An debate in the International Breastfeeding Journal [1] has revealed how a US government agency designed to safeguard the health of low-income women, infants and children could be putting the lives of over 700 babies per year at risk, exploits the government-funded distribution network as a promotional and brand loyalty tool, encourages inflated retail prices and may even contravene human rights.

The article focuses on the WIC program (The United States' Special Supplemental Nutrition Program for Women, Infants and Children), launched in 1974 and administered by the Food and Nutrition Service of the US Department of Agriculture. The WIC program “serves to safeguard the health of low-income women, infants, & children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care”.

The WIC provides free formula milk to the needy if: 1) they are individually determined by a competent professional to be in need of the special supplemental foods supplied by the program because of nutritional risk; and 2) meet an income standard, or receive or have certain family members that receive benefits under the Food Stamp, Medicaid or Temporary Assistance for Needy Families Program. The total cost of the WIC program in the 2004 financial year was US$4,890,200,000 for 7,904,000 participants.

The cost of the formula milk was rebated to the WIC at between 85 to 98 percent of the wholesale price in 2000 financial year, and for the US as a whole, net prices averaged 18 cents per can of milk-based liquid concentrate that year. The manufacturers of the formula are paying most of the cost of the actual product, the author suggests, for the following reasons: low product cost, inflated retail prices, brand loyalty, and expanded reach. This is corroborated by the following facts: during the 1970's, one company paid a million dollars to the City of New York for the privilege of donating free formula to all of the City hospitals; In 1989, Abbott Laboratories and Bristol Myers got into a bidding war in Canada over the exclusive right to supply free formula to Canada’s largest maternity hospital.

It is universally accepted that breastfeeding is preferable to formula feeding in most cases. The infant mortality associated with not breastfeeding is relatively small in richer countries, but it is not negligible. Recent studies indicate that formula feeding in the US causes substantial numbers of excess infant deaths. The risk of post-neonatal (29-365 days of age) mortality is about 27% higher among infants who are never breastfed compared to infants who are ever breastfed. On this basis, about 720 infant deaths in the US would be averted each year if all infants were breastfed. WIC has a vigorous and effective program for promoting breastfeeding, resulting in steadily increasing breastfeeding rates among clients. However, a USDA report acknowledges: Although breastfeeding rates are increasing among women participating in WIC—both while in the hospital immediately after giving birth, and 6 months after giving birth—the rates continue to be lower than those of non-WIC women. Although some have questioned whether WIC provides a disincentive to breastfeeding by supplying free infant formula, the women most likely to participate in WIC, including mothers who are poor and have low education levels, are less likely to breastfeed their children in general. WIC has a breastfeeding promotion program, but its positive impact is diluted by WIC’s infant formula program. It is difficult to see how offering free formula could fail to be an incentive to use formula. The inducement is not simply that something of value is being offered at no cost. Even if it is unspoken, there is the implicit message of endorsement: if a government agency is handing out this product, it must be good.

It is also suggested that the WIC program may contravene human rights law: The most directly applicable international human rights agreement is the Convention on the Rights of the Child, an international human rights agreement that came into force in 1990, which states, “States Parties recognize the right of the child to the highest attainable standard of health” and they shall take appropriate measures “to combat disease and

malnutrition . . . through the provision of adequate nutritious foods, clean drinking water, and health care.” It also says States Parties shall take appropriate measures “To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition [and] the advantages of breastfeeding . . .” and that States Parties shall "take appropriate measures to diminish infant and child mortality.”

The author concludes:

"If infant formula could be demonstrated to produce better infant health, there might be a reason to distribute it without cost to those who could not otherwise afford it. However, there is no evidence to support the generalization that the use of infant formula results in better infant health than breastfeeding. On the contrary, the evidence clearly and consistently shows that the use of infant formula increases the risks of morbidity and mortality throughout the life cycle. The use of infant formula has been shown to be harmful to the health of mothers as well. The inescapable conclusion is that the government should not be distributing free infant formula... WIC could reasonably provide infant formula, but only in exceptional cases, if that is recommended for a specific reason by a physician or a lactation counselor. An initial list of acceptable reasons could be drawn from the Lawrence study of contraindications to breastfeeding. The rebate program should be ended. The WIC program should stop providing free infant formula to the majority of its clients, and should be limited to providing infant formula to no more than a small percentage of its clients... Currently, WIC acts in a way that benefits commercial enterprises at the expense of infants. The government should not risk infants’ health in order to support commercial enterprises."

The book Eat Right 4 Your Baby [2] gives suggestions on how to encourage and promote a good flow of breast milk, and where necessary, the use of soya-based formula milk is gaining popularity due to colic and digestive problems from cows' milk. Predigested protein is also available. The best formula for your baby should be decided in conjunction with your paediatrician.

Follow up:

References:

1. WIC'S Promotion of Infant Formula in the United States [Open Access Article]

Kent G

International Breastfeeding Journal 2006, 1:8

2. Eat Right For Your Baby : The Individualized Guide to Fertility and Maximum Heatlh During Pregnancy by Peter J. D'Adamo and Catherine Whitney. ISBN: 0425196143. pp. 287-93