Breastfeeding Trends Following the US Infant Formula Shortage

Abstract

OBJECTIVE: Breastfeeding enhances maternal and child health, yet US breastfeeding rates remain below optimal levels and substantial disparities persist. The 2022 infant formula crisis had the potential to influence infant feeding practices due to formula shortages and fears about the safety of formula feeding in the wake of recalls. This report studies the evolution of breastfeeding-initiation trends during the infant formula crisis and compares the effects across subpopulations. METHODS: This study analyzed 2016–2022 national birth certificate data from 47 states and the District of Columbia based on Bayesian structural time-series analysis to measure average changes in breastfeeding-initiation trends and a linear probability model to test for heterogeneous effects. RESULTS: During the 2022 infant formula crisis, average breastfeeding-initiation rates increased by 1.96 percentage points (pp) (95% credible interval, 1.68 pp to 2.23 pp) and remained elevated above historical levels at the end of the formula crisis. The increase was particularly pronounced among mothers with lower education levels, those receiving Special Supplemental Nutrition Program for Women, Infants, and Children assistance, residents of less populated counties, Medicaid recipients, and Black mothers, possibly due to their higher reliance on formula feeding. Populations meeting all of these sociodemographic criteria experienced the largest increase in breastfeeding initiation at 6.06 pp (95% confidence interval, 5.26 pp to 6.87 pp). Preexisting disparities in breastfeeding initiation declined in 2022. CONCLUSION: The infant formula crisis highlights the potential for addressing breastfeeding disparities and reducing associated child and maternal health risks through targeted interventions to promote breastfeeding.