursery and are instead required to care for said infant alone in their hospital room. Or the requirement that the nurse get an order for a bottle of infant formula and then sign it out, as if it were a narcotic, before giving it to a mom to feed her baby.

    I raised my children, and did so without lactation rooms or mandatory times available to pump. I used my own sick leave for maternity time, there was no available paternity leave, and we all survived. I for one am not willing to pay taxes for a year of maternity leave for someone else to have children, and don’t think employers should be required to support lactation with extra breaks and special rooms—-talk about special interest groups.

  15. #15 KRowbot
    Grand Rapids, MI
    February 14, 2013

    Lisa — you say “if mom wants to nurse her child, fine” but stating that employers shouldn’t be required to “support lactation with extra breaks and special rooms” makes it awfully hard for mom to breastfeed. Please see my earlier comment (three from the top, I think). Giving lip service to the idea that women should be able to breastfeed if they want coupled with the barrier of no time/place to pump at work and nowhere to safely store that milk is disingenuous.

    I think it’s amazing that you were able to raise your children while things were harder on moms, babies, and families. I think it’s interesting that you seem to think that it should be just as hard for other moms now as it was for you then. And I’m a little fuzzy on how employers providing maternity leave of any length affects your taxes. Maybe you could flesh out that claim.

  16. #16 Greenpa
    http://littlebloginthebigwoods.blogspot.com/
    February 14, 2013

    My mother passed away from breast cancer some 15 years ago. When it was my turn to help, I learned a bunch of things about my childhood; and my mother, that had just never come up before.

    Like the fact that I was breastfed (born in 1948; not “in”) – and my previous 3 siblings had been bottle babies. My mother switched. And my younger brother, 2 years later- she also breast fed.

    And a disturbing thing, which I still don’t know what to make of; regarding how easy, or hard, my mother “had it”; turns out her labor with me was 14 hours long. I’d always known I’d been born in the Bethesda Naval Hospital in DC- the same one usually responsible for the primary care of the President. So I assumed she’d gotten good care. But- she never told me; my father let it slip; her labor; and my birth- were in the hallway, on a gurney. No rooms.

    Weird, huh? Very weird to learn that, at the age of 40 something. So; she had 5; 3 bottles; last two breast. I never got a chance to talk to her about the comparisons; from the mother’s point of view; just a little too intimate, even then.

    My point- every mother is different. We all know that. But honoring it is sometimes more difficult.

  17. #17 Renee Axtell
    United States
    February 16, 2013

    I had positive experiences with WIC many years ago in rural South Dakota. I breastfed my daughter for 10 months, my son for 6, and then had to go back to work and started feeding him formula. I don’t remember ever running out of formula, but there’s probably been budget cuts since then. (My kids are now 17 and 15.) When I was breastfeeding, and again when the kids were old enough to drink cow’s milk, we always had too much. I would freeze it, and we ate lots of milk-based soups and casseroles!

    The best part was the monthly visits with the WIC ladies. They loved the babies, were sympathetic and supportive of the moms, and provided helpful information on child development and just general stuff that experienced moms know and new moms don’t. That’s probably unique to the small town where we lived. I don’t imagine it would be the same in a big city where the staffers are required to crank through hundreds of clients a day. I also was blessed with a schedule that allowed me time to go to the WIC office. I’ve had other jobs where that would have been impossible.

  18. #18 Greenpa
    February 18, 2013

    A new blurb from the BBC today; with data from “Save The Children” foundation (which I would prefer to have validated by another agency; but still).

    http://www.bbc.co.uk/news/health-21496078

    800,000 lives a year? That’s a lot.

  19. #19 Jennie
    NW Iowa
    February 28, 2013

    I actually wrote a post recently about my experiences as a full time working mother while breastfeeding.
    http://myfreedompath.blogspot.com/2012/08/breastfeeding-exclusively-while-working.html
    Baby #2 is 9 months now and just starting to wean himself.

    I have found it takes courage and fortitude to breastfeed babies for 9-12 months. With my first baby I had to walk away from a great paying job in the 1st trimester of pregnancy because they couldn’t/wouldn’t treat me right. (My team couldn’t respectfully deal with my morning sickness, I knew there was no way they would handle maternity leave or breast feeding with any sort of grace or support.) Hubby and I weren’t rich, had only been married for 2 months, and yet he didn’t even hesitate when I confessed to him how badly I was being treated. We both decided we would handle whatever came, and that I didn’t need to be there. (I was the main breadwinner then, as I am now.) That was a rough year and a half, and baby and I ended up on WIC. BUT, we had a healthy pregnancy and he breastfed through his 11th month and I don’t think either of those things would have been true had I stayed with that engineering firm.
    WIC often seemed to contradict itself. “Eat your fruits and veggies!” was on every poster in the waiting room, but they always gave me way more juice and processed cereal coupons than fruit/veg coupons. Breastfeeding is “encouraged,” but I never saw a WIC office with actual information about the physical how-to’s and realities of breastfeeding. And it’s not all butterflies and daisies. Those first few weeks are ROUGH, I handled it better the second time around, but it’s still just a grit your teeth and get through kind of time.

    A word or two on the business community finding it “in their best interest” to support breastfeeding. This may sound egotistical, but I consider myself a valuable commodity. I am a hard working engineer, and I’m a mother. If a company wants my brain power and work potential, they have to support my other position as mother. Period. If they don’t, they don’t get my brain power and work potential. Period. I feel like by taking this stance, I’m helping the business community to realize that it IS in their best interest to provide support for mothers. Women are getting more than half of all college diplomas these days. Sometimes I wonder what it would take as a group, if we were to push the issue with the business community. How many of us working moms would have to walk off the job before supporting us in our maternal work entered the realm of “in their best interest.”

  20. #20 Thisbe
    March 2, 2013

    I read this a few days ago and I keep thinking about it, so I decided I would come back and comment even though it’s a pretty old post.

    It’s actually a little bit hard for me to tell what the thesis statement of this particular post is supposed to be. Just “we ought to be more supportive of breastfeeding”? Something more specific about WIC?

    The concern that I have (and it’s a big one) about societal support for breastfeeding is that unless we’re very careful, “supporting breastfeeding” could very easily end up looking like “trapping women as stay-at-home-moms”, even if that’s not in any way the goal.

    The reason for that is partly that for some (many) women, breastfeeding exclusively is just not compatible with going to work. This could be because of the nature of the work, the nature of the baby, or both. That means that encouraging those women to breastfeed exclusively for 6 months is actually encouraging them to take six months off from any job they might have. Time that career women take off from work to stay home with babies has real financial and career-progression penalties, so this is important. And that assumes that a woman is even able to take six months to a year off work and still have enough money to live on.

    So then the answer might be, better maternity leave and also (as discussed above) mandating that workplaces accomodate pumping or feeding breaks. That’s fine as far as it goes, but it actually doesn’t go very far. Already (even without decent maternity leave policies in our nation), it is not hard to find employers who will openly admit that they would rather not hire women of childbearing age. All things being equal, if there are two acceptable applicants for a job and one is a man, well, if the man gets hired the employer won’t have to deal with maternity leave and breastfeeding support.
    (I wish I were speaking hypothetically about this, but I’m not. This happens. It is illegal, but it absolutely happens.)

    Women will never, ever be equal to men in the workforce (and thus will never, ever be equal in society) until parenting expectations are equal and are equally supported by law. That means that if a female parent gets six months of parental leave to allow breastfeeding, a male (or non-gestational female) parent gets six months of parental leave to be taken at the same or a different time to allow parenting.