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.
Chatterjee et al. (2026) studied this question.