Getting Formula Was a Strain for Many Low-Income Families Before Shortages

Miracle Abbott fell pregnant in her junior year at University of South Carolina Upstate.

Her low-wage work and student debt meant that she turned to the Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC, at the age of 19 to receive infant formula and food. After giving birth, her baby suffered from colic and severe reflux. Her pediatrician recommended that she use a special formula that was not available through the program.

It took four months, three appointments with a pediatrician and two meetings at the local WIC office before she received formula that worked. In the end, she spent hundreds of dollars on formula. That was in 2020. This was years before an Abbott manufacturing facility in Michigan was shut down because of concerns about bacterial contamination. Massive shortages of infant formula in the United States were caused by the February shut down and the concomiting recall.

Families across the country are experiencing tremendous stress due to a lack of formula, particularly those who rely on WIC. According to the U.S. Department of Agriculture (which runs WIC), the federally funded grant program is administered by nearly 90 states, territories, and tribes. It accounts for almost two-thirds of all formula purchase in the U.S.

WIC has been in existence for nearly 50 years provided food assistanceLow-income mothers and their children. About half the babies in the U.S. — 1.5 million — received benefits from WIC in 2021. The program’s purchasing power led to significant cost savings for both the federal government and the state governments. But the program’s massive purchasing also limits choices for families and can make it hard for mothers like Abbott to get formula that is a good fit for their infants.

These limitations were established in 1989 by WIC administrators who opted for a policy where formula companies could bid to be the sole provider for each state. The winning manufacturer offers a limited selection of formulas to the states.

The agreement allows the companies to give WIC programs significant rebates on the formula they buy. David Betson is an associate professor of economics at the University of Notre Dame and has studied WIC. He explained that for every $1 WIC pays formula companies, it can get back as much 93 cents as rebates.

Rebate savings reduce annual program costs $1.6 billion last yearAccording to the USDA, they are. KHN was informed by the USDA that the rebate system allows states more efficient use of their food grants and offsets the cost formula so that more people can be served without increasing federal funding.

And because of WIC’s bidding policies, nearly half of all WIC-supported infants get formula from just one brand: Similac, which is made by Abbott. After the February recall and plant shut down, it is possible that over half a million babies had to switch formulas.

While most babies are able to tolerate almost any formula, some parents find that their baby is more comfortable with a particular brand or type of formula.

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

When Jenny Murray, a mom of three in Florida, started getting WIC benefits, the formula her baby had been using was not one of her state’s WIC-approved options. The formula WIC chose for her baby made him feel gassy. Officials at her WIC office told her she needed a note from her doctor to get a different formula, but her doctor said it wasn’t medically necessary to switch. She has remained with the same formula. Now, amid the shortage, she’s struggling because WIC allows participants to buy only small cans of formula, and she said those are the hardest to find. (Some states’ WIC programs are temporarily changing policies amid the shortage.)

“I didn’t even make dinner tonight because I knew we’re going to be spending the rest of the evening just going from store to store to store to store in hopes that we’ll find some [formula],” Murray said. A few times, she has had to resort to paying about $40 out-of-pocket for a large can of formula because that’s all that was available.

Betson stated that higher prices have resulted from states having formula manufacturers compete for WIC service. He discovered that wholesale formula prices are higher. across the board nearly doubledFrom 1989, when WIC began its bidding process, to 2002. Another study foundThe formula prices have increased by 30% between 2006 and 2015. Betson claimed that formula companies take a hit on formula they sell via WIC and compensate by charging higher prices for non-WIC clients.

However, other economists believe that formula companies will benefit from an increase sales after they win a WIC contract. prices for non-WIC customers haven’t been affected. (Store-brand formulas, which are made by Perrigo Nutrition, a company that doesn’t participate in WIC contracts, are about 40% less expensive than the formula brands that do participate in WIC and have nearly identical ingredients.)

WIC spends more money on formula than any other food because 88% of WIC-supported infants get at least some formula. Because of the greater barriers to breastfeeding, lower-income mothers are more likely to use formula. About 25% of low income individuals must return to work two weeks after giving birth to be eligible for formula. Ifeyinwa AsioduAssistant professor at the University of California, San Francisco, whose research focuses upon infant feeding disparities. Those same parents may also work in jobs that don’t have lactation accommodations, and they may be afraid to jeopardize their jobs to ask for them, she said.

Because of the federal program’s high rates of infants on formula, WIC administrators have tried incentivizing breastfeeding by giving more food to breastfeeding moms, and some states have tried to limit access to formula for mothers who start breastfeeding. Emeline Pratt is a Vermont-based mother of two. She said that her WIC office required her meet with a lactation consultant for formula. Even though she stated she had stopped breastfeeding, the consultant demanded that she get formula. Pratt was in tears after the uncomfortable appointment.

Asiodu stated that she would like to see more policies that support breastfeeding and allow greater access to human milk from the milk banks. She also believes there is a need for more flexibility with WIC.

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

Miracle Abbott also said that WIC should have more options for formula-feeding moms. Despite having a colicky baby, going to school, and dealing with the problems of the pandemic, she said, “WIC is probably the most frustrating thing we’ve had to deal with.”

KHN(Kaiser Health News is a national newsroom that produces detailed journalism on health issues. KHN is one the three major operating programs. It includes Policy Analysis and Polling. KFF(Kaiser Family Foundation). KFF is an endowed, nonprofit organization that provides information on health issues for the nation.

KHN (Kaiser Health News)This national newsroom produces in-depth journalism on health issues. Together with Policy Analysis and Polling KHNOne of the three main operating programs at KFF(Kaiser Family Foundation). KFF is an endowed, nonprofit organization that provides information on health issues for the nation.

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