Addressing the Nation's Infant Formula Crisis – Center For American Progress

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Center for American Progress
Congress must act now to resolve the nation’s infant and specialty formula crisis by addressing supplies, cost, and accessibility and then take steps to prevent future shortages.
Building an Economy for All, Child Care, Coronavirus, COVID-19, Economy, Family Economic Security
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Across the country, parents and other caregivers are frantically scrambling from store to store in search of formula for their infants and loved ones. The infant and specialty formula shortages that have resulted in empty grocery store shelves have collided with skyrocketing food prices to create a serious crisis. The deep fissures in the responsiveness and resilience of the U.S. food production and safety system have only been compounded by supply chain breakdowns and other economic challenges stemming from the COVID-19 pandemic.1
Formula is essential to infants’ healthy growth and development as well as to the health and survival of people with certain disabilities and medically fragile individuals. Congress must respond to the urgency of this crisis and shore up formula supplies, strengthen the country’s safety net, and ensure accessibility for all who need it. While recent action by the Biden administration and Congress2—including taking important steps to address production and distribution challenges—has helped to address the immediate crisis,3 the Center for American Progress proposes several strategies that the federal government can implement in the short term to prevent future shortages and to build a more responsive, resilient, and safe food production and distribution system:
While the formula crisis did not emerge overnight—a product of long-standing market concentration among four main production competitors—it is currently taking a heavy toll on parents and caregivers, especially single parents and guardians in low-wage jobs who were disproportionately affected by the pandemic and economic recession.4 Similarly, the shortage is severely affecting parents who do not breastfeed and individuals with disabilities or other health issues who rely on formula for their nutritional intake and survival.5 In addition, LGBTQI+, foster, and adoptive parents who rely on formula for their infants are hit hard by the shortages.6 This shortage has an impact on countless families: By the age of 3 months, fewer than half of all babies in the United States are exclusively breastfed—and in fact, 19 percent of infants receive some formula within the first two days of life.7 Clearly, this crisis touches families of all makeups and income levels across the country.
The production of infant and specialty formulas in the United States is especially vulnerable to shocks. Currently, there are only four primary domestic manufacturers, and the largest three produce about 98 percent of the formula purchased in the country.8 But what truly tipped the scales was the February 2022 closure of an Abbott Laboratories infant formula manufacturing plant in Michigan due to a bacterial contamination and other safety concerns, which resulted in the deaths of two infants.9 A prominent producer of specialized formula for infants and other medically fragile people with certain allergies, gastrointestinal conditions, and metabolic disorders, the closure of the Abbott plant has had dramatic ramifications for the broader supply of formula on the market:10 As of May, the out-of-stock percentage of infant formula has risen to 43 percent.11
The present shortage exposes America’s flaws when it comes to supporting women, families, and other underserved communities, especially those with low incomes or struggling with financial precarity. Furthermore, the backlash from this crisis—with some asserting that parents should simply breastfeed12—reveals the enduring stigma around formula feeding and a lack of understanding of the needs of disparate populations who rely on formula.13 The formula crisis also highlights the shortcomings of the U.S. food production and distribution system, which can be brought to its knees by the closure of a single manufacturing facility, and underscores the fragility of national systems designed to prepare for and respond to public health threats.
There is no single solution for addressing the formula crisis, but attacking the challenges with supply, production, and access in a multipronged manner is required. It will take regulatory and legislative action to ensure that get critical infant and specialty formulas find their way back on shelves in a safe and expeditious manner, while strengthening the resilience and responsiveness of the nation’s food and nutrition system. This issue brief details the steps involved in this multipronged strategy.
