Disparities in Longer-term Breastfeeding Practices and Postpartum Mental Health After the 2022 Formula Crisis

To evaluate the longer-term impacts of the 2022 infant formula crisis on breastfeeding and mental health among historically socioeconomically disadvantaged groups.

We used 2017-2022 national serial cross-sectional data from the US Pregnancy Risk Assessment Monitoring System (N=193,383) to compare changes in breastfeeding initiation, breastfeeding duration, and postpartum depressive symptoms before (January 2017-January 2022) versus after (February-December 2022) the infant formula crisis. We compared pre-post trends among participants versus non-participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and by race and ethnicity, akin to a difference-in-differences study design.

Trends (i.e., slopes) in the outcomes were similar among WIC participants and non-participants and by race and ethnicity before the formula crisis occurred. However, among WIC participants (relative to non-participants), the formula crisis was associated with increased breastfeeding initiation (3.2 percentage point [pp]; 95% CI: 2.4, 4.0) and duration (0.46 weeks; 95% CI: 0.24, 0.69), and no change in depressive symptoms. Among non-Hispanic Black respondents (relative to non-Hispanic White respondents), there was an increase in breastfeeding initiation (4.9pp; 95% CI: 3.7, 6.0), duration (0.61 weeks; 95% CI: 0.30, 0.92), and depressive symptoms (0.10-points; 95% CI: 0.02, 0.18).

The formula crisis resulted in increased breastfeeding among historically marginalized groups, likely because it differentially disrupted access to formula among these populations. However, the concurrent rise in postpartum depressive symptoms suggests that this was a disproportionately stressful exposure for these individuals, highlighting the need for more comprehensive family support systems and policies in the postpartum period.