Log in

Impact of scarcity is falling hard on Black, low-income and rural families

By JULIE MINDA

National baby formula shortages that began early this year have abated slightly but remain a concern for new parents across the U.S.

Mackey Roberson, the lactation consultant at CHRISTUS Highland Medical Center in Shreveport, Louisiana, shows a breast milk pump to a new mother. Roberson says a recent slight uptick in moms choosing to breastfeed may be related to concerns with baby formula shortages.

Pediatricians and a lactation consultant from the Catholic health ministry say they've been particularly attuned to the amplified challenges low-income, rural and minority families have been facing in securing sufficient formula to feed their infants.

A June report by Kaiser Family Foundation on the impact of the formula shortage states that infants from low-income households, infants living in rural areas and infants of color are more likely to be fed formula diets exclusively or as a supplement to breastmilk than are white babies born to higher-income families.

"In addition to being more likely to use formula, low-income families also may have less resources to search for and purchase in-stock formula," and those living in rural areas may have fewer retailers to fall back on when their regular store runs out, the researchers said.

Woods

"There is a health equity aspect to these (formula) shortages," said Dr. Ashanti Woods, a pediatrician with Mercy Family Care Physicians in Baltimore, which is affiliated with Baltimore's Mercy Medical Center.

Bruning

"The formula shortage hits people of all demographics. Populations with lower rates of breastfeeding will be hit harder than those with higher rates," said Dr. Kara Bruning, a pediatrician with Avera Medical Group in Sioux Falls, South Dakota.

Recall
According to the Centers for Disease Control and Prevention, pandemic-related supply chain issues that impacted formula availability were exacerbated by a formula recall early this year by Abbott Nutrition, one of the largest makers of formula in the U.S. The company recalled three brands of dry formula mix made at its plant in Sturgis, Michigan, and temporarily closed the plant in February after the U.S. Food and Drug Administration cited safety and sanitary concerns with formula production at the plant. Several babies became sick and two died from a bacterial infection.

Abbott says the specific contaminant that caused the infections had not been found in the Sturgis plant at the time of the closure. The plant shutdown set off widespread shortages well beyond the formulas produced at the Abbott plant. News reports based on information collected by Datasembly from 130,000 stores showed shortages continued to grow in late May. About three out of four stores were out of stock on formula the week ending May 28.

Abbott restarted some of its production in early June, but in less than two weeks, it was forced to shut down again to clean up from a flood. It reopened July 1, according to published reports.

To ease shortages, the Biden administration launched Operation Fly Formula, which lightened restrictions on importing formula from overseas manufacturers, and it sent military cargo jets to haul formula back from Europe. It activated the Defense Production Act May 18, requiring suppliers to provide manufacturers with the ingredients they need to produce the formula more quickly. In early July, the FDA reported shortages were abating.

Scrambling
Woods said during the worst of the shortages — in April and May — parents of his patients scrambled to find formula and his practice gave families in a bind canisters of formula from its in-office supply.

Dr. Ashanti Woods, a pediatrician with Mercy Family Care Physicians in Baltimore, examines a patient. He has been advising new parents about how best to navigate baby formula shortages.

Mackey Roberson, the lactation consultant at CHRISTUS Highland Medical Center in Shreveport, Louisiana, said that while the supply has stabilized as more formula is being produced, spot shortages were still happening in mid-July and were a concern for parents she works with.

Woods, Bruning and Roberson suggest parents navigate the shortages by enlisting friends and family in the hunt for baby formula. They recommend that families connect with each other on social media in the hope that posts will flag stores with available supplies. Pregnancy resource centers and Community Action Agencies may have formula or know where to get it. And local breast milk banks could be another resource for desperate families.

The U.S. Department of Health and Human Services' guide for navigating the infant formula shortage advises parents that it's generally OK to substitute different brands of formula, including store brands, as long as they have the same base — like cow's milk or soy — as the baby is accustomed to. The guide says any substitution should be done with the supervision of a health care provider.

Diluting formula to stretch the supply, using expired formula or making homemade formula are considered unsafe practices, according to the guide.

Woods has been spreading these tips through media interviews. Many ministry facilities have been sharing advice through their websites and social media.

Boost for breastfeeding
Roberson said as a lactation consultant she has seen an increase in the number of women interested in breastfeeding, including some who had not breastfed their previous children, and some who initially wanted to bottle-feed but who changed their minds after being discharged from the hospital. Sometimes women can begin breastfeeding if there has not been too long a lapse post-birth. Roberson said she thinks more women are choosing to breastfeed because of the difficulty of getting formula.

