Lessons learned from the infant formula shortage

Almost two years ago, in February 2022, 3 million American parents scrambled to find food to feed their babies–with potentially risky choices and dangerous consequences. Some parents diluted the baby formula they had on hand to make it last longer, nursing moms shared their breast milk with friends, other parents sought donor milk from unregulated online sources, and yet others resorted to making their own formula concoction. 

The situation was even more dire for babies requiring medically necessary formulas and for those dependent on highly specialized formulas. Families could not just switch to an alternative brand or product that was available.

The crisis exposed the fragility and vulnerability of the infant formula supply in the US, that was due in large part to the formula market being controlled by a handful of companies producing the majority of formulas in a few US manufacturing plants. After a foodborne contamination event in just one Michigan Abbott Nutrition plant, the US lost 40% of its infant formula supply overnight.

How did we get here? 

The US infant formula industry historically lacks competition because the largest purchaser of infant formula is the US government. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) buys more than half of the infant formula via state-by-state contracts. Just two manufacturers control 80% of the market and four companies are responsible for over 90% of the market.

How do we ensure the formula shortage never happens again? 

Let’s start by diversifying the options. After decades of recommending cow milk-based formula as the preferred alternative for non-breastfed or supplemented babies, the American Academy of Pediatrics recently updated their guidelines on choosing a baby formula in October 2023. The recommendations now include goat milk-based infant formula as a first-line option along with cow milk-based products, and soy milk-based products for certain medical issues.

Yes, American pediatricians now recommend goat milk formula as appropriate and complete nutrition for a baby’s first year. Infant growth and product safety is equivalent between cow and goat milk-based products and has been clearly demonstrated in double-blind randomized controlled trials. While this product is new to the US, goat milk-based infant formula has been used for decades worldwide.

During the 2022 shortage, European and Australian goat milk-based baby formula manufacturers, Kendamil and Aussie Bubs, came to the rescue to import and provide baby formula that met US nutritional and safety standards. And, the leading goat milk baby formula worldwide, Kabrita, recently became the first and only goat milk-based infant formula to meet all FDA requirements. It is available for sale in the US as of January 2024. Other manufacturers from abroad are starting the formal FDA regulatory process, which will increase the supply of legally imported infant formula options.

These products will be a welcome addition to the US infant formula market. Even before the shortage, consumer demand for high-quality ingredients and responsible animal practices led to 14% of American parents buying unregulated European baby formula through untrustworthy  middleman gray markets.

We also need to support evidence-based methods that promote breastfeeding success. While major medical organizations endorse breastfeeding for the first two years of life, the most recent US breastfeeding report card (CDC) showed 75% of American babies rely on formula supplementation or formula as complete nutrition by six months of life. 

Breastfeeding is a learned process. It’s not as natural as you might think, and the hardest hurdles are at the beginning. Of many factors, pain and sheer exhaustion often lead to early weaning. 

Babies instinctively know how to suck and a mother’s body knows how to make milk. But the technique of getting a baby latched on correctly requires a great deal of patience, practice, and frequently, professional help. Improper latch and poor positioning result in traumatized nipples and breast infections, and difficulty with milk transfer or low milk supply can adversely affect newborn weight gain. It’s no wonder why so many women stop nursing. Certified IBCLC lactation consultant services help families through these early nursing struggles and beyond. Their services should be routinely covered in insurance benefits and accessible to uninsured families. 

Breastfeeding moms who return to the workplace have to find the time and space to pump with the same frequency as their babies eat—every three hours—to maintain their milk supply and feed their babies. This can be a real challenge and requires supportive workplace environments.

That said, not all families can or choose to exclusively breastfeed and they should be able to confidently feed their babies without fear or guilt.

In the past year, the FDA has taken some steps to improve the situation. The FDA released a progress report in December 2023 with an update on ensuring a safe and consistent infant formula supply. The report calls for tighter inspection and industry wide regulations. The National Academies of Science, Engineering, and Medicine is also conducting an independent study to address the challenges and factors influencing the manufacturing and sale of infant formula. But the FDA may need to streamline its regulatory policy and the government may need to expand WIC contracts to a larger number of manufacturers to prevent these shortages from happening again.

This moment is an opportunity to support breastfeeding, significantly broaden our options for infant nutrition, and improve product safety. We need to think bigger and find permanent solutions. Our babies need us to do better.