For many parents, the formula shortage isn’t over; it has become a gnawing ongoing element of their lives. And for many parents, it’s becoming an ongoing crisis that’s a centerpiece of parenting in the U.S.
Hillary Bowler Davis gave birth to her first child, a son, in January. She knew about the formula shortage that began when major U.S. formula producer, Abbott, went offline in February due to contamination issues. But Bowler Davis wasn’t too concerned because she had a subscription to a specialty formula that her baby required because he suffered from severe reflux, and her Amazon subscription arrived every couple weeks like clockwork. Gerber, who made her specialty formula, actually increased production after the Abbot recall, so her family had a good supply.
But then people scrambled and bought up whatever they could when they couldn’t get Similac—including specialty formulas. By early summer, the subscription was delayed.
In late June, Bowler Davis and her husband got a notice that the subscription wouldn’t arrive for a month. “A month delay doesn’t work for feeding your baby,” she said. Her husband canceled the subscription.
That was the day that she and her husband felt the “first taste of panic” and drove to three Walmart locations looking for food for their baby. “The shortage hit us late,” says Bowler Davis, but months later, it’s still hitting them.
“The frantic feelings are just cyclical now,” she says. “We get a supply for a few weeks and then it starts all over again, and we go from store to store hoping they are stocked. It re-starts every 3-4 weeks.”
She now describes feeding her baby as an ongoing stress. “Will I be able to feed my baby?” That question just hangs over me all the time.”
Part of what’s vexing about the formula shortage is that it’s only happening in America. The formula shortage cannot be chalked up to supply chain issues—other countries are flush with infant formula, and in fact, are sending formula to the U.S. to provide relief.
So how did the richest country in the world, that helped develop life-saving baby formula and got parents hooked on it, end up without enough to feed its infants? The story itself is uniquely American.
The current crisis represents a rupture in one of the great developments in the history of human health. Before the advent of a safe, reliable formula supply, babies died much more frequently, often because of feeding issues.
“We take for granted the existence of safe infant formulas and have forgotten the dire fate of babies that were not breast fed in the past,” wrote researcher LT Weaver in the Archives of Disease in Childhood.
Weaver noted that in 1790 babies in a Dublin, Ireland, hospital who could not be breast fed had a mortality rate of 99%. “‘Dry’ feeding with substitutes such as raw cow’s milk and other concoctions was a death sentence, and wet nursing was hardly better,” he adds.
As recently as the 19th century, for example, Europe’s infant mortality rate of around 150 per 1,000 live births, or 15% , was blamed on severe malnutrition and diarrhea associated with infant food contamination according to the Archives of Disease in Childhood. For comparison, now Europe’s infant mortality rate is 3.2.
Nourishing newborns has always been a challenge for humans. Feeding infants animal milk and other alternatives is an ancient practice, and the use of hollow animal horns and other devices to feed infants goes back to the earliest recorded human history.
Breast milk alternatives have always been necessary, because, for one thing, death in childbirth was much more common before the 21st century, frequently leaving infants orphaned or without food.
But there has never been a shortage of reasons that humans had to rely on alternate infant foods. Throughout history, babies have been born to women who had to work to support them, or who were enslaved and made to work instead of feeding their infants. Babies have been born to women who had low milk supply or were undernourished themselves or had inverted nipples. Babies have failed to latch due to tied tongues or other physical issues.
For most of human history, survival for such babies was dependent on the quality and availability of breast milk alternatives or wet nurses—women who were used (through payment or forced labor) to feed babies that were not their own, often to the detriment of their own babies.
The problem was, alternative milk concoctions, often made of animal milk, nut mixtures or grains, without modern sterilization and refrigeration, were easily contaminated with pathogens.
The results for babies were devastating.
An article published in Lancet in April of 1858 recorded that in London, Birmingham and Leeds England, the death rate of infants was 40-55%, highly correlated with “poor diet” due to mothers being forced to return to factory work shortly after giving birth. In the U.S., even at the turn of the 20th century, about 15% of babies fed with breast milk alternatives perished.
We take fresh cow’s milk for granted now, but refrigerators full of milk available at your grocery store are a relatively new convenience that was made possible thanks to the advent of refrigeration in the 1800’s, and Louis Pasteur’s pasteurization process, discovered in the 1860’s.
Before that, unpasteurized cow’s milk carried pathogens that we don’t even think about now, including typhoid fever, cholera and diphtheria.
But the real breakthrough for infants came when Gail Borden, a native New Yorker who moved to Texas and led an exciting life as an inventor and land surveyor who helped plan the cities of Houston and Galveston, invented a way to preserve milk safely in cans.
As the story goes, Borden was on a ship from London and the milk from the cows on board made passengers ill—including children who drank it. This inspired Borden to create a process in 1853 that would heat milk to condense and sterilize it and seal it in sterile cans. The result was Borden’s sweetened condensed milk.
Anyone who has made one of their grandmother’s recipes is familiar with Borden’s condensed milk as a sweet syrup sometimes used in baking, but Borden’s product at the time made milk shelf-safe and transportable without refrigeration and was used as a milk replacement (the fact that heaps of sugar were added probably aided in its popularity). It was lifesaving for many soldiers in the Civil War.
