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What's behind the US infant formula shortage – and how to make sure it doesn't happen again
An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.
Steven A. Abrams, University of Texas at Austin
A baby formula shortage has added to the woes of American parents already confronted with the pressures of raising an infant during a pandemic in a country ranked low for family-friendly policies.
Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have scrambled to find scarce supplies, or driven long distances to buy formula.
But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading expert on pediatric health at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.
1. Why there is a shortage of formula now?
There are really two factors that have driven the current shortage. First, we have the supply chain problem, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it became worse.
Then in February a major baby formula manufacturing plant in U.S. went down. The FDA shut down Abbott Nutrition’s factory in Michigan. The closure came after Abbott’s nationwide recall of multiple brands of formula, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.
Closing the factory had to be done amid an investigation into bacterial infections in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.
Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.
On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.
2. Who is the shortage affecting?
A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive all their nutrition through breast milk. But by the age of 6 months, the majority of babies get at least some formula. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.
But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, called WIC, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.
I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.
The other thing to note is that the shortage is affecting both regular infant formula, and specialized versions. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.
3. What are the potential consequences of the shortage?
In the first six months, babies should only have breast milk or formula – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.
Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives not nutritionally complete, they may not be entirely sterile.
After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.
4. Are there any viable alternatives?
Why the US has a baby formula shortage — and who is most at risk
America is enduring its worst baby formula shortage in decades.
Why baby formula is in short supply — and who is most at risk
America is enduring its worst baby formula shortage in decades.
By Dylan [email protected]@vox.com May 12, 2022, 2:50pm EDT
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Paul Hennessy/SOPA Images/LightRocket via Getty Images
Baby formula has been running low all over the United States, threatening the health of infants and other people who depend on it for their sustenance.
Experts say this is the worst formula shortage in decades. It’s also the latest example of how the US health system’s failures consistently fall hardest on people with complex medical conditions and people who are socioeconomically disadvantaged.
The shortage can be traced back to a contamination problem at an Abbott factory that produces much of the Similac formula, as well as several other brands, for the US market, Abbott voluntarily shut down the factory in February, amid consumer complaints about contaminated formula that was linked to two infant deaths. As of mid-May, it’s still not up and running again. As Politico reported this week, it’s not exactly clear why Abbott and the FDA have failed to come to an agreement that would allow the plant to resume producing formula and help alleviate the shortage.
That factory’s prolonged shutdown, combined with general supply-chain problems for the formula ingredients and packaging, have led to formula stock drying up fast. Nationwide, about 40 percent of the most popular baby formula brands were out of stock as of April 24, according to the Wall Street Journal, much higher than the 10 percent average in normal times. Some parts of the country, like the San Antonio metropolitan area, are seeing more than half of their normal supply out of stock. Panic buying amid news of the shortage has already caused some major chains to limit the number of formula containers that any one person can buy. Public officials are already worried about the possibility of price gouging.
As long as supplies are limited, some people may struggle to feed their children or themselves. It is people of color and people living in poverty, along with the people who must take special formulas for medical reasons, who will be most exposed to the health and economic consequences of a prolonged formula shortage.
“Certainly, the families who have fewer resources, have fewer options, who aren’t able to pay premium prices are going to be more at risk,” said Ann Kellams, a University of Virginia faculty pediatrician and board president of the Academy of Breastfeeding Medicine.
Why a baby formula shortage is so serious, briefly explained
Most families rely on infant formula to one degree or another. Nearly one in five babies receive formula within their first two days of life, according to the CDC. By three months, less than half of babies are exclusively breastfeeding, meaning they are taking at least some formula as a supplement.
But all families are not equally reliant on formulas. According to CDC survey data, people living in poverty are most likely to report that they’ve supplemented with formula in the first three months of their baby’s life. Black, Hispanic, Asian, and American Indian parents are all more likely to say that they used formula within three months than white parents.
And for some people, formula isn’t a choice but a necessity. Sometimes an infant struggles with breastfeeding and needs formula to continue gaining weight. But allergies or immune conditions can also necessitate using formula, including into childhood and adulthood. As Politico noted in its report, about 2,000 Americans have a metabolic disorder so severe that amino acid formula is their only means of survival.
Changing formulas is definitely possible, but can still be tricky with infants because of digestive issues — and can be difficult if a person’s dietary needs are especially strict. During natural disasters, when formula can become even more scarce, the CDC urges breastfeeding mothers who also use formula to consider breastfeeding more.
But for some people, that is not going to be possible, either because they can’t breastfeed or pump more or because they need specialty formula. And experts strongly discourage people from trying to make their own formula at home, giving the severe risks — including death — if a nonprofessional doesn’t get the formula right.
