Infant Formula Shortage: This Should Not Be Our Reality

These are challenging times for the United States (U.S.). The COVID-19 pandemic has exposed existing inequities in federal, state, and local public health infrastructures. The continuous gun violence, attacks on reproductive rights and abortion access, and ongoing pandemics have contributed to an overall sense of insecurity, anxiety, and despair. The school shooting in Uvalde, Texas, is one of the latest national tragedies and a stark reminder of how little the U.S. has prioritized the health, safety, and well-being of its most purposively marginalized citizens, including children. This senseless violence, coupled with the long overdue COVID-19 vaccine for children and infants five years of age or younger, and current infant formula shortage are further evidence of this fact.

All of these unfortunate incidents are reproductive justice issues. One of the tenets of reproductive justice states that all families have the right to parent their children in a safe and healthy environment.¹ For most, the current environments are not safe or healthy. This is particularly true when the infant formula shortage is examined.

The infant formula shortage is an ongoing structural issue that has been exacerbated during the pandemic.² Instead of discussing and addressing these systemic and structural issues, the infant formula shortage quickly devolved into a breastfeeding-versus-formula-feeding battle. The negative discourse between breastfeeding and formula supporters across social media platforms reinforced parenting wars, defensiveness, guilt, and shame while taking attention off the true culprits: the lack of policies and practices³ (e.g. paid parental leave, workplace lactation accommodations, Baby-Friendly Hospitals, Medicaid expansion, and greater federal oversight of infant formula production, safety,⁴ and unethical marketing practices⁵) that prioritize capitalistic goals and corporate profits over human milk feeding and the health and wellbeing of birthing and lactating parents.

This is not the first infant formula shortage the U.S. has faced in recent memory.² For many low wage earning families, securing the necessary formula needed to nourish their infants and children has been a constant struggle, as many live in communities burdened by food apartheid.⁶ Food apartheid speaks to the way racism and discrimination are operationalized to perpetuate harmful policies, such as racial and economic segregation, that have limited access to high quality foods in some rural and urban communities.⁶ Some may forget that just two and half years ago, at the beginning of the pandemic, access to infant formula was very limited.⁷ Panic buying and hoarding of household staples was not limited to toilet paper. Infant formula was also in high demand. The difference between the early days of the pandemic and now is that the families most impacted at that time were communities of color and those without the financial means or space to store items in bulk. Now that white, middle-income, and more affluent families are affected, the inaccessibility of formula is considered a national crisis.

It is worth noting that many of those sharing their infant feeding experiences online started with breastfeeding or pumping expressed milk. Though the maternal and infant health benefits associated with breastfeeding are well known,^8,9 the fact that most families currently using infant formula started with breastfeeding or pumping expressed milk is left out of the discussion. The U.S. data are clear, pregnant women want to breastfeed or provide human milk to their infants after birth.¹⁰ However, most encounter significant barriers beyond their control that make achieving their breastfeeding goals very difficult, thus increasing reliance on infant formula.^11,12 Barriers such as limited access to lactation education and skilled lactation support providers, poor access to donor human milk, inadequate paid family leave,¹³ and lack of lactation accommodations when returning to work lead to early cessation of breastfeeding.¹⁴ Other parents experience low milk supply,¹⁵ breast/nipple pain,¹⁶ or infant or maternal health complications,¹⁷ while some opt not to breastfeed. Systemic and structural barriers such as racism and inequitable access to maternity care practices supportive of breastfeeding further perpetuate human milk feeding inequities in Black communities.¹⁸

Online discussions on this topic have been centered at the individual level, instead of community or systems levels. The calls to ‘just breastfeed’ as an easy and quick solution to the infant formula shortage are harmful.¹⁹ This leaves mothers and parents feeling forced to justify their infant feeding decisions and is counterproductive. The idea that infant feeding decisions, especially breastfeeding, are a choice is a myth. The truth is, having a choice is a privilege. Many purposively marginalized individuals and communities experience barriers that make meeting human milk feeding goals unattainable.¹¹ These are decisions that are informed and influenced by media, family and friends, social media, federal, state and local policies, formula and breast pump industries, lived experiences, and available community resources.^20,21