In June, shoppers at a Walmart in Carmel, Indiana, had limited choices of baby formula as a national shortage dragged on. The shortage peaked in April and May and began to ease in early summer after the Biden administration lifted some restrictions on formula imports and took steps to stimulate domestic production and one of the country's biggest infant formula manufacturing plants came back online.

'Dangerous spot'
Woods said that there are barriers to breastfeeding for low-income women. Without paid parental leave, they may need to return to work shortly after they give birth and they may be in a work environment that does not allow the time or provide a place for pumping milk, and pumping is necessary to maintain a milk supply for breastfeeding. Also, the most efficient and convenient milk pumping machines are expensive, he said.

Getting formula amid a shortage can be much more difficult for the poor. With gasoline prices at or near all-time highs, Woods said people with low-wage jobs or little money or family support may not be able to afford to drive around to multiple stores. Roberson said families who live in neighborhoods without groceries and other stores won't have many choices for where to get formula. Bruning said the distance to shops is a big concern for families in rural areas.

Formula can be very expensive, and Roberson said working-class families may not be eligible for subsidies for formula. Woods added that even families who get benefits through the Special Supplemental Nutrition Program for Women, Infants, and Children, and/or the Supplemental Nutrition Assistance Program are being stung by the formula shortages. That is because WIC benefits only can be used for certain brands of formula. If those brands are out, families may use precious SNAP dollars to buy other brands, diverting funds needed for other food for the family. Woods said Mercy has asked WIC to relax the requirements during the formula shortage, as has been done in some states.

The infant feeding experts said thankfully they have not yet seen babies in their practices suffer ill health due to the formula shortages. But, Woods said, "There is a great risk to babies" if they are not fed properly, and so he and other providers are continuing to educate parents about the issue.

Dr. Ashanti Woods, a pediatrician with Mercy Family Care Physicians in Baltimore, has been interviewed by Baltimore-area media outlets about the baby formula shortages. Here are some of the television news stories featuring Woods:

Medical Alert: Tips on dealing with formula shortage - WBAL-TV

Maryland families struggle to find baby formula amid a ... - WJLA

Coping with the baby formula shortage: Keeping infants safe

Baby formula shortage creates panic for many parents - WMAR

CHRISTUS facility runs support group to address culture-based hesitancy to breastfeeding

Health care practitioners advise that breast milk generally is the best nutritional source for babies in the first year of their lives. However, some women who physically can breastfeed may struggle with the decision to do so, due to cultural concerns.

Roberson

That is according to Mackey Roberson, the lactation consultant at CHRISTUS Highland Medical Center in Shreveport, Louisiana. She leads a support group for Black, Latina and Asian moms who "have trouble with lactation from a historical and social perspective."

The Centers for Disease Control and Prevention breastfeeding facts show Black infants are less likely to ever be breastfed as compared to Asian, White and Hispanic infants.

Using grant dollars from Louisiana in partnership with Cafe Aulait, CHRISTUS Highland began the support group several years ago and provides a space as a community benefit. Roberson, who leads the group, said about 10 to 15 women attend at a time. Attendees are predominantly Black moms, says Roberson. Participants can choose to attend in-person or virtually.

Roberson said the group talks through the stigma and barriers to breastfeeding for moms of color. She believes breastfeeding rates have been relatively low among Black women for decades because of the wide availability of formula and because of the legacy of slavery.

Roberson explained that female slaves were forced to be wetnurses for the infants of slave owners. "So, women's breasts were weaponized against them."

An aversion to breastfeeding has been passed down through generations, she said. Only recently have breastfeeding rates been rising among Black mothers.

A November 2016 article in Nursing Research and Practice indicates that although Latina moms in the U.S. initiate breastfeeding at a higher rate than the national average, they are less likely than other groups to breastfeed exclusively. The article notes that the World Health Organization recommends breastfeeding be the exclusive source of nourishment and hydration in the first six months of life.

The study authors wrote that there are many reasons Latina mothers supplement breast milk with formula. Among them:

• Inadequate knowledge of breastfeeding.
• Cultural beliefs that "breastfeeding is a practice of the poor" who can't afford formula.
• The cultural axiom that a heavier baby is a healthier baby may cause a woman to worry whether she will produce sufficient milk to nourish her baby.
• Women in low-wage jobs who aren't able to take unpaid time away from work nor pump milk while at work may have little choice than to rely on formula.

Among other recommendations, the study authors say there is a need for greater education by perinatal nurses, lactation consultants and other obstetric health practitioners on the benefits of breastfeeding exclusively.

Roberson provides that education and said the women in her support group encourage each other in their breastfeeding.

— JULIE MINDA