Talking with U of M

Talking the baby formula shortage with the U of M

Portrait of Ellen Demerath in a hospital setting.
Professor Ellen Demerath

Since early May 2022, grocery stores and pharmacies across the U.S. have been scrambling to find supplies of infant formula, an essential food for babies up to six months of age who are not receiving breast milk. A major Abbott Nutrition formula production facility shut down in January and, though it is now up and running again, predictions show that the formula shortage could last through 2022.

University of Minnesota School of Public Health epidemiologist Ellen Demerath, Ph.D., an expert in how early-life factors affect growth rate and body composition, explains why this shortage is so difficult for new parents, what options they have and what lessons we’re learning from a supply chain issue of such significance.

Q. Why is baby formula so scarce now?
It's a combination of supply chain shortages stemming from the COVID pandemic and the abrupt shutdown of one of the infant formula manufacturing plants owned by Abbott Nutrition due to the discovery of harmful bacteria. Abbott is the biggest of only three major formula manufacturing companies in the United States, with 40% of the market share. 

The Abbott plant in Michigan returned to production on June 4, but will not be up to full capacity for another two months. A quick online search for infant formula in Minnesota pharmacies shows most products are not available on the shelf. It has been predicted that supplies may be somewhat limited through the end of 2022.

Q. Why do babies need formula? Can't they drink other forms of milk? And why can't parents make their own formula?
Infant formula is created to meet the unique nutritional needs of babies and is a good alternative for those who do not have adequate resources and support to breastfeed, who do not have time off of work to get breastfeeding started or do not have workplace accommodations to allow them to pump milk. Approved infant formulas contain the essential vitamins, minerals and fats that babies need to be healthy. 

Infants cannot drink pure cow’s milk because it’s too high in protein for the infant’s developing kidneys, and because it is too low in sugars for human infants who have a uniquely high need for sweet milk to support rapid brain growth. Parents should not make their own formulas by mixing other milks with added ingredients. The appropriate number of calories and nutrients per ounce must be within strict ranges in order to ensure the baby will grow properly. For these reasons, homemade formulas are not recommended.

Q. Why don't parents just breast feed their baby?
Some medical conditions can impair lactation and many social factors make it difficult to breastfeed after leaving the hospital. Breastfeeding is time-consuming initially, with parents needing to feed their babies every 2-3 hours for weeks. Parents need time away from work and other home responsibilities to get their milk supply where it needs to be to support 100% of their infant’s needs. Many families do not have the resources at hand and feel they must use formula, despite its very high cost.

If you haven’t been breastfeeding, it’s difficult to start. Lactation is mainly about supply and demand. If the infant does not suckle or the milk is not otherwise expressed, the supply goes down quite quickly, within a few days after birth. After about a week without nursing or pumping, supply will be nearly zero. That is why a person cannot simply start breastfeeding anew. It is possible to start breastfeeding again after using formula to feed your infant, but it involves a time intensive process of very frequent pumping and suckling in order to restart production of milk. It can be successful, but without access to adequate lactation support and time to do this intensive work, it will be very hard and is often not successful. 

Q. Are there any options for parents during this shortage?
Yes, there are a number of viable options.

  • For families who are using both breast milk and formula, consider shifting more of your baby’s diet to breast milk. To increase your breast milk supply, you can breastfeed your baby more frequently or add pumping sessions between breastfeedings. Pumped milk can be kept in a refrigerator and stored frozen for later use.
  • Consider changing the brand/type of formula you use. Most babies will do just fine with different brands of formula, including store brands, as long as they're the same type, like cow's milk-based, soy, hypoallergenic or elemental. Try introducing small amounts of the new formula at a time by mixing it with your regular formula. Slowly increase the amount of the new formula over time until your baby gets used to it.
  • Consider using foreign formulas. In June 2022, the FDA started providing information on regular and special nutritional needs formulas shipped from foreign manufacturers that they will temporarily allow to be sold in the U.S. to increase supply. This is estimated to increase the formula supply by 6 million cans this year. A list of approved foreign formula products is on the FDA website
  • If you need hypoallergenic or medical specialty formula, talk to your pediatrician or other healthcare provider about acceptable substitutes. Depending on which formula they need, they may be able to submit an urgent request for specialized formula.
  • Sharing human breast milk with friends or purchasing it on the internet is not recommended, but you can talk with your pediatrician or other health care provider about using human milk from a human milk bank, preferably a milk bank that is accredited through the Human Milk Banking Association of North America. 
  • Don't use homemade formula, and don’t water down your formula or use formula after the “use by” date. Please do not purchase more than you need. That only exacerbates the shortages.

Q. What's the most important lesson to take away from this shortage?
Human milk is the optimal food for babies and is free. Infants fed human milk have lower risk of gastrointestinal infections, asthma and obesity, and breast milk contains numerous special components that are key to proper development of the infant gut and brain. Almost all women and some transgender men can breastfeed their infants if they have the necessary social support and access to lactation consultation, baby friendly maternity care and family-friendly employment policies. However, this support is not available for everyone, particularly low-income families, rural families and families of color.

The formula shortage shows us why the U.S. must prioritize maternal and child health. If all families were provided with the support and resources needed to breastfeed, the need for formula — costing families $1,500/year or more and the billions in healthcare costs that formula use incurs — would be greatly reduced. In the short-term, we have also learned that it is dangerous for a very small number of companies to monopolize the marketing of this essential food and that monitoring of formula supply should be linked to proactive policies to increase the national supply when needed.  

About the School of Public Health
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