Soon after Borden’s arrived on the scene, its cousin evaporated milk arrived, and that was the real game changer for infants and the modern formula industry. Evaporated milk was developed in the 1880’s, by evaporating 60% of the water from milk in a sealed metal still, then heating the remaining milk to above 200 degrees. The result was milk that was homogenized, shelf safe and easier for babies to digest, thanks to a smaller milk curd.
Evaporated milk was designed to be mixed with water at home to create a pitcher of milk, much the way that juice concentrates or coffee concentrates are designed today, and it caught on quickly with parents.
With evaporated milk, for the first time studies published in the 1920s and 1930s demonstrated that large numbers of babies fed evaporated milk formula grew as well as breastfed infants did. This massive reversal in fortune for non-breastfed babies was a huge breakthrough for infant health and survival, and pediatricians and parents took note and, well, latched on.
In fact, pediatricians were part of the movement to discover a viable infant milk alternative, and they pioneered some of the innovation around fine-tuning and “humanizing” evaporated milk formulas to make its composition more like breastmilk by adjusting proteins and sugars and adding vitamins and minerals.
Alfred Bosworth, a chemist at Harvard Medical School, experimented with varying amounts of vegetable oils, calcium and other components, eventually performing over 200 clinical trials with his partner, Dr. Henry Bowditch.
The pair had their new formula marketed by the Moores and Ross Milk Company in Columbus, Ohio, in 1924. It was sold by physicians in cans, and they marketed their product as “Similac,” as in “similar to lactation.”
Soon parents and doctors adopted commercial formula as a pediatrician-approved, affordable and convenient alternative to nursing, and a market opportunity presented itself. Industrial food makers took note, and an industry sprung up. Mead Johnson’s Enfamil (for “infant milk”) hit the shelves in 1959, and big players like Nestle jumped in with their own formulas.
By the 1960’s, the percentage of women who breastfed their newborn reached an all-time low (25%), in part because of the ease of use and low cost of commercial formula, and a belief that formulas were “medically approved” to provide optimal nutrition for young infants. Commercial formula was provided to parents at the hospital free of charge, normalizing the practice.
Very quickly, evaporated milk formula represented an uneasy relationship with American capitalism as a life-saving technology, but one that could easily be exploited for economic gain.
“You had doctors who were giving women formula in their office, and there was this idea that it was more scientific and complete and better than breastmilk,” says Amy Bentley, professor of Food Science at NYU. “Manufacturers are keen on getting women to purchase them, and doctors and nurses go along with it.”
Marketing and convenience combined to replace breast feeding with formula, and formula became a multi-million-dollar business that was taken over by massive industrial food conglomerates who had the budgets and incentives to push formula over breastmilk even more.
“Women are interested, and those that can afford it start using formula,” says Bentley. “Breastfeeding becomes declassee; the attitude is that women in National Geographic expose their breasts, why would we do that.”
In the 70’s and 80’s, there was finally pushback and a movement back toward “breast is best” that we see today. The CDC recommends breastfeeding as the most nutritious way to feed infants for the first year of life.
But Americans are still largely dependent on formula, and the market is growing, not shrinking. Today, baby formula is a $6 billion industry in the U.S., and the global infant formula market is projected to reach $109 billion by 2027.
Baby Care vs. Capitalism
Over time, American dependence on baby formula has become more complicated and systemic than mere habit and convenience, says Bentley. “In the 20th century, formula was foisted upon women, but also upper-class women were interested in it as a form of liberation, flexibility and a way of creating looser ties to home.”
“But for other women who have to work, like factory seamstresses and telephone operators, they have no choice but to use formula.”
Today, more than half of American families—62%—have two parents working outside the home, according to 2022 Bureau of Labor Statistics data.
Other wealthy countries support breastfeeding with generous family leave of up to a year or more, but the U.S. remains the only wealthy nation with no federal maternity leave. In fact, 1 in 4 people who give birth in the U.S. return to work within two weeks.
Breastfeeding babies need to eat every 2-4 hours, or eight to 12 times every 24 hours, according to the CDC, which equates to a full-time, around-the-clock job.
That means that many children born in the U.S. are just as dependent on breast milk alternatives as babies born to factory workers in London in the 1700’s. They just have a safer alternative.
“There have been many opportunities and failures [in the U.S.] to support post-partum families,” says Dr. Bridget Young, who has a Ph.D. in nutrition and studies the composition of breastmilk and formula.
“We often have poor lactation follow up, we have limited to no paid maternity leave,” says Young, which means that many families that might like to breastfeed don’t have the opportunity. “We fail some of these formula-fed families,” says Young.
Bentley points out that we are in an interesting moment regarding shifting American cultural attitudes about baby feeding: “We are in this interesting moment in early 21st century where now many upper-class women are breastfeeding. And now there’s a lot of pressure by hospitals that if they don’t, they are not doing the best for their child.”
“Now breastfeeding is the luxury,” says Bentley, for those who have the time and financial means to take time off from work to do it. “As wealthier women start doing it, the cachet goes up, the cycle flips around again.”
