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Unpacking The Infant Formula Shortage: What Are We Really Short On?

by  Marsha Walker     Aug 15, 2022
men-talking-warehouse

Food safety is something we often take for granted until an incident occurs that reveals shortcomings in the food production chain. The recent and ongoing infant formula crisis is the culmination of several shortcomings, some of which were preventable.

The infant formula market in the US is highly concentrated, with Abbott, Mead Johnson (owned by Reckitt Benckiser), Gerber (owned by Nestle SA), and Perrigo (maker of store brand formulas) being the major players and controlling about 90 percent of the US infant formula supply. Formula manufacturing is conducted in only a few large facilities. Adding to this, the USDA’s WIC program accounts for more than half of the US formula market and its competitive bidding process narrows the market even more when states rely on a single supplier.

With such a concentrated system, when something goes wrong its impact can be profound. This is especially true when infants and children require specialty or metabolic formulas. It started with the supply chain shortages due to the COVID pandemic and then exploded when Abbott’s Sturgis, Michigan facility shut down due to reports of infant illnesses and deaths from formula contaminated with Cronobacter sakazakii. Store shelves emptied quickly as the formula was recalled, and parents scrambled to find formula for their infants. Due to federal trade restrictions and high tariffs (17.5 percent) on imported formula, purchasing imported formula was an uncertain, unpredictable, and precarious option.

Adding insult to injury, both Abbott and Mead Johnson have been sued for misrepresenting how many bottles their cans of powdered baby formula can make. Their labels claim a certain number of bottles can be made per container, but consumers have found that when following the mixing guidelines, the yield is about 10 percent fewer bottles. This deception places even more pressure on anxious and frustrated parents. Efforts are being made to import formula, ease WIC restrictions on what formulas can be used, and ramp up domestic formula production. But we are still short on efforts to reduce the demand for infant formula.

While certainly more breastfeeding could ease the problem of formula shortages, there remain challenges. Not all parents wish to breastfeed. Some cannot, some have encountered problems, and some older children who require specialty formulas are well beyond the breastfeeding stage. Breastmilk production cannot be turned on like a faucet.

We can reduce the demand for infant formula by enacting a national PAID family leave policy so that parents can meet their breastfeeding goals, increase the rate of breastfeeding initiation, duration, and exclusivity, and relieve the emotional and financial burden that this omission engenders. The US is the only high-income country with no national paid family leave policy.

Responses to the infant formula crisis have often bypassed best practices such as assuring that all lactating parents have access to the level of lactation support and care that they require, educating parents and healthcare providers about breastfeeding and relactation, boosting human milk banking, and informing legislators and policy makers about the health and financial outcomes of not breastfeeding.

Shortsightedness was demonstrated last month when the US Senate failed to pass the PUMP for Nursing Mothers Act (S.1658/H.R.3110). The bill would have expanded workplace protections for lactating employees by requiring employers to provide certain accommodations to cover salaried employees and other types of workers not covered under existing law.

Further, time spent to express breastmilk was to be considered hours worked if the employee was also working while pumping milk. The bill increased the available time period for such accommodations from one year to two years. This bill would have extended breastfeeding protections at work to 9 million potentially nursing employees during the ongoing formula shortage, helping to reduce the need for formula by facilitating breastmilk expression at the worksite. Breastfeeding employees who cannot express milk at work must turn to infant formula that is absent from store shelves, simply worsening the situation.

As nurses, we can act as change agents at the bedside and beyond. We can make sure that we are knowledgeable about breastfeeding care by reading journals and lactation books attending continuing education offerings, and sharpening our clinical lactation management skills. We can refer high acuity or complex lactation situations to International Board Certified Lactation Consultants (IBCLC).

We can educate our legislators regarding the needs of lactating parents and work to help draft supportive legislation. We can contact policy makers asking them to include breastfeeding and lactation in federal and state agency policies. Your voice is important as we speak up for those we serve.  

Jones & Bartlett Learning invites qualified instructors to request a review copy of my text, Breastfeeding Management for the Clinician: Using the Evidence, in consideration of course adoption.

Request a Review Copy

About the author:

Marsha Walker, RN, IBCLC,
 is the Vice President of the Federal Policy Committee for the National Lactation Consultant Alliance. She is a registered nurse and international board certified lactation consultant. She has been assisting breastfeeding families in hospital, clinic, and home settings since 1976. As such, she advocates for breastfeeding at the state and federal levels. She served as a vice president of the International Lactation Consultant Association (ILCA) from 1990-1994 and in 1999 as president of ILCA. She is a previous board member of the US Lactation Consultant Association, Baby Friendly USA, the Massachusetts Lactation Consultant Association, and the Massachusetts Breastfeeding Coalition. She serves as Associate Editor of Clinical Lactation and a board member of the National Lactation Consultant Alliance. Marsha is an international speaker, and an author of numerous publications including ones on the hazards of infant formula use, Code issues in the United States, and Breastfeeding Management for the Clinician: Using the Evidence, Fifth Edition.

More from this author: 

Read Marsha Walker's analysis on how breastfeeding can help tune infant sleep cycles. 

