Thousands of families in the United States are struggling with a shortage of infant formula sparked by the closure of an Abbott Nutrition plant in Michigan in February 2022. The effects of the shortage are still being felt despite measures implemented by the government to alleviate the consequences in the short term. This crisis has sparked a major debate about the nature of health and labor policy in the US and the necessity of major changes in order to protect children’s health.
Katheryn Russ, associate professor at UC Davis and fellow at the Peterson Institute for International Economics, estimated that almost 2.5 million infants in the US are vulnerable to supply shortages like the current one. However, their health can also be jeopardized by contaminated formula and unsanitary conditions in factories. This was the case with the formula produced in Abbott’s Michigan factory, which was contaminated with the germ Cronobacter sakazakii. The consumption of the contaminated formula has led to the hospitalization of 25 infants and the death of at least two, possibly even more, according to the International Baby Food Action Network (IBFAN).
Deprioritization of breastfeeding has negative effects
Ensuring adequate access to safe infant formula is necessary for making sure that parents who for whatever reason cannot breastfeed, can provide adequate nutrition to their children. On the other hand, promoting formula consumption over breastfeeding, which is the case in the US, is certain to have serious implications for public health. The World Health Organization (WHO) continues to stress that breastfeeding has a positive effect on both infants, reducing the likelihood of developing diabetes or obesity later in life, and mothers, for whom it reduces the chances of developing breast cancer, among other things.
While US delegates at this year’s World Health Assembly spoke of the importance of breastfeeding, little has been done to promote it domestically. The US is the only high-income country with no statutory national paid maternity leave, meaning that many new mothers are forced back to the workplace right after giving birth. Many hospitals still lack the necessary workforce and resources to provide quality lactation guidance to families.
Poor and working class families are affected the most. The same families are more likely to find themselves in jobs without a level of flexibility which would allow them to breastfeed or express milk during working hours.
Working class families first impacted by crisis
Poor and working class parents and other caregivers are also the ones who have been burdened the most by the infant formula shortage. As many were unable to find the formula options they usually purchased through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), they were forced to purchase formula at gouged prices or spend nights driving around looking for leftover supplies. When all else failed, some parents resorted to diluting the formula they had or attempting homemade recipes, moves that can represent health risks for infants.
As parents and families were struggling, producers of commercial milk formula were enjoying an even more privileged position than they had half a year ago. The largest US producers, Reckitt Benckiser (previously Mead Johnson) and Abbott Nutrition, who together held almost 80% of all commercial milk formulas sales in the US in 2019, and Cargill, were called to expand their production capacities, making good use of President Biden’s invocation of the Defense Production Act. Producers from other countries, including Nestle and Danone, were granted import applications, bypassing the usual red tape for formula imports to the US.
Drive for profit undermines solution
Amid the shortage crisis, producers of infant formula still persisted in aggressive marketing strategies, many of which are barred by the International Code of Marketing of Breastmilk Substitutes. Among other things, the Code bans strategies such as the direct marketing of commercial milk formula to mothers, as such practices are proven to lead users to believe that relying on formula rather than breastfeeding is safer or healthier, which has been disproven by the WHO and other groups.
Yet, producers still find ways to circumvent the rules and find a way to impose their products on families. Recent reports by UNICEF and the WHO have described cases of commercial milk formula producers using direct marketing or social media groups in different countries. In the US, which until today continues to oppose the recommendations set out in the Code, similar practices are not unusual, and they have taken a particularly morbid tone in the shortage-ridden US.
Several women reported receiving packages of Reckitt-produced Enfamil infant formula without having signed up for anything of the sort. According to reports, the company purchases customers’ information from selected stores and sends samples to women who they see as potential customers, such as women who purchase pregnancy tests. Severe criticisms were launched at such companies for pursuing such a strategy when many families were desperate for the formula and could not get it.
Dear @Walgreens I received this package today a week after purchasing a pregnancy test at your store. I was asked to take the test by my doctor despite having no Fallopian tubes. 1/X pic.twitter.com/EZTsTPf7jd
— Nicole (@melancholynsex) July 17, 2022
Enfamil, for its part, stated it encourages re-gifting of the promotional package in case the original recipient does not need it. But by not stopping the practice as the formula shortage rolled out, the company hinted once again that the interests of the commercial milk formula industry do not correspond with communities’ needs.
To protect infants’ health, the US will have to do much more than airlift formula from other countries, hinted IBFAN in its statement. Elisabeth Sterken, a member of IBFAN Global Council, said: “The US policy has left citizens without Code regulation, trained health worker force, breastfeeding support and mandatory maternity leave for decades. This has not only benefited the US formula industries but US exports also impact negatively on child health and survival globally.”
In a public comment submitted to the Federal Trade Commission, Katheryn Russ and Phillip Baker, senior lecturer in human nutrition at Deakin University call for policy makers trying to resolve the shortage to address market power and ensure resilient supply chains without delay. This should not only mean creating buffers through easing the import of commercial milk formulas, but also creating policies to support breastfeeding and human donor milk banks, which would help dismantle the monopoly power currently held by the industry. By doing that, signaled Russ and Baker, they would improve food security for thousands of infants in the US and offer better nutrition opportunities for their families.
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