That leaves many families with few options available to them, prompting them to wonder how they will feed a loved one who depends on out-of-stock specialty formula to survive.
Some are taking drastic measures, with the New York Times reporting parents have been rationing formula or watering it down, both of which can be harmful to kids. Some experts recommend checking with your pediatrician for samples, but that is another way in which the US health system disadvantages certain people: People in poverty and people of color are also less likely to have a regular source of health care.
The US policy failures are colliding in the formula shortage
What’s Behind America’s Shocking Baby
Bacteria, a virus, a trade policy—and a lesson
What’s Behind America’s Shocking Baby-Formula Shortage?
Bacteria, a virus, a trade policy—and a lesson
By Derek Thompson
MAY 12, 2022, 5 AM ET
About the author: Derek Thompson is a staff writer at The Atlantic and the author of the Work in Progress newsletter.
Sign up for Derek’s newsletter here.
America’s baby-formula shortage has gone from curious inconvenience to full-blown national crisis.
In many states, including Texas and Tennessee, more than half of formula is sold out in stores. Nationwide, 40 percent of formula is out of stock—a twentyfold increase since the first half of 2021. As parents have started to stockpile formula, retailers such as Walgreens, CVS, and Target have all moved to limit purchases.
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The everything shortage isn’t new. But rationing essentials for desperate parents? That’s a twisted turn in the story of American scarcity.
Three factors are driving the U.S. baby-formula shortage: bacteria, a virus, and a trade policy.
First, the bacteria. After the recent deaths of at least two infants from a rare infection, the Food and Drug Administration investigated Abbott, a major producer of infant formula, and discovered traces of the pathogen in a Michigan plant. As a result, the FDA recalled several brands of formula, and parents were advised to not buy or use some formula tied to the plant.
Derek Thompson: America is running out of everything
Recalls are common. Thousands of drugs and products are recalled every year, and they don’t create a meltdown at pharmacies or require CVS to instate Soviet-style rationing of essentials. So something else is going on here.
That brings us to the second cause: the virus. The pandemic has snarled all sorts of supply chains, but I can’t think of a market it’s yanked around more than infant formula. “During the spring of 2020, formula sales rocketed upwards as people stockpiled formula just like they stockpiled toilet paper,” Lyman Stone, the director of research at the consulting firm Demographic Intelligence, told me. Then, as “families worked through their stockpiles, sales fell a lot. This oscillation made planning for production extremely difficult. It was complicated to get an idea of the actual market size.” Meanwhile, Stone’s research has found that an uptick in births in early 2022 has corresponded with a “very dramatic decline in rates of breastfeeding” among new mothers, which pushed up demand for formula once again.
In brief: Demand for formula surged as parents hoarded in 2020; then demand fell, leading suppliers to cut back production through 2021; and now, with more new mothers demanding more formula in 2022, orders are surging faster than supply is recovering.
Finally, the third factor: America’s regulatory and trade policy. And while that might not sound as interesting to most people as bacteria and viruses, it might be the most important part of the story.
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FDA regulation of formula is so stringent that most of the stuff that comes out of Europe is illegal to buy here due to technicalities like labeling requirements. Nevertheless, one study found that many European formulas meet the FDA nutritional guidelines—and, in some ways, might even be better than American formula, because the European Union bans certain sugars, such as corn syrup, and requires formulas to have a higher share of lactose.
Some parents who don’t care about the FDA’s imprimatur try to circumvent regulations by ordering formula from Europe through third-party vendors. But U.S. customs agents have been known to seize shipments at the border.
U.S. policy also restricts the importation of formula that meet FDA requirements. At high volumes, the tax on formula imports can exceed 17 percent. And under President Donald Trump, the U.S. entered into a new North American trade agreement that actively discourages formula imports from our largest trading partner, Canada.
America’s formula policy warps the industry in one more way. The Department of Agriculture has a special group called WIC—short for Special Supplemental Nutrition Program for Women, Infants, and Children—that provides a variety of services to pregnant and breastfeeding women and their young children. It is also the largest purchaser of infant formula in the United States, awarding contracts to a small number of approved formula companies. As a result, the U.S. baby formula industry is minuscule, by design. A 2011 analysis by USDA reported that three companies accounted for practically all U.S. formula sales: Abbott, Mead Johnson, and Gerber.
Read: Americans have no idea what the supply chain really is
The Biden administration is focused on expanding domestic manufacturing of formula to meet families’ needs. But the bigger problem is our trade policy. “The U.S. is a captive market for domestic dairy producers like Abbott, and during times of crisis, the lack of alternative supplies becomes a pretty big problem,” Scott Lincicome, the director of general economics and trade for the Cato Institute, a libertarian think tank, told me.