As the formula shortage continues to grip the US, many parents have been left struggling to access the product they rely on to feed their babies.
At the start of May, 43% of baby formula was out of stock at retailers, according to Datasembly, a product data firm. One mother, speaking to the New York Times, described the situation as “a nightmare”.
Here’s a look at how the problem started, what parents can do and what the FDA and government are doing to try to end the shortage.
What caused the crisis?
In February, Abbott Laboratories, maker of popular baby formulas, closed a manufacturing facility in Sturgis, Michigan, after it recalled infant formula products when a federal investigation started after four babies taking the formula developed bacterial infections, two of whom died. Abbott has said there is no link between its formula and the illnesses.
Baby formula was already being affected by pandemic-related supply chain problems, but the Michigan plant closure “really exacerbated things”, said Dr Christopher Duggan, director of the Center for Nutrition at Boston children’s hospital.
Some Republicans have falsely suggested shortages are down to the Biden administration sending baby formula to undocumented immigrants. Steven L Schooner, a professor of government procurement law at George Washington University told the New York Times that the amount purchased for migrants, “is statistically the equivalent of zero in terms of market share”.
Who has been most affected by the shortages?
Some states are facing more severe shortages, including Tennessee, Texas and Iowa where more than 50% of the top-selling products are out of stock, according to CBS.
The crisis is hitting poorer families disproportionately hard. Nearly half of baby formula in the US is bought under the Wic program, aimed at helping low-income women, infants and children. States give exclusive contract rights for this formula to one company under a bidding process. Abbott provides formula to about half of the babies receiving Wic benefits. When these products disappeared, families were left scrambling to find alternatives.
There are racial disparities, too. Rates of breastfeeding are lower for Black babies than white babies, according to a 2019 report from the Centers for Disease Control and Prevention. Black women are more likely to live at or below the poverty level and more likely to return to work sooner, the report states.
“Those women are less likely to have flexibility in their jobs to be able to pump and express milk,” said Dr Ann Kellams, a University of Virginia faculty pediatrician and board president of the Academy of Breastfeeding Medicine. “They are the ones I worry most about right now. They are going to be the ones who are less likely to have a relative in a pocket of the US where they still have enough formula on the shelves to send it to them.”
What is the latest advice for people struggling to access formula?
When Kellams talks with families, she explains: “This is a really difficult situation to be in. It’s hard enough to be a parent to a baby, infant or toddler, and it’s OK to use a different brand of formula than you’re used to using.”
For children with a medical condition that is treated with formula, however, parents must talk with their pediatrician or a pediatric registered dietitian to ensure a switch will be safe and well tolerated, said Duggan.
If a mother has been partially breastfeeding and their baby is four months old or younger, there are also ways to boost production but parents should see a lactation consultant or breastfeeding medicine physician, said Kellams, whose organization published a list of recommendations.
Other guidance includes:
Do not share formula or breastmilk with people online who you don’t know or trust.
Only put as much formula in a bottle as you think the baby will take because you can always add more.
Do not dilute formula to maintain supply because it could mean babies don’t get the nutrients they need.
How long are the shortages expected to last and what is the FDA and government doing to help?
Families could soon see some relief. The FDA and Abbott have reached a proposed settlement that would allow the company to reopen the closed Michigan facility, with oversight from an independent expert, according to the agency.
The company stated it could restart the site within two weeks and that it would then take an additional six to eight weeks before its products are available.
The FDA has also announced a series of measures designed to increase supply. On Monday, the agency said it would implement processes to make it easier for foreign baby formula manufacturers to sell their products in the US. Currently the US produces about 98% of formula domestically.
The FDA will also, on a case-by-case basis, ease some of the requirements it puts on formula companies, for example around labeling.
House Democrats have proposed a bill that would provide the FDA with $28m to address the shortage, according to the Washington Post. But it’s unclear if Republicans would support the spending measure.
How many companies make baby formula?
Four companies control about 90% of the US baby formula market – Abbott (which accounts for nearly half the market), Mead Johnson Nutrition, Nestlé USA and Perrigo. Only 2% of formula is imported and FDA rules make it very hard for new companies to enter the market.
The fact that there are so few companies means that when one factory is shut down, it creates a domino effect, Kellams said. A letter to the agriculture secretary, Tom Vilsack, from eight senators including Cory Booker and Elizabeth Warren stated: “The infant formula industry has reached an alarming level of corporate concentration.”
What could be done to stop this happening again
Some are calling for federal action to tackle the monopoly a handful of companies have on the formula market. Booker, Warren and other senators call for immediate antitrust review in their letter to Vilsack, writing: “This is yet another example of how alarming levels of consolidation hurt American families and can no longer be ignored”
Kellams and Duggan also call for policy changes to better support breastfeeding mothers. The US is the only industrialized nation that does not mandate paid maternity leave. “It’s very difficult to successfully breastfeed your child and still go back to work,” said Duggan. “There are a lot of things that our government and policy makers could do to support breastfeeding families.”