At the community level, there has been chronic underfunding of public health systems and infrastructure. This has included the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program, outpatient lactation services, and communities of color-centered infant feeding organizations and community-led breastfeeding support programs.¹² State and local breastfeeding coalitions do their best to fill in gaps, yet greater financial investments are needed to sustain critical efforts.²²

On a federal level, by not supporting the World Health Organization/UNICEF International Code of Marketing of Breast-milk Substitutes (WHO Code)²³ or developing Infant and Young Child Feeding in Emergencies^24,25 policies prior to the COVID-19 pandemic, this shortage was inevitable. The WHO Code was created to promote and support safe infant nutrition while protecting consumers from predatory infant formula marketing practices, such as giving free gifts and infant formula samples to families and healthcare providers, creating misleading advertisements and product labeling, and offering substantial sales and giveaways in racialized communities.⁵ However, during the World Health Assembly in 1981, the U.S. was the only country to vote against adopting the WHO Code.²⁶ It would take another 13 years for the U.S. to endorse the WHO Code at the World Health Assembly meeting in 1994. During the World Health Assembly in 2018, the U.S. attempted to derail the presented breastfeeding resolution.²⁷ This move further solidified the influence of the infant formula industry and served as a reminder that the U.S. has been beholden to the $55 billion dollar⁵ global formula industry for over 40 years. This inability to put the health of infants and birthing people ahead of corporate interests confirms how little the U.S. prioritizes these populations.

Stronger policies and practices rooted in reproductive justice²⁸ that truly support individuals and families before, during, and after pregnancy are needed to support human milk feeding goals and prevent infant formula shortages in the future. The formula shortage has been an eye-opening and dreadful situation all around. However, witnessing the ways communities and lactation support providers have come together through setting up community milk depots, sharing unopened, unexpired or recalled cans of formula to families in need, supporting relactation²⁹ efforts, and helping families breast/chestfeeding longer has been inspiring. While heartwarming, these individual-level solutions are not sustainable. Communities without access or means to obtain or pay inflated infant formula prices or receive lactation support continue to be significantly impacted.

Families that rely on infant formula deserve proper infant feeding education and resources, unbiased and ethical infant formula marketing practices, and high-quality formula. Greater federal oversight and coordination of infant formula production are needed to ensure parents do not have to worry about their infants’ formula supply or the safety of the infant formula being used. Collective efforts are needed to call on infant formula companies, the Food and Drug Administration, and U.S. government to put infants, children, and families first.

Call to Action:

• Prioritize funding for regional and national organizations supporting human milk and formula feeding families.

• Strengthen formula regulations and set higher standards for infant formula safety and production.

• Increase access to culturally-informed lactation education, resources, and support across the perinatal period.

• Invest in Black, Latinx, Pacific Islander, Indigenous-centered and community-led breastfeeding support programs.

• Prioritize diversification of the lactation workforce.

• Ensure timely payment and reimbursement for lactation support, counseling, and services.

• Ensure equitable access to inpatient and outpatient donor human milk and mandate expanded insurance coverage.

• Provide opportunities for sustainable community milk sharing practices.

• Strengthen public health systems and infrastructure by investing in the perinatal public health workforce, home visiting programs, outpatient lactation services, and WIC.

• Increase infant and human milk feeding education across all curricula in health professions programs.

• Advocate for paid family leave and workplace lactation accommodations.

• Revisit and revise the 2011 Surgeon General’s Call to Action to Support Breastfeeding.¹²

• Develop and implement Infant and Young Child Feeding in Emergencies policies, at the state and federal levels.^24,25

• Enforce the World Health Organization/UNICEF International Code of Marketing of Breast-milk Substitutes (WHO Code).²³

Let us not wait until another infant formula shortage threatens the health and wellbeing of our nation’s children. We need to develop equitable public health policies and practices that are truly supportive of parents, families, and communities across the life course. The time for urgent action to create safe and healthy environments for children to thrive in is now.