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Unpacking The Infant Formula Shortage: What Are We Really Short On?

by  Marsha Walker     Aug 15, 2022
men-talking-warehouse

Food safety is something we often take for granted until an incident occurs that reveals shortcomings in the food production chain. The recent and ongoing infant formula crisis is the culmination of several shortcomings, some of which were preventable.

The infant formula market in the US is highly concentrated, with Abbott, Mead Johnson (owned by Reckitt Benckiser), Gerber (owned by Nestle SA), and Perrigo (maker of store brand formulas) being the major players and controlling about 90 percent of the US infant formula supply. Formula manufacturing is conducted in only a few large facilities. Adding to this, the USDA’s WIC program accounts for more than half of the US formula market and its competitive bidding process narrows the market even more when states rely on a single supplier.

With such a concentrated system, when something goes wrong its impact can be profound. This is especially true when infants and children require specialty or metabolic formulas. It started with the supply chain shortages due to the COVID pandemic and then exploded when Abbott’s Sturgis, Michigan facility shut down due to reports of infant illnesses and deaths from formula contaminated with Cronobacter sakazakii. Store shelves emptied quickly as the formula was recalled, and parents scrambled to find formula for their infants. Due to federal trade restrictions and high tariffs (17.5 percent) on imported formula, purchasing imported formula was an uncertain, unpredictable, and precarious option.

Adding insult to injury, both Abbott and Mead Johnson have been sued for misrepresenting how many bottles their cans of powdered baby formula can make. Their labels claim a certain number of bottles can be made per container, but consumers have found that when following the mixing guidelines, the yield is about 10 percent fewer bottles. This deception places even more pressure on anxious and frustrated parents. Efforts are being made to import formula, ease WIC restrictions on what formulas can be used, and ramp up domestic formula production. But we are still short on efforts to reduce the demand for infant formula.

While certainly more breastfeeding could ease the problem of formula shortages, there remain challenges. Not all parents wish to breastfeed. Some cannot, some have encountered problems, and some older children who require specialty formulas are well beyond the breastfeeding stage. Breastmilk production cannot be turned on like a faucet.

We can reduce the demand for infant formula by enacting a national PAID family leave policy so that parents can meet their breastfeeding goals, increase the rate of breastfeeding initiation, duration, and exclusivity, and relieve the emotional and financial burden that this omission engenders. The US is the only high-income country with no national paid family leave policy.

Responses to the infant formula crisis have often bypassed best practices such as assuring that all lactating parents have access to the level of lactation support and care that they require, educating parents and healthcare providers about breastfeeding and relactation, boosting human milk banking, and informing legislators and policy makers about the health and financial outcomes of not breastfeeding.

Shortsightedness was demonstrated last month when the US Senate failed to pass the PUMP for Nursing Mothers Act (S.1658/H.R.3110). The bill would have expanded workplace protections for lactating employees by requiring employers to provide certain accommodations to cover salaried employees and other types of workers not covered under existing law.

Further, time spent to express breastmilk was to be considered hours worked if the employee was also working while pumping milk. The bill increased the available time period for such accommodations from one year to two years. This bill would have extended breastfeeding protections at work to 9 million potentially nursing employees during the ongoing formula shortage, helping to reduce the need for formula by facilitating breastmilk expression at the worksite. Breastfeeding employees who cannot express milk at work must turn to infant formula that is absent from store shelves, simply worsening the situation.

As nurses, we can act as change agents at the bedside and beyond. We can make sure that we are knowledgeable about breastfeeding care by reading journals and lactation books attending continuing education offerings, and sharpening our clinical lactation management skills. We can refer high acuity or complex lactation situations to International Board Certified Lactation Consultants (IBCLC).

We can educate our legislators regarding the needs of lactating parents and work to help draft supportive legislation. We can contact policy makers asking them to include breastfeeding and lactation in federal and state agency policies. Your voice is important as we speak up for those we serve.  

Jones & Bartlett Learning invites qualified instructors to request a review copy of my text, Breastfeeding Management for the Clinician: Using the Evidence, in consideration of course adoption.

Request a Review Copy

About the author:

Marsha Walker, RN, IBCLC,
 is the Vice President of the Federal Policy Committee for the National Lactation Consultant Alliance. She is a registered nurse and international board certified lactation consultant. She has been assisting breastfeeding families in hospital, clinic, and home settings since 1976. As such, she advocates for breastfeeding at the state and federal levels. She served as a vice president of the International Lactation Consultant Association (ILCA) from 1990-1994 and in 1999 as president of ILCA. She is a previous board member of the US Lactation Consultant Association, Baby Friendly USA, the Massachusetts Lactation Consultant Association, and the Massachusetts Breastfeeding Coalition. She serves as Associate Editor of Clinical Lactation and a board member of the National Lactation Consultant Alliance. Marsha is an international speaker, and an author of numerous publications including ones on the hazards of infant formula use, Code issues in the United States, and Breastfeeding Management for the Clinician: Using the Evidence, Fifth Edition.

More from this author: 

Read Marsha Walker's analysis on how breastfeeding can help tune infant sleep cycles. 

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