The COVID-19 Pandemic and the 2022 Formula Shortage: Associations with Breastfeeding Initiation over 5 Years in the State of Florida, United States

OBJECTIVES: To examine hospital breastfeeding initiation trends and their association with COVID-19 pandemic and the infant formula shortage. METHODS: Using a multivariable logistic regression model, we examined associations between breastfeeding initiation and exposure to the COVID-19 pandemic and infant formula shortage, and the modifying roles of race/ethnicity, residence, and WIC participation in 1,060,057 individuals aged 15-49 years with institutional childbirths in Florida between January 1, 2018, and December 31, 2022. RESULTS: Overall, 922,922 (87.06%) initiated breastfeeding before hospital discharge. Initiation declined as COVID-19 progressed, but started increasing as the formula shortage hit and continued. The rates show a declining trend once the shortage was addressed. Compared with non-Hispanic White, the odds of breastfeeding initiation were higher for all groups except for non-Hispanic Black, and for urban than rural mothers. The odds increased with formula shortage onset for WIC beneficiaries across race/ethnicities and among urban WIC beneficiaries compared with nonbeneficiaries. CONCLUSION: The combined pressures of COVID-19 pandemic and formula scarcity increased breastfeeding initiation rates, especially in WIC beneficiaries. However, breastfeeding initiation rates returned to prepandemic levels as the formula shortage resolved.