How The Formula Shortage Has Gone From Bad To Worse

In February, when we first reported on a nationwide formula shortage, experts were optimistic that the problem was getting better and would soon be solved. But on Feb. 17, the problem went from bad to worse when Abbott Nutrition, a company that manufactures a large portion of the nation’s formula supply, announced a recall of certain products manufactured at their Sturgis, Michigan, plant. The recall was due to a serious bacterial contamination that caused four infants to become ill, two of whom died. (Abbot has vigorously contested that their product caused the infant’s deaths, but the FDA also cited the company for numerous additional violations, including a failure of employees working directly with the product to wash their hands, and a failure to keep the building where the formula is manufactured in clean, sanitary condition.) On Monday, May 16, Abbott and the FDA reached an agreement on the necessary steps to reopen their plant, which the New York Times reports includes having “a qualified expert to oversee a variety of improvements at the Sturgis facility.”

Even though a reopening is now on the horizon, it will still be two weeks before production resumes — a timeline that’s leaving families in desperate straits.

According to a statement released by the White House, Abbott Nutrition was the only supplier of 20 specialty formulas that are used by about 5,000 infants, as well as some older children and adults. That recall has turned what was already a precarious situation into a full-blown crisis as parents are left scrambling to get what they need.

When did the formula shortage start?

Despite a recent explosion of media coverage about this issue, the formula shortage started nearly 10 months ago, according to Datasembly, a source that collects data on major retailer’s ability to keep products in stock. What the site calls “stocking challenges” began in July 2021. “One store wouldn’t have what you needed but another one nearby would,” says Dr. Jennifer Hood, a speech-language pathologist who provides feeding therapy at several different NICU units in the Washington, D.C.-Maryland area, and who was also a new parent in the summer of 2021. The problem became more serious in the fall and winter of last year, but by early 2022, she was seeing some signs of improvement. Then, she says, after Abbott’s recall in February, “things have gone downhill quick and just continue to worsen.” Datasembly puts the current out-of-stock rate for formula at 43%; for the same week last year, the out-of-stock rate was between 2% and 8%.

How are families being affected?

Kendra Kline, a mother in Athens, Georgia, is one of thousands of parents nationwide who has been affected by this devastating shortage. Her 5-year-old son was born at 26 weeks and spent months in the NICU; later, he was diagnosed with eosinophilic esophagitis, an allergic condition that causes his esophagus not to contract properly. The entirety of his caloric needs are met through “elemental formula” (a type of formula in which the amino acids have been fully broken down), which he receives through a feeding tube. When Kline first heard about the recall on Twitter, she didn’t panic. “I thought, ‘Surely it can’t be every single can we have,’” she says. “And then I was looking through all the cans and the recall affected every single can we had. My son was supposed to eat in two hours and I was like, ‘What am I supposed to do?’”

That weekend, help came from samples at her pediatrician’s office, but she hasn’t had a secure supply since. Her son is supposed to receive 22 cans of elemental formula each month that are covered by medical insurance, but she hasn’t received a single can since March. Hood, whose daughter also has severe food allergies that entitle her to receive formula through a medical supply company, hasn’t received a shipment since January.

Like many parents in this precarious situation who are turning to mutual aid groups, Kline has had to rely on the kindness of friends and family to get through. The cans are $50 each on Amazon; one can lasts her son for 1.5 days. “If we didn’t have a network and a community willing to step up for him, I don’t know what we would have done,” she says. “And not everyone has that. And still, we’re on the verge of not being able to feed him all the time.” Her family, which already took a serious financial hit during Covid, cannot spend $1,100 a month on feeding her son.

Jordan Kelley in Dover, Pennsylvania, has four kids ranging in ages from 3 months to 10 years old. She first started noticing the shortage late last winter, she tells Romper via Facebook message. Her 3-month-old daughter specifically needs Nutramigen formula because she has an allergy to cow’s milk and soy. In early January, a friend drove a good 30 minutes to bring her a little sample can of Nurtraimagen. She particularly had difficulty finding formula that came in the 12.4-ounce size, the only size covered by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). At one point in January, she was forced to buy a large can for $55 that WIC didn’t cover, and then later that month to drive almost two hours to get cans in the WIC-approved size. “During the shortage, it would be nice if they covered the bigger cans, but just in a smaller quantity that it would still be the same amount,” she writes. Help eventually came not from any official channels but through a friend in a buy-nothing group, who texted her late one night that a local woman was giving away cans. “I was able to go and pick up 16 cans of formula from her for free that she did not need. I was so thankful.”

Many other parents are still struggling. Kayla Hoelzel, who lives in Rochester, New Hampshire, has a prescription for Similac Alimentum formula for her 4-month-old son. Her baby has serious gastrointestinal problems, she tells Romper via Facebook message, and “cried almost 24/7” before he started on the Alimentum formula, which is covered by her family’s insurance. Last winter she started mixing her remaining Similac Alimentum with a soy-based formula to stretch it out. “It’s been a rough road over here,” she says.

