A formula shortage during the COVID-19 pandemic created an experiment for the researchers to see if and how breastfeeding patterns change in response to the crisis
In 2022, the U.S. faced a severe infant formula shortage caused by the recall and shutdown of a major supplier, further compounding access challenges from earlier COVID-19 supply chain disruptions.
At the time, two researchers from UConn's College of Agriculture, Health and Natural Resources (CAHNR), Ph.D. candidate Luis Seoane Estruel and Tatiana Andreyeva, associate professor of agricultural and resource economics and director of economic initiatives at the Rudd Center for Food Policy and Health, were conducting a study on breastfeeding and childhood obesity rates during the pandemic.
They hypothesized that the COVID-19 pandemic would increase breastfeeding rates, which has been a known predictor of lower childhood obesity risk, as more new mothers would be staying home due to the lockdowns.
"We were thinking that COVID-19 would have an impact on formula behavior and increase breastfeeding because of the mandates to work from home," Seoane Estruel says. "That could help mothers who, in the past, could not breastfeed while away from the child at work."
The onset of the formula shortage created an experiment for the researchers to see if and how breastfeeding patterns could change in response to the crisis.
The researchers found a significant increase in breastfeeding rates during the formula shortage while no changes were observed during the pandemic. Based on national birth certificate data, breastfeeding initiation rates, within the first 24 to 48 hours after giving birth in a hospital, increased by nearly 2 percentage points during the crisis and remained elevated at the end of the formula crisis.
Seoane Estruel and Andreyeva recently published these findings in Pediatrics, an official journal of the American Academy of Pediatrics.
"In our study, we noted that a myriad of positive and negative factors could influence behavior. We didn't find any significant changes during the pandemic before the formula crisis, likely because we were unable to disentangle these factors during such an unprecedented time," says Seoane Estruel.
The largest increase in breastfeeding was seen among mothers who were previously more reliant on formula, namely mothers with lower levels of education, Black mothers, those receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance, residents of less populated counties, and Medicaid recipients.
As the researchers did not have access to income data, they used WIC and Medicaid, which are income-based programs, as proxies for income.
"The formula shortage impacted the most vulnerable mothers," Seoane Estruel says. "If you go to the store and you don't find formula, then you need to go to other stores, or have a network of people to look for you. We think that mothers who in the past were more reliant on formula, had fewer options, fewer tools to try to bypass the formula shortage because they don't have the time, the network, or the money to buy formula."
Historical discrepancies between mothers who breastfeed or not likely stem from differences in work situations and support systems in place. Women with less education and lower income are more likely to work minimum wage jobs where it may be more challenging to breastfeed or pump milk every few hours.
However, Seoane Estruel says understanding that mothers were willing to switch to breastfeeding when there was pressure from the shortage indicates that they would be open to interventions that make breastfeeding a more realistic possibility, such as making workplaces more supportive of breastfeeding mothers, or implementing paid family leave.
"What we see is there is room for change," Seoane Estruel says. "Mothers are willing to change depending on some specific circumstances and supports."
Aside from the correlation with childhood obesity rates, breastfeeding has a host of evidence-based health benefits for children and mothers, including reduced risk of ear and gastrointestinal infections, inflammatory bowel disease, childhood leukemia, and asthma. Not breastfeeding is linked to higher risks of sudden infant death syndrome, necrotizing enterocolitis, and respiratory illnesses in infancy. Mothers who breastfeed also have lower risk of breast and ovarian cancer, cardiovascular disease, hypertension, and type 2 diabetes. There is also evidence that children who are breastfed have higher IQ.
Having completed this study, the researchers are now interested in looking at breastfeeding duration and exclusivity to see if there was a similar effect, as well as if there has been a longer-term shift toward breastfeeding after the shortage.
They are also interested in seeing if increased breastfeeding rates impacted the mother labor outcomes since, if they are taking the time to breastfeed, that is time they are, hypothetically, not working, especially if their workplace is not breastfeeding-friendly.
"Even small decreases in time worked after the birth of a child do impact future earnings in a potentially sizable and significant way," Seoane Estruel says. "So, we want to check using this experiment if there is evidence that this is happening."
This work relates to CAHNR's Strategic Vision area focused on Enhancing Health and Well-Being Locally, Nationally, and Globally, and Promoting Diversity, Equity, Inclusion, and Justice.
