Infant formula shortage crisis forced parents to switch to risky feeding methods, survey finds

30 Jun 2023 --- During the US infant formula shortage last year, 48.5% of parents using formula resorted to potentially harmful feeding methods, such as watering down the formula, using expired or homemade formula, or human milk from informal sharing. Before the shortage, this figure amounted to 8%, according to US researchers. 

Through an online, anonymous survey of US parents, researchers found that those who shared milk increased from 5% to 26% while using watered-down formula grew from 2% to 29% in the formula crisis. 

“These are alarming statistics. The infant formula shortage increased food insecurity and threatened the nutrition of millions of American infants,” says lead author Jennifer Smilowitz from the University of California, US. 

“Our survey found that parents were not offered many safe alternatives and resorted to unsafe methods in an attempt to feed their infants.”

Parents also used more pasteurized human donor milk from milk banks, which is considered a safe alternative. During the shortage, the use of these milk sources increased from 2% to 28%. 

However, Smilowitz notes that donor milk is limited due to the small number of US milk banks (28 nationwide) and high costs, ranging from US$3 to US$5 per ounce. 

Policy changes needed 
The survey was completed by 99 US parents between May 25 and June 7, 2022. Among the respondents, 79% used US infant formula brands before the shortage, which dropped to 27% during the crisis. 

In the study published in BMC Pediatrics, 80% of infants were fed by both breastmilk and infant formula. 

During the crisis, sharing breast milk increased from 5% to 26% and using watered-down formula grew from 2% to 29%.According to the researchers, the study points to the need for policy changes within “regulatory and the healthcare system to provide families with clinical prenatal and postnatal lactation support, access to pasteurized banked donor milk and access to more commercially available products.” 

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

In the study, parents rated prenatal and postpartum lactation support as the most valuable to feed their babies. 

Moreover, workplace policies need to support the needs of breastfeeding women. Inadequate paid family and medical leave policies can result in earlier formula feeding. In contrast, some policies don’t support the privacy and time needed to pump breastmilk, disproportionately affecting low-income parents. 

Formula shortage crisis 
The 2022 US informant formula shortage was compounded by Russia’s invasion of Ukraine, the supply chain crisis, product recalls by Abbott Nutrition and post-pandemic effects.

Abbott Nutrition is the largest formula producer in the US, providing over 40% of the country’s supplies. The company shut down its manufacturing plant in Michigan after an FDA investigation concerning Cronobacter sakazakii and Salmonella in subsamples of the company’s products, which caused illness to four infants and two fatal cases.

Trade policies further worsened the situation, making it challenging to import infant formula, these were temporarily suspended in July. The researchers note that by May 2022, the shortage peaked, with several states reporting an out-of-stock rate of 90%. 

“Ninety percent of the infant formula sold in the US is sold by four companies,” cautions Smilowitz. “This has resulted in systemic failures that inequitably impact low-income communities.” 

Abbott Nutrition dominated most contracts for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which serves over 40% of US infants, accounting for over half of infant formula consumption. 

US healthcare, workplace and regulatory policies need to change systematically to prevent another crisis, warns Smilowitz.The researchers note that most survey respondents were WIC recipients, which could explain the increased use of watered-down infant formula. 

Health consequences 
Smilowitz hopes the infant formula shortage will not have health consequences for infants.

“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,” she explains. 

“We can only hope that the shortage resulted in only acute effects and that infants will be robust enough to overcome potential long-term problems.”

The researchers note that breastfeeding and human milk feeding are the most nutritious, safe and reliable food sources for infants. 

They add that the accessibility and growth of donor milk banking services are partly thwarted by a lack of federal public health policies that integrate donor milk banking or regulate its operations. 

By Jolanda van Hal