Breastfeeding:

Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect Against Misuse of WIC Name

GAO-06-282: Published: Feb 8, 2006. Publicly Released: Feb 8, 2006.

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Millions of U.S. mothers and infants each year forgo the health benefits of breastfeeding and rely on infant formula. Infants who are breastfed are less likely to develop infectious diseases and chronic health problems, such as diabetes and asthma, while breastfeeding mothers are less likely to develop certain types of cancer. Recognizing the health benefits of breastfeeding for infants and mothers, the U.S. Department of Health and Human Services' Healthy People 2010 campaign has recommended that more U.S. infants be breastfed and that babies be breastfed for longer periods of time. According to the U.S. Department of Agriculture (USDA), the U.S. would save a minimum of $3.6 billion in health care costs and indirect costs, such as parents' lost wages, if breastfeeding increased to meet these Healthy People goals. Breastfeeding rates are particularly low among infants who participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). WIC is administered by the USDA's Food and Nutrition Service (FNS) in cooperation with state and local agencies. The program provides free food and infant formula to improve the health and nutritional well-being of low-income women, infants, and young children. Nearly half of infants born in the U.S. receive benefits through WIC. Although formula manufacturers agree that breastfeeding is best, they market infant formula as an alternative for mothers who do not exclusively breastfeed. A congressional committee asked us to review the potential impact of infant formula marketing on breastfeeding rates, especially for infants in the WIC program. We answered the following questions: 1) What are the estimated breastfeeding rates for infants in the general population and for infants on WIC, and how do these rates compare to recommended breastfeeding rates? 2) How is infant formula marketed to women in general and to women on WIC in particular? 3) What is known about the impact of infant formula marketing on the breastfeeding rates of women in the general population and women on WIC?

On December 14, 2005, we briefed interested congressional staff on the results of our analysis. This report formally conveys information provided during that briefing. In summary, WIC and non-WIC breastfeeding rates fell short of most national goals, but rates were substantially lower for WIC infants. Infant formula marketing targets non-WIC mothers and also reaches WIC mothers. Some of these marketing efforts use the trademarked WIC acronym in promotional materials. Although FNS requires states to restrict this practice in their WIC contracts, most states do not. A majority of studies we reviewed that examine giving free formula samples to mothers at hospital discharge found lower breastfeeding rates among both WIC and non-WIC mothers. However, little is known about the impact of most types of marketing.

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendation for Executive Action

    Recommendation: In order to better protect the WIC acronym and logo from being inappropriately used in infant formula advertisements, the Secretary of Agriculture should educate all states about FNS' policy restricting the use of the WIC acronym and logo and ensure that all state formula contracts include provisions restricting the use of these trademarks in infant formula advertisements.

    Agency Affected: Department of Agriculture

    Status: Closed - Implemented

    Comments: In a December 2008 WIC Policy Memorandum to all Regional Directors of Supplemental Food Programs, the Director of FNS' Supplemental Food Programs Division cited our report and recommendation. Pursuant to our recommendation, she instructed the Regional Directors to include a provision in all food manufacturer contracts, including those for infant formula, stating that the manufacturer will not use the WIC logo in advertising or promotional materials. The provision also prevents the manufacturer from using the WIC acronym in any manner that could imply the program's sponsorship or approval of the product. This additional guidance will help prevent the misuse of the WIC acronym and logo, and the false impression that the program promotes formula feeding over breastfeeding.

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