I Need You to Care About the Baby Formula Shortage

In the first year of COVID we became armchair experts in infectious disease. The next, we earned our PhD’s in global supply chains, chalking up the months-long wait times for new screen doors and patio furniture to that container ship stuck in the Suez Canal. Most recently, it’s baby formula that’s been affected by disrupted global supply chains.

As a mom who feeds her baby formula, this isn’t a headline I can avoid by changing channels. This crisis has burrowed its way into the back of my brain, where it pulses, its own beating heart, reminding me all the way down to my bones that it’s 2022 in the most powerful, richest country in the history of humankind, and we can’t feed our babies.

I reached out to Tinglong Dai, Professor at Johns Hopkins University Carey Business School, and expert in global supply chains, wanting to understand these issues and what seemed to be an absolute lack of leadership from government and accountability agencies. On our call, Dai was angry. Being a woman and a mother—two demographics often accused of overreacting—I was surprised that Dai was equally disturbed. “This goes way beyond the scope of a typical supply chain shortage,” he said. As we spoke, it scared me to hear my worst fears were justified. This crisis is a microcosm for everything that’s broken in our country, a massive socio-, economic and political collapse that tells the story of how we failed the most vulnerable people in our country: babies.

And yet, I also felt an overwhelming sense of something else, something lighter; I was relieved. Relieved that in a culture of indifference, Dai cared. Now, I would like you to care.

So, why, exactly, is there a baby formula shortage? There are some supply chain issues with key ingredients (like cow’s milk) and labor shortages. But Dai, again, whose expertise lies in global supply chains, tells me these are short-term. They are also predictable—once one domino falls (or slows down), common sense tells us the rest will follow suit. In other words, it is highly unlikely leadership couldn’t have seen this crisis coming and done something to avoid the panic we find ourselves in now.

There’s another thing about baby formula that’s important to understand: It’s a highly controlled market. While there’s been a surge in demand for foreign products (like, European-style brands) and “farm-to-formula” ingredients (like ByHeart), Food and Drug Administration labelling and ingredient requirements as well as tariffs hovering around 17.5 percent disincentivize outside competition. And as a consumer, one can’t just go to Amazon Canada and order formula because of strict FDA labeling and ingredient regulations. (Third-party sellers that slip through the cracks often price gauge or sell false goods, which can be very dangerous.)

The result? There are literally four companies that control nearly 90 percent of the market share in the Unites States: Mead Johnson (Enfamil), Abbott (Similac), Nestle (Gerber), and Perrigo (store brands like Walmart, Amazon, Target, Kirkland et al). When you go to the store thinking you get to hand-pick the baby formula that best suits your baby, in reality, that choice has already been made for you.

But the mirage of a free market dissolves further. The big four essentially have state-wide monopolies. See, welfare programs (known as Special Supplemental Nutrition Program for Women, Infants, and Children or WIC) have exclusive contracts with formula manufacturers. For example, New York state’s contract infant formulas are all Enfamil and one soy-based Similac product. In Texas, it’s mostly Similac products. Before this nationwide baby formula shortage, governments, according to estimates from the Department of Agriculture as reported by Politco, were already controlling between 57 and 68 percent of all infant formula sold in the U.S.

So, back to that domino metaphor. One would think that if one those dominos were to start swaying—let’s say it’s the one that accounts for nearly a quarter of all formula produced in the United States—it might be smart to brace for impact.

That domino, of course, was Abbott Nutrition’s Sturgis, Michigan infant formula plant.

In February 2022, the writing was already on the wall with logistics limitations and transportation constraints when Abbott “voluntarily” shut down its Michigan factory due safety concerns. Back in October 2021, a whistleblower at that Michigan Abbott factory filed a complaint about safety violations after reports surfaced of an infant being hospitalized for a rare but deadly bacteria after consuming formula from that same plant. Two months following the complaint, two infants died and more were hospitalized after drinking formula from the same plant. As reported by Politico, House Appropriations Chair Rosa DeLauro said that the FDA did not interview the whistleblower until December 2021. It took until January 31, 2022 for the FDA to inspect the plant. Finally, on February 17, 2022, four months following the complaint, the formula was recalled. What we’re seeing now is really a result of this February recall.

One more time for everyone in the back: The whistleblower filed their complaint in October 2021. It took until February 17, 2022 for the formula to be recalled. In that time, two babies died, and others got sick. This is one of the most regulated food industries in the world—so regulated that there’s little to no real market competition—and yet it took the FDA two months to open an investigation on the complaint, which was then confirmed and led to the voluntary shut down, as in, the FDA never even mandated the factory close. And now, AP reports that the FDA has told lawmakers as of May 19 that the Sturgis factory could be reopening next week. Oh good, the factory that distributed formula with a rare but deadly bacteria is opening again? Yay? I guess this is what happens when four companies own 90 percent of market share—the factory that produces 25 percent of all formula in the country that's rife with deadly safety violations should just reopen and keep shipping out baby food. This is an absolute regulatory failure.

“Can we really trust the FDA to protect babies? There’s very little evidence that FDA cares about babies,” Dai told me. He has little faith that even if there is enough baby formula on the market that it will be safe. Like the professor, I’m holding my applause for this reopening. Babies died. There should be a criminal investigation. “We should take a page from the finance industry,” Dai believes, referring to the 2008 housing crisis and how financial institutions started rewarding whistleblowers. “The same should be done in the baby formula industry.” In the short-term, Dai is a supporter of importing quality foreign formula and relaxing WIC restrictions, which the two bills heading for the Senate, as well as President Biden’s invocation of the Defense Production Act, aim to address. In the meantime, we still find ourselves unsure how to feed our babies in the richest, most powerful country in the world.

At this point, I’m hoping, hoping, that this massive political and economic failing has made you care. But maybe you’re still on the fence, wondering if there’s all this hubbub about formula, why can’t parents just use breastmilk? Isn’t it the gold standard for babies anyways? Isn’t the American Academy of Pediatrics’ official recommendation for infant feeding exclusive human milk up to six months?

These are great questions—great questions that should humble you to your knees, as you beg for mercy from the mother you just asked this. And what about the single fathers, gay fathers, adoptive parents, foster parents and other types of caregivers where the “breast is best” argument is null and void? 

Scientific literature shows us that nearly 15 percent of first-time birthing people do not make enough milk to feed their babies. And even if everything goes perfectly and the baby latches and the parent produces milk and it’s not gut-punchingly painful, there are the realities of living in a country without parental leave. In order to bodyfeed, a person needs the time to do so. It can take a newborn an hour to get the amount of food they need in one session. If you’re pumping, it requires the expensive machinery and the time (30 minutes or so) to set up shop and pump and then more to clean and sterilize the parts. All this and…the benefits of breastmilk are trivial. How can a person reasonably work full-time and feed their infant?

There is this illusion that parents have a choice. A choice to use formula. Of what type of formula. To breastfeed. Where to breastfeed. When to breastfeed. As a mom who breastfed for nine months until my baby simply decided to go cold turkey on the stuff, I can tell you from my experience, my baby made that choice for me.

So, when you see a mom silently panicking while shhing her newborn in front of rows of empty shelves where formula used to be, it’s not her choices that led her here—those choices were made long before those shelves were empty—possibly before this mom knew she was even pregnant—by leaders in the most powerful, richest country in the world. If there’s any choice we do have, it’s to choose to care. I hope that you do.