The infant formula shortage led to unsafe feeding for many babies, study shows

The infant formula shortage of 2022 may be a thing of the past—we certainly hope so—but it’s bringing to light how harmful a shortage can be. A 2023 report in BMC Pediatrics found that almost half of parents using formula went to some potentially harmful extremes to feed their babies.

An anonymous survey from 99 parents in the U.S. found that the number who used at least one unsafe feeding practice soared from 8% before the shortage to almost 50% during the crisis. What’s considered unsafe? Using homemade formula, turning to expired products, watering down formula, or informal sharing of human milk are all on the list of no-nos.

The percentage of parents who shared human milk went from 5% before the shortage to 26% during it. Watering down formula became more necessary too, going from 2% before the scarcity to 29% when formula was increasingly hard to access.

The researchers were taken aback by the numbers.

“These are alarming statistics. The infant formula shortage increased food insecurity and threatened the nutrition of millions of American infants,” Jennifer Smilowitz, a faculty affiliate with the UC Davis Department of Food Science and Technology, says in a statement. “Our survey found that parents were not offered many safe alternatives and resorted to unsafe methods in an attempt to feed their infants.”

At a loss for what to do, many parents were left to their own devices. Many of us remember the tremendous pressure of having to drive for hours just to find enough formula to get through the week—and the stress of not knowing where the next batch would come from.

Showing inequalities in baby formula supply slowdowns

The shortage was both a result of pandemic supply chain issues and the shutdown of an Abbott Nutrition plant in Michigan. The company makes more than 40% of baby formula used in the U.S.

“Ninety percent of the infant formula sold in the U.S. is sold by four companies,” Smilowitz adds. “This has resulted in systemic failures that inequitably impact low-income communities.” She noted that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides support to more than 40% of babies in the U.S., and makes up more than half of baby formula consumption. Abbott had a large majority of contracts for WIC at the time when supplies started to vanish off store shelves. (Interestingly, 75% of survey respondents used WIC, so researchers really were able to reach people directly affected.)

Parents did use pasteurized human donor milk from milk banks, which is considered a safe alternative. During the shortage, the percentage of parents who used milk banks increased from 2% to 26%. But that was limited by the amount of the milk banks—and the expense that comes with using them. Donor milk can run anywhere from $3 to $5 per ounce. 

Preventing another infant formula shortage

The team’s goal wasn’t just to look at what exactly happened during the infant formula shortage—they wanted to find ways to prevent similar problems in the future.

The report called for policy changes to give families better clinical prenatal and postnatal lactation support. Smilowitz also wants to enhance access to banked donor milk and to give parents access to more commercially available products.

Workplace policies need to change to support breastfeeding parents, too. That’s because inadequate paid parental leave can cause some parents to start formula feeding earlier. Then there’s the issue of having space at work to give parents time and space to pump. These policies disproportionately affect low-income parents, the authors say.

“We should not forget what happened during this formula shortage,” Smilowitz notes. “Another crisis is looming if healthcare, workplace and regulatory policies in the U.S. do not systemically change.”

It’s unclear if the children affected by the shortage will have any long-term issues, Smilowitz points out.

“We have this generation of children affected by the formula shortage and we won’t know for maybe a decade if there was an impact on brain development. We can only hope that the shortage resulted in only acute effects and that infants will be robust enough to overcome any potential long-term problems.”

– Jennifer Smilowitz, a faculty affiliate with the UC Davis Department of Food Science and Technology

This isn’t the only report calling for change to prevent another baby formula crisis. A report out last year says the first step is to ensure that critical formulas aren’t made by a single factory or company. 

“Some of the most specialized formulas, such as metabolic formulas, are not significant income producers for companies, and as such, incentives may be needed to ensure that the supply sources are broader than one factory or company,” the authors wrote. 

They called for broader reassessment on how products are marketed. This should be overseen by nonfederal groups like the American Academy of Pediatrics and others in partnership with the federal government, they say. 

Something else that could help: Agencies and WIC offices should create lists detailing the specific recalled formulas with the names of the most similar products for categories like amino-acid based, or low lactose. And that list should always be easy to access for everyone, the authors say.

Earlier this year, the U.S. Food and Drug Administration released a plan to thwart future baby formula supply challenges. Some of the strategies will include creating redundancy risk management and mitigation plans, better inspection at manufacturing facilities, and fast-forwarding premarket submissions for new formulas. 

Meanwhile, the Federal Trade Commission is investigating the shortage of baby formula to see if formula manufacturers like Abbott inappropriately coordinated with other market participants on bidding for state contracts. They’re also looking to see if any deals affected sales outside of the WIC program. 

Keeping your baby formula supply safe

Even though the shortage left a lot of parents feeling pretty powerless, there are learnings you can take away from that dreadful time in baby-feeding history.

Remember that the bacteria that contaminated the Abbott formula–Cronobacter sakazakii–is a common pathogen that doesn’t affect most of us. But it can be harmful to little ones, especially if they have weakened immune systems or were born early. Properly sanitizing your bottles and breast pump gear is a good way to prevent it.

Think you may be using formula in the near future? It never hurts to keep a couple extra containers handy—but just watch the expiration dates. 

A version of this story was originally published on July 24, 2023. It has been updated.