# Triple Threat or Mere Inconvenience? Exploring the Effect of COVID-19 Precautions, Lack of Access to Lactation Care, and the Infant Formula Shortage on Breastfeeding Behavior of Parents in the Midwest of the United States

## TL;DR

This study examines how the combined effects of the pandemic, lack of lactation support, and infant formula shortages impacted breastfeeding in the U.S. Midwest.

## Contribution

The study is one of the first to analyze the combined impact of three simultaneous threats on breastfeeding behavior.

## Key findings

- Access to lactation support was the only statistically significant predictor of breastfeeding duration.
- The infant formula shortage caused stress for both formula-fed and breastfeeding families.
- Decreased lactation support during the pandemic may have hindered breastfeeding success.

## Abstract

To explore the combined effects of COVID-19 and the infant formula shortage.

A cross-sectional survey explored breastfeeding behavior by COVID-19 infant feeding guidance, access to lactation support, and awareness and effect of the infant formula shortage. A multilinear regression model with backward elimination with bootstrapping was used to determine statistically significant predictors of breastfeeding duration. Text responses were analyzed to calculate the number and type of effects of the infant formula shortage.

The number of effects of the infant formula shortage on the family, access to lactation support in the hospital, and number of hours of employment outside the home were the three most predictive variables for breastfeeding duration. However, access to lactation support was the only predictor that was statistically significant. Free form text responses demonstrated that formula feeding and some breastfeeding parents felt stress from the infant formula shortage.

Access to lactation support in the hospital is widely recognized as a predictor of breastfeeding success. The decrease in lactation support that occurred during the COVID-19 pandemic may have created a barrier to breastfeeding. It is also remarkable that, regardless of feeding practice, the infant formula shortage created stress for families.

Access to a lactation consultant continues to be a significant contributor to breastfeeding behavior. Infant formula shortages may create risks for formula fed and breastfed infants. Breastfeeding protection and promotion may be a critical step in decreasing dependence on infant formula.

The online version contains supplementary material available at 10.1007/s10995-026-04237-4.

Research has considered the isolated impact of COVID-19 safety measures and the infant formula shortage on breastfeeding behavior. However, there is little research on the combined effects of these crises on breastfeeding behavior. This study considered three simultaneous threats, or a triple threat, to breastfeeding duration among a sample of parents in the United States (U.S.). Threats included the COVID-19 safety guidance, lack of access to lactation care, and the infant formula shortage. Understanding the combined effects of these events will be critical in planning for future emergencies.

The online version contains supplementary material available at 10.1007/s10995-026-04237-4.