Social Support Infrastructure for Nutrition of Infants
One of the most important social support programs in the United States is the the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Like the Supplemental Nutrition Assistance Program (SNAP), it is intended to provide gap-coverage for families of limited socio-economic means to purchase wholesome and nutritious foods which may otherwise be beyond their reach (Kraft & Furlong, 2013; Food and Nutrition Service (USDA), 2014). Unlike SNAP, WIC is a discretionary program, rather than an entitlement program (Kraft & Furlong, 2013). A discretionary program must have funding renewed every year by House and Senate Appropriations Committees at the Federal level whereas an entitlement program is exempt from annual review and not appropriated to states per se (Longest, 2010). The nature of WIC funding is such that the Federal budget appropriates a set dollar amount per state each year for program funding. If enrollment exceeds funding, families are placed on a prioritized waiting list for available funds based on the age of the child(ren) in the family.
Of the many expenditures of WIC, powdered infant formula accounts for at least $2.6 billion (USD) per year, with an increase of $127 million (USD) per year in recent years. The combined prevalence of formula feeding in the WIC population, and of the population relying on WIC (>50% of infants born each year) results in 57-68% of all formula purchased in the United States being done so through WIC (Oliviera et al., 2010). This is a significant up-front financial burden. The burden does not, unfortunately, stop here. Infants who are fed formula grow up to be children with more chronic and acute illness, greater incidence of diabetes, and higher likelihood of progressive chronic illnesses as adults (Ip et al., 2007). To reiterate, more than half of the children born in the United States are born into families receiving entitlement and discretionary social assistance for nutrition and health support (Oliviera et al., 2010). One in ten adolescents suffer from a chronic illness, and these young people are able to discuss the impacts of their illness on health, insurability, family finances, negative social perceptions of peers, and life-long consequences (Lindsay et al., 2011). Bartick and Reinhold (2010) analyze the cost of suboptimal breastfeeding in the United States, encompassing all of these aspects and many more beyond the scope of this discussion, to a minimum of $3.6 billion (USD) of compounded financial and quality of life burden annually. It is an unfortunate reality that much of the social responsibility hinges on the WIC program. Slow changes are making positive impacts in reducing WIC recipient dependence on formula by increasing the breastfeeding initiation, exclusivity, and duration. Excellent commentary on this topic by a candid expert can be found here.
What are the options?
In the absence of exclusive breastfeeding within the family, health care professionals frequently default to a recommendation of human milk provided through a milk bank. In cases where sufficient need can be established for the infant or young child in question, some state Medicaid programs will pay for the cost of donor milk. This milk is at least $4.50 (USD) per ounce. Clearly, even if supply were able to meet the demand of the millions of children in the country served by WIC who currently do not receive breastmilk, this is not a realistic fiscal option. Donor milk provided through PAMS, theoretically, could be. The milk is provided to recipient families at no cost*, and many donors offer several thousand ounces during their participation (Bond, 2014). With infrastructure to support localized PAMS donors in serological screening and potentially biological screening of the milk itself, it is conceivable that such a program could be feasible. Provision of human milk has been shown consistently to reduce the disease severity and incidence in fragile infants, and it is possible that provision of donor milk to otherwise healthy infants could reduce the disparity of health burden between those who primarily breastfeed (financially secure White families) and those who primarily formula feed (minority and financially insecure families) (Lindsay et al., 2011; Nelson, 2013).
Providing nutrition and health support for families in fragile financial circumstances is a worthy and necessary expenditure. Provision of formula through WIC creates a paradox in which the child must be fed, but social constructs of lactation and employment do not support the achievement of both breastfeeding and employment simultaneously. The provision of infant formula enables employment, and provides adequate infant nutrition in the short term, while perpetuating a cycle of chronic and acute illness, potential disability from these chronic illnesses, and continued dependence on an already strained social support system. WIC is doubly tasked with ensuring infants are fed, and reducing dependence on infant formula to do so. This task essentially happens in a void of greater social, financial, cultural, and political support evident in the near complete absence of systemic breastfeeding support infrastructure. PAMS currently exists in an unknown role and relationship to this social quandary.
* Recipient families will frequently reimburse the cost or reciprocate storage bags/containers, and pay shipping costs where applicable.
Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics, 125(5), e1048-e1056.
Bond, A.B. (2014). Unpublished data.
Furlong, S. R., & Kraft, M. E. (2013). Public policy: Politics, analysis, and alternatives. Washington, D.C: CQ Press. Fourth Edition.
Hedberg, I. C. (2013). Barriers to breastfeeding in the WIC population. MCN. the American Journal of Maternal Child Nursing, 38(4), 244-249. doi:10.1097/NMC.0b013e3182836ca2.
Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., … & Lau, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment, (153), 1.
Lindsay, S., Kingsnorth, S. and Hamdani, Y. (2011), Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions. Journal of Nursing and Healthcare of Chronic Illness, 3: 186–208. doi: 10.1111/j.1752-9824.2011.01090.x
Longest, B. B. (2010). Health policymaking in the united states. Fifth Edition. Chicago: Health Administration Press.
Nelson, M. M. (2013). The Benefits of Human Donor Milk for Preterm Infants. International Journal of Childbirth Education, 28(3).
Oliviera, V., Frazao, E. and Smallwood, D. (2011). Rising infant formula costs to the WIC program: Recent trends in rebates and wholesale prices. United States Department of Agriculture. Economic Research Report Number 93.