But, she says, the formula shortage exposes the lack of social services and policies that allow all women to breastfeed.
Like Young, Bentley points out that formula dependence is now built into a culture with a lack of policies that support families, in an economy that usually requires two incomes to support a child.
“Immediately people say parents should be breastfeeding anyway, but then on second examination, why do all these women rely on formula? They might not want to rely on it. The question should be, ‘why haven’t we made any social policies that allow parents to breastfeed?’”
Boon to Bust (?)
As more families become dependent on formula, leaving the feeding of infants to multinational conglomerates and market forces has proven disastrous for babies for decades, and the current crisis is another chapter in that history.
Making baby food in our current system dominated by monopolies isn’t always about what’s good for babies, it’s also about what’s good for shareholders.
When it comes to improving the bottom line, corporations “can’t control the birth rate, but they can cut corners and raise prices,” says Amanda Starbuck, a research director at the Food & Water Watch group, a food safety NGO. “Consumers are fed this lie that prices go down with market consolidation, which is not the case.”
The darkest chapter was the Nestle formula scandal in the 1970’s, when Nestle was accused of expanding its customer base by getting women in developing countries hooked on formula by giving them samples and selling it as “superior to breastmilk.” But these were poor families who didn’t have adequate sanitation for bottles or money for formula, and after they started using formula and their milk dried up, babies starved and died.
The allegations led to hearings in the Senate and the World Health Organization, resulting in a new set of marketing rules. Despite this, aggressive marketing and sales tactics continue, including in the U.S., where doctors no longer sell or give out formula, but post-partum parents are presented with ready-to-use formula samples in the hospital.
The current crisis is a new episode in a system that was developed to save baby’s lives but has evolved in the U.S. in a way that can harm them while benefitting large corporations.
It’s well-known at this point that the U.S. shortage is due the fact that baby formula has become so monopolized in the U.S. that it’s only made by four big manufacturers. This has created a “too big to fail” scenario for feeding many of the nation’s infants.
“Monopolies matter a little less if we are talking about soda,” says Amanda Starbuck, a research director at the Food & Water Watch group, a food safety NGO. “But it matters a lot more when we’re talking about essential food for infants.”
There is some special irony in the fact that contamination and poor regulation—the same conditions that formula was meant to solve—have festered under our current system to lead to its collapse. Whistleblowers from within the Michigan factory reported filthy conditions and puddles of leaked water where the formula was being manufactured, according to the New York Times investigation.
The Way Forward
For solutions, the U.S. can look to other countries with diversified formula industries that don’t have these problems.
European countries, and Germany in particular, have a very diverse formula industry with lots of players and competition, which keeps their supply protected and keeps quality high.
The care that Europeans take with their baby food supply is mind-boggling by American standards and says a lot about how each country treats the importance of infants. German formula, for example, is made with “Demeter” milk: Demeter farms produce at least half of the fodder they require for their animals themselves. This means high quality biodynamically grown feed or fresh pasture.
Meat and bone meal, and antibiotics and hormones that are commonly used in U.S. agriculture, are prohibited. The European Food Commission standards for infant formula bans corn syrup, glucose, fructose, rice syrup, table sugar (sucrose) or carrageenan commonly found in American formula.
Does this make a difference to the health of babies?
“From an infant formula research perspective there is no research, so as a researcher I don’t have an opinion because we don’t have the evidence on which to base one,” says Young.
A significant amount of research on formula is paid for by formula companies, she explains, who invest in research that has the potential to provide a monetary benefit for them.
“I have never seen research comparing formula from a Demeter Farm vs conventional, so I can’t say yay or nay,” she says. “Depending on who is funding research, certain questions may be overlooked–like is organic formula better–that’s important to infant care, but we have no research to answer the question.”
The way to go about this, Starbuck says, is to first break up the formula monopolies. “We need to move beyond this dubious idea of ‘economic efficiency’ that largely doesn’t benefit people, but the largest corporations.”
One way to help convince the public and policy makers of the benefits of pushing back against powerful agriculture conglomerates and their lobbies is a return to American pride in feeding their children well.
“After World War II, there was a lot of pride in the idea that America had enough food to feed everyone. American kids had the best food and the most food, which was a pretty amazing feat because for most of human history, humans have not had enough food for all classes,” says Bentley.
“However, few decades later, it’s not just about quantity, it’s about quality, nutrients, and we understand ‘the best’ in a different way,” she says.
Perhaps the current crisis is a chance to return to a culture of feeding our babies well. Bentley points out that the child benefits during the pandemic, for example, briefly ended child poverty, which show that government investments in child welfare pay off.
“If we wanted to end child hunger and feed our children well in America, we could,” she says, with a note of optimism that the possibility is dangling within reach. “We don’t do it now,” she says, “but we could.”
Lane Anderson has won awards for her writing on inequality and social and family issues. She is based in New York City with her husband and daughter, where she is a Clinical Associate Professor at New York University. She is co-author of the Matriarchy Report newsletter, which reports on issues and solutions for raising kids in the U.S.