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Is WIC promoting infant formula?

US government could be worldís biggest violator of the International Code

The United States Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a massive government program aimed at ensuring the wellbeing of low-income and nutritionally at-risk infants, children, and their mothers.

Nearly half of all infants (47 per cent) born in America are serviced by the program, which aims to provide "nutritious foods to supplement diets, information on healthy eating, and referrals to health care."

But an article published in 2006 in the International Breastfeeding Journal[1] raises some very disturbing questions about the role WIC is playing in promoting infant formula use. While WIC includes breastfeeding promotion in its budget and the breastfeeding rates among its clients are steadily increasing, so are the rates for the population as a whole and WIC clients are lagging well behind the rest of the country. Since the programís inception in 1974, the breastfeeding rates of WIC clients at six months have consistently been one-third to one-half that of non-WIC mothers, and there is reason to believe something about the WIC program is discouraging mothers from breastfeeding.

While it has been demonstrated that low-income mothers are often less-likely to breastfeed, the statistic of low WIC breastfeeding rates holds true even when controlling for socioeconomic status, ethnicity, the motherís age and the birthweight of the baby. So why are mothers who are serviced by WIC not breastfeeding as much as the rest of the country?

George Kent, author of the article in IBJ, points to a number of possible reasons. First of all, WIC gives out free formula to mothers who choose not to breastfeed. Mothers assume that if a government agency is distributing infant formula it must be a healthy and unproblematic product. This positive image of formula, coupled with the fact that it is made readily available to mothers who are under financial strain, makes WIC clients more likely to formula feed.

The mechanism by which WIC distributes formula might also contribute to low breastfeeding rates among its mothers. WIC gives its clients vouchers which they can take to stores and exchange for formula, at no cost to the mothers themselves. WIC pays the retail price for the baby food, but formula companies give huge rebates back to the program once vouchers are redeemed. The largest amount WIC is charged for a tin of formula after rebates is 15 per cent of the wholesale price.[2]

Rebates amount to a huge contribution to WICís budget, which in 2004 was over $5 billion.[3] In addition to this $1.4 billion was recouped from formula rebates allowing them to extend their services to an additional two million mothers.[4] It appears that WIC employees have an incentive to give out formula vouchers, as doing so ultimately expands their budget and enables them to engage with larger numbers of at-risk infants and mothers.

It may seem curious that formula companies would sell their formula for such low prices, but in looking at the larger picture it appears to be a very shrewd tactic capable of ensuring long-term profits for the corporations. First, formula companies are not losing much money by selling their product at only a percentage of the wholesale price. Formula is incredibly cheap to produce, and both retail and wholesale prices are much higher than the cost of manufacture.

Secondly, in areas where WIC is highly active, formula prices are inflated by retailers. Grocers and other merchants are aware that doing so will lead to greater profits since WIC will be providing mothers with vouchers, the mothers themselves will not be deterred from buying high-cost formula. These inflated retail prices at grocery stores and pharmacies also mean that mothers who arenít serviced by WIC end up footing some of the bill of the low-cost formula, recouping some of the companiesí lost profits.

Thirdly, WIC only provides mothers with formula for a limited time. Most mothers terminate their relationship with the program after about a year, and many before that point. The free samples of formula distributed through WIC help to build a brand loyalty between mother and company, and it is likely she will buy the same brand of formula once she is no longer serviced by WIC, or when she has another child. This ensures continued profits for formula companies.

Similarly, the WIC formula program allows companies access to more mothers than they could possibly reach on their own. WIC enlists the mothers and does all the work in terms of ensuring they get free formula, which is a dream come true for formula companies, who are spared having to invest resources in targeting mothers with free samples. WIC does it for them, expanding the companiesí reach and ensuring that more mothers have their brand of formula in their cupboards.

It appears that the WIC program is in severe violation of the International Code of Marketing of Breastmilk Substitutes. Article 6.2 of the Code states "No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code." WIC can be viewed as part of the health care system and distributing free formula is undoubtedly a form of promotion.

Article 6.6 says that formula should only be "distributed for infants who have to be fed on breastmilk substitutes." There are only a small number of medical reasons to formula feed. If an infant has a medical condition such as galactosemia or phenylketonuria, or if a mother has certain infectious diseases or uses certain pharmaceuticals or street drugs, breastfeeding is not recommended. Kent estimates that only about five per cent of American infants are in medical need of infant formula, yet WIC is prepared to distribute it to all its clients, nearly half the population of US infants.

WIC must seriously reconsider the role it is playing in promoting formula use to its clients. It is estimated that at least 720 infant deaths could be prevented in the US each year if breastfeeding practices were improved.[5] The fact that WICís clients are low-income parents is a reason to discourage formula feeding rather than encouraging it, as artificial feeding places added financial strain on households because of the cost of formula and the hospital bills associated with less-healthy babies. Improved breastfeeding would also decrease government expenditures of the health care system.

Kent argues that WIC needs to implement protocols for determining the small number of its clients for whom breastfeeding is not recommended. These mothers should receive free formula from WIC for the duration that their infant needs it. The rest of WICís nearly 8 million clients however, must be made thoroughly aware of the benefits of breastfeeding and the substantial risks associated with artificial formula, and counselled in proper breastfeeding techniques. This would help ensure that Americaís at-risk infants grow up healthy and have a better chance of leading successful lives.

George Kentís article is available online at http://www.internationalbreastfeedingjournal.com/content/1/1/8


1 Kent G. "WICís promotion of infant formula in the United States." International Breastfeeding Journal, 1:8 2006.

2 United States. General Accounting Office. United States. Congress. House. Committee on the Budget: Food Assistance: Information on WIC Sole-source Rebates and Infant Formula Prices: Report to the Chairman, Committee on the Budget, House of Representatives. Washington, D.C.; 1998.

3 WIC Food Package: What are the Federal Regulatory Requirements for WIC-eligible Foods?
Food and Nutrition Service. United States Department of Agriculture; 2004.

4 Richter J: Holding Corporations Accountable: Corporate Conduct, International Codes, and Citizen Action. London and New York: Zed Books; 2001.

5 Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year? Lancet 2003, 361:2226-2234


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