WIC Serves Families with Limited Financial Resources

Ohio WIC serves income-eligible pregnant and postpartum people, infants, and young children who are determined to be at nutritional risk. The program’s income threshold is generally 185% of the Federal Poverty Income Guidelines. [1] Families within this income range may have limited ability to absorb unexpected or recurring expenses, including the purchase of additional infant formula.

Formula Needs and Benefits Vary

WIC formula benefits vary according to an infant’s age, feeding status, prescribed formula, and container size. USDA establishes maximum formula benefits in reconstituted fluid ounces rather than simply as a fixed number of cans or containers.[2]

For fully formula-fed infants, WIC aims to provide enough formula to meet their full nutritional need. However, the National Academies notes that WIC’s formula amounts are fixed by age category and cannot be individually increased, for example, for a faster-growing infant. As a result, some participating families still purchase additional formula at retail prices because their infant consumes more than the WIC benefit provides.[3]

Families may also encounter gaps caused by benefit timing, changing feeding needs, difficulty paying for additional formula, or lack of availability at participating stores.

Formula Insecurity Can Lead to Dangerous Choices

When families cannot obtain enough appropriate formula, some may attempt to stretch their supply or use alternatives that are not appropriate for infants. Studies of families experiencing formula shortages have documented practices including diluting formula with additional water and using other potentially unsafe feeding alternatives.[4]

Public-health authorities specifically warn against several such practices:

Diluting formula with additional water: CDC instructs caregivers to use the exact proportions specified by the manufacturer. Excessive water can result in inadequate nutrition and dangerous electrolyte disturbances.[5] Medical literature has documented hyponatremia and seizures in infants receiving overly diluted formula or excessive water.[6]
Giving cow’s milk before 12 months: CDC states that cow’s milk before age one can increase the risk of intestinal bleeding, contains more protein and minerals than an infant’s kidneys should handle, and does not contain the appropriate balance of nutrients for an infant.[7]
Putting cereal or other solid foods in bottles: CDC warns that this does not help infants sleep longer and can increase the risk of choking.[8]
Using homemade infant formula: FDA advises caregivers not to make or feed homemade formula because recipes may contain inadequate nutrients or become contaminated. FDA has received reports of infants requiring hospitalization after receiving homemade formula.[9]

Ensuring that families can obtain an adequate supply of appropriate infant formula therefore has direct implications for infant nutrition and safety.

Availability Can Create Additional Barriers

WIC participants cannot necessarily substitute any formula they find on a store shelf. Formula benefits specify eligible products, and participants redeem those benefits through WIC-authorized vendors.[2] [3]

The 2022 national infant-formula shortage demonstrated the additional difficulties this can create for WIC families. The National Academies found that WIC participants faced unique challenges because they sometimes could not find and redeem the brands permitted by their benefits.[10] Ohio WIC consequently advised families who could not find their formula to contact or visit other stores and ask retailers when shelves would be restocked.[11]

Accordingly, when an authorized formula or container size is unavailable, families may need to contact or visit multiple retailers, wait for restocking, or find another way to obtain formula. For households with limited transportation, money, or time, even a temporary availability problem can create an urgent need.

Regional Need

Approximately 16,500 infants are born annually across Ashtabula, Lake, Geauga, and Cuyahoga Counties, based on 2024 resident birth data. Ohio’s official birth dataset provides county-level birth counts and can be used to update this figure as new annual data become available.[12] The data regarding how many of those infants use formula or how many experience formula insecurity is far less clear.

NEST intends to develop stronger local evidence over time by tracking its own service activity, including:

Number of infants assisted
Formula containers distributed
Emergency requests received
Repeat or recurring needs
Requests resulting from retail availability problems
Requests from WIC participants whose immediate needs exceed available benefits or household resources

WHY NEST MATTERS

NEST provides safe, age-appropriate infant formula when a family cannot obtain enough through existing benefits or household resources. By responding quickly and without stigma, NEST helps:

Ensure infants receive appropriate nutrition
Reduce pressure to dilute or ration formula
Prevent the use of unsafe substitutes
Address urgent gaps that other programs cannot immediately resolve

Difficulty obtaining adequate infant formula is a documented health and safety concern.[4] [10]

Sources

[1] Ohio Department of Health — Ohio WIC Program Eligibility
Ohio’s eligibility criteria, including the 185% Federal Poverty Income Guidelines standard.
Ohio WIC Program Eligibility

[2] U.S. Department of Agriculture, Food and Nutrition Service — WIC Food Packages for Infants
Current USDA description of WIC infant food packages and maximum formula amounts by infant age and feeding status.
Food Package I: Infants

[3] National Academies of Sciences, Engineering, and Medicine — Challenges in Supply, Market Competition, and Regulation of Infant Formula in the United States (2024)
Especially useful discussion of WIC formula benefits. The report explains that WIC aims to meet fully formula-fed infants’ full nutritional needs but that fixed age-based amounts do not necessarily meet every individual infant’s actual consumption; some WIC families therefore purchase additional formula.
Chapter 4: Infant Formula Demand and Supply Before the 2022 Shortage
Full National Academies Report

[4] Cernioglo K., et al. — “Infant feeding practices and parental perceptions during the 2022 United States infant formula shortage” (2023)
Peer-reviewed research documenting changes in infant-feeding practices during formula scarcity and associated health concerns.
PubMed record
Free full text through NIH/PMC

[5] Centers for Disease Control and Prevention — Infant Formula Preparation and Storage
CDC guidance on safely preparing powdered formula and following manufacturer-specified proportions.
Infant Formula Preparation and Storage

[6] Bruce R.C., Kliegman R.M. — “Hyponatremic seizures secondary to oral water intoxication in infancy”
Medical literature documenting seizures associated with excessive water intake, including excessively diluted formula.
PubMed record

[7] Centers for Disease Control and Prevention — Cow’s Milk and Milk Alternatives
Explains why cow’s milk should not replace breast milk or infant formula before 12 months, including intestinal-bleeding, renal, and nutritional concerns.
Cow’s Milk and Milk Alternatives

[8] Centers for Disease Control and Prevention — Infant and Toddler Nutrition FAQs
CDC guidance stating that putting infant cereal or solid food into a bottle can increase choking risk.
Infant and Toddler Nutrition FAQs

[9] U.S. Food and Drug Administration — Infant Formula Safety
FDA guidance warning against homemade infant formula because of nutritional deficiencies and contamination risks, including reports of hospitalized infants.
Infant Formula: Safety Do’s and Don’ts

[10] National Academies of Sciences, Engineering, and Medicine — 2022 Formula Shortage Findings
Documents the particular difficulty WIC participants experienced finding formula brands that could be redeemed with their benefits during the national shortage.
Summary: Challenges in Supply, Market Competition, and Regulation of Infant Formula

[11] Ohio Department of Health — Formula Shortage Guidance
Ohio WIC guidance issued during the 2022 shortage, including recommendations to check other retailers and ask when stores expected formula to be restocked. This source documents what families may have to do during a shortage; it should not be used to imply that such shortages are currently routine.
Ohio WIC Formula Shortage FAQ

[12] Ohio Department of Health / DataOhio — Ohio Births Dataset
Official Ohio dataset containing annual birth counts, including county of residence. The 2024 counts for Ashtabula, Lake, Geauga, and Cuyahoga Counties total approximately 16,500 births.
Ohio Births Dataset