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Why is there a shortage of breast milk substitutes in the United States, and what can parents do? | Lack of infant formula in the United States

As the lack of formula continues to grip the United States, many parents have struggled to access the product they depend on to feed their babies.

At the beginning of May, 43% of baby replacements were sold out at retailers, according to Datasembly, a product data company. A mother, speaking to the New York Times, described the situation as “a nightmare”.

Here̵[ads1]7;s a look at how the problem started, what parents can do and what the FDA and the government are doing to try to end the deficiency.

What caused the crisis?

In February, Abbott Laboratories, a manufacturer of popular baby substitutes, closed a manufacturing facility in Sturgis, Michigan, after recalling infant formulas when a federal investigation began after four babies who took the formula developed bacterial infections, two of whom died. Abbott has said that there is no connection between the formula and the diseases.

Baby replacements were already affected by pandemic-related supply chain problems, but the closure of the facility in Michigan “really made things worse,” said Dr. Christopher Duggan, director of the Center for Nutrition at Boston Children’s Hospital.

Some Republicans have erroneously suggested that the shortage is due to the Biden administration sending baby compensation to undocumented immigrants. Steven L Schooner, a professor of public procurement law at George Washington University, told the New York Times that the amount purchased for migrants “statistically equates to zero market share.”

Who has been most affected by the deficiency?

Some states face more serious shortages, including Tennessee, Texas and Iowa where more than 50% of the best-selling products are sold out, according to CBS.

The crisis is hitting disproportionately hard on poorer families. Nearly half of breast milk substitutes in the United States are purchased under the Wic program, aimed at helping women, infants and low-income children. The states grant exclusive contract rights for this formula to one company during a tender process. Abbott provides infant formula to about half of the babies who receive Wic benefits. When these products disappeared, families were studied to find alternatives.

There are racial differences as well. The breastfeeding rate is 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 faster, the report says.

“These women are less likely to have the flexibility of their jobs to pump and pump milk,” said Dr. Ann Kellams, a pediatrician at the University of Virginia and chair of the Academy of Breastfeeding Medicine. “They are the ones I worry about the most right now. They are going to be the ones who are less likely to have a relative in a pocket in 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 the formula?

Speaking to families, Kellams explains: “This is a very difficult situation to be in. It is difficult enough to be a parent of a baby, infant or toddler, and it is OK to use a different type of formula than you are used to. . to use.”

However, for children with a medical condition treated with formula, parents must talk to their pediatrician or a pediatric-registered dietitian to ensure that a change is safe and well tolerated, Duggan said.

If a mother is partially breastfeeding and their baby is four months old or younger, there are also ways to increase production, but parents should consult a breastfeeding consultant or breastfeeding doctor, said Kellams, whose organization published a list of recommendations.

Other guidance includes:

  • Do not share formula or breast milk with people online that you do not know or trust.

  • Only have as much formula in a bottle as you think your baby will take because you can always add more.

  • Do not dilute the formula to maintain the supply because it may mean that babies are not getting the nutrients they need.

How long is the deficiency expected to last, and what are the FDA and the government doing to help?

Families could soon see some relief. The FDA and Abbott have reached a proposed settlement that will allow the company to reopen the closed Michigan facility, under the supervision of an independent expert, according to the agency.

The company stated that it could restart the site within two weeks, and that it would then take another six to eight weeks before the products are available.

The FDA has also announced a number of measures designed to increase supply. On Monday, the agency said it would implement processes to make it easier for foreign baby-replacement manufacturers to sell their products in the United States. Currently, the United States produces approximately 98% of the formula domestically.

The FDA will also, on a case-by-case basis, ease some of the requirements it places on formula companies, for example around labeling.

House Democrats have proposed a bill that would give the FDA $ 28 million to meet the shortfall, according to the Washington Post. But it is unclear whether the Republicans will support the spending measure.

How many companies make infant formula?

Four companies control about 90% of the US baby replacement market – Abbott (which accounts for almost half of the market), Mead Johnson Nutrition, Nestlé USA and Perrigo. Only 2% of the formula is imported and FDA rules make it very difficult for new companies to enter the market.

The fact that there are so few companies means that when a factory is closed, it creates a domino effect, Kellams said. A letter to the Secretary of Agriculture, Tom Vilsack, from eight senators, including Cory Booker and Elizabeth Warren, stated: “The parenting industry has reached an alarming level of corporate concentration.”

What can be done to prevent this from happening again?

Some call for federal action to tackle the monopoly a handful of companies have in the formula market. Booker, Warren and other senators called for an immediate review of antitrust in their letter to Vilsack, writing: “This is another example of how alarming levels of consolidation are hurting American families and can no longer be ignored.”

Kellams and Duggan are also calling for political change to better support breastfeeding mothers. The United States is the only industrialized nation that does not require paid maternity leave. “It’s very difficult to breastfeed your baby and still go back to work,” Duggan said. “There are many things our government and decision-makers can do to support breastfeeding families.”

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