Hood has also seen the effect on families who are being discharged from the hospitals where she works: “The problem comes when we are discharging babies home and their parents need to find formula. We have had parents report having to drive far to get the formula they need. Or they’re having issues getting the exact formula they need through state-funded programs.” Out of desperation, she’s started her own daughter on solids sooner than she had planned to. “You go in some stores and there is not a single can, or only a few cans. I see parents begging desperately in mom groups to find formula that previously would have been stocked full on shelves.”

Can parents “just breastfeed”?

The perception that formula is a “choice” and that all babies have easy access to breast milk may be one of the many reasons this crisis has escalated so quickly. Despite what a certain cohort on Twitter have suggested, the answer to whether some parents can “just breastfeed” is no. Surrogacy, foster care, and adoption are just three of many dozens of scenarios in which an infant won’t have access to breast milk. Kate DiMarco Ruck, an international board certified lactation consultant and certified breastfeeding specialist, tells Romper that many families use a combination of breastfeeding and formula: “Certainly, I work with so many families who mix-feed, and all formula-feeding families deserve access to quality, affordable food.”

Finally, DiMarco Ruck notes, when a parent is not already exclusively breastfeeding, it’s hardly simple to undertake the process of relactation, the term for beginning breastfeeding again after having stopped. “Relactation is a long process, you need professional guidance, and sometimes medication, and it’s a huge undertaking. You need to pump every two hours. That’s just not realistic for someone who is back to work and looking to supplement their baby. And it’s very insensitive — it would be a horrible thing to say to someone who struggled with breastfeeding in the first place,” DiMarco Ruck says.

The cumulative effect of asking this question over and over is to make parents who use formula feel shame on top of the dread and fear. “It’s disheartening when I turn on the news and when they are reporting about the formula shortage, they are immediately talking about ways to boost your milk supply and the benefits of breastfeeding,” says Hood, whose own daughter couldn’t tolerate breastmilk due to her allergies. “I am all for providing lactating moms resources to boost milk — I am here all day for that support — but not in conjunction with the formula shortage where moms are likely choosing not to or physically cannot provide milk due to medical reasons of mom or baby. This makes an already emotional situation even more emotional and is not the answer to this problem.”

What solutions are being offered?

On May 12, the White House released a statement pledging to “work urgently” on the problem. Proposed steps include removing the limits on the size of formula cans that families who use WIC can buy and potentially lifting some restrictions that currently prevent the United States from importing formula from abroad. Yet the proposed steps stopped short of some of the larger changes that might bring relief to families faster. Elliot Haspel proposed in Fast Company that families with children under 1 should receive a $250 check to help offset some of the expense of formula that’s falling on their shoulders; the group Moms Rising created a petition urging Biden to invoke the Defense Production Act, which would allow the federal government more control over directing manufacturing of formula. (CNN reports that Biden is considering taking that step though it seems less likely to occur now that Abbott and the FDA have agreed upon a reopening timeline.) Some local government officials have stepped in to address the shortage on their own–Levar Stoney, the mayor of Richmond, Virginia, has pledged $25,000 of city money to assist families who are on WIC to get access necessary formula even if it not on the “approved” list of WIC products (in Virginia, WIC has temporarily loosened restrictions on what products may be purchased with WIC benefits; Stoney has called upon the program to make those changes permanent).

As of May 16, the FDA has temporarily loosened its restrictions on importing formula from foreign countries–Reuters reports that Abbott has sent millions of cans from its facility in Ireland and US Today reports that Nestle is importing formula products from Switzerland and the Netherlands.

And yet, as anyone who has juggled a screaming infant while trying to heat up a bottle can attest, when you need formula, you need it in minutes, not hours, not days, and certainly not weeks. And parents who are already exhausted from parenting in a pandemic have experienced this added stress. “I think when the recall happened… my brain just shut down,” Kline says. All she has heard from the medical supply company is that her son’s formula will be available May 31 “or later.”

What can parents do to cope with the formula shortage?

One thing that’s a definite no is trying to stretch formula supplies by watering them down and using less powder in each bottle. “Watering down formula can cause an electrolyte imbalance and malnutrition. Babies can die from it,” DiMarco Ruck explains. USA Today published a list of suggested tips for parents to try in order to weather this shortage, but most of them are simply ways of sourcing formula — there isn’t really any substitute. Also, don’t try to make your own formula at home, even if a Facebook post says you can. “The fact remains that formula is a unique product,” DiMarco Ruck says. At the root of the problem, she says, is the fact that “we don’t prioritize how we feed our babies, and we don’t prioritize families.”

Sources interviewed:

Kate DiMarko-Ruck, international board certified lactation consultant and certified breastfeeding specialist

Jennifer Hood, speech language pathologist