The U.S. Food and Drug Administration (FDA) reportedly received notice of safety concerns at the Abbott plant in October 202114—several months before the factory closed in February 2022, and before four infants were hospitalized with bacterial infections that proved fatal to two.15 The Senate has only recently convened a panel to investigate Abbott’s business practices and its focus on profits, which may have shaped its decisions about health practices in its infant formula facility.16 When it comes to ensuring that products are safe, affordable, and easily available across communities, strong government oversight is critical:
The consolidation of infant formula production in the United States creates inherent risk to a system that so many individuals and families rely upon. The closure of the Abbott facility in Michigan was devastating to the entire country’s supply of infant formula, and without action, the risk of similar events will remain even after that plant is back up and running. Reducing market concentration and diversifying production to boost the supply of infant formula and prevent such shortages in the future are imperative:
Reducing market consolidation can go a long way in ensuring that parents and caregivers have access to a diverse range of competitively priced formula products. Preventing supply shortages in the future is imperative to ensuring a stable and diverse market:
Preventing price gouging and enabling other companies to participate in the U.S. market is a critical step toward ensuring that families have stable and affordable access to a range of food and nutrition options. Loosening some of the government inflexibilities in benefit programs such as WIC can similarly ensure that parents and caregivers have access to a wider pool of products and alternatives:
Women and families with low incomes, who disproportionately rely on WIC services for their food and nutritional needs, have endured a particularly dangerous situation because of the formula shortage.27 Already at greater risk of food and nutrition insecurity,28 women, families with low incomes, and many others from marginalized communities, including LGBTQI+ people29 and people with disabilities,30 depend on the social safety net. WIC and similar food and nutrition programs offer these individuals and families the support they need to maintain their health and well-being and to protect them from the consequences of supply shortages of necessary goods.
What’s more, current gaps in the social safety net—including inadequate breastfeeding workplace laws that create obstacles for their employees,31 coupled with insufficient paid parental leave policies—have made the effects of the infant formula shortage all the more harmful, particularly for women of color and low-income families.32 It is critical to strengthen federal safety net programs to be more responsive to emergencies:
For communities most deeply affected by the infant formula shortage, federal intervention cannot come soon enough. Many individuals and families lack the resources to build up a sufficient supply or to travel out of their way to purchase formula when there are slim offerings close to home, as is the case for many living in rural areas or food deserts that do not have any grocery stores.34 Low-income women, as well as women of color, are more likely to rely on formula regardless of their feeding preferences, due at least in part to inadequate workplace supports.35 Further, parents and caregivers who have disabilities; have opted to exclusively formula feed; are LGBTQI+, foster, or adoptive parents; or whose infants are medically vulnerable, have extremely limited options for ensuring that their babies get the nutrition they need to support healthy growth and development.36 Creating systems that center these communities helps to mitigate the consequences of their historical marginalization and protect them against future shortages:
The Biden administration and congressional lawmakers40 are implementing several bipartisan measures41 to mitigate the formula crisis, including reducing bureaucratic hurdles to get formula on grocery shelves faster, cracking down on corporate price gouging, and increasing supplies. Additionally, federal agencies, including the USDA, FDA, HHS, and FTC, are considering regulatory changes that will increase flexibilities, coordination, and efficiencies in formula production and distribution, ensuring access and affordability of a range of products in all communities.
While these interventions will go a long way in addressing the formula crisis in the short term, federal policymakers must also focus on long-term solutions, including building an equitable, sustainable food system that ensures universal access to safe and quality foods for all people nationwide.
Congress’ reauthorization of the Child Nutrition and WIC Act42 and the farm bill offers an unprecedented opportunity to strengthen America’s food production and distribution systems, while addressing emerging challenges of the impact of climate change on national and global food systems. Furthermore, the upcoming White House conference on hunger, nutrition, and health provides a chance to reimagine America’s food system, focusing on sustainable, resilient productions; strong supply chains; adequate supply; and access to culturally and nutritionally diverse, quality, and affordable food for every person. A similar food and nutrition conference last held by the White House in 1969 was a pivotal event that influenced the country’s food policy agenda over the past half-century.43 As the world has changed considerably during that period, it is time to revisit this conversation through the lens of equitable access and affordability and long-term sustainability.
The authors would like to thank Anona Neal, Osub Ahmed, Marc Jarsulic, Jill Rosenthal, Caroline Medina, Elyssa Spitzer, Emily DiMatteo, and Mia Ives-Rublee for their invaluable guidance and support on this brief.
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