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Formula for a crisis: Parents left scrambling to secure infant formula

August 18, 2022

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Photo by Pexel user nappy

Baby-formula expert Bridget Young has seen it all since February. That’s when the United States’ main provider of infant formula, Abbott Nutrition, closed its Sturgis, Michigan, plant as the Federal Drug Administration began investigating bacterial infections in infants.

Young, who has a PhD in nutritional sciences, works at the University of Rochester Medical Center. She said the past few months, while the country has experienced a baby formula shortage, has been unprecedented.

“This really united parents across all socio-economic classes,” Young, whose passion project is her website: Baby Formula Expert. “We don’t recommend people do this, but I did see a lot of breastfeeding mothers offering milk from their freezer to their local community. There are a lot of beautiful stories about communities really rallying together – lots of formula exchanges. A lot of parents went on Facebook and Instagram saying ‘I have this can. I have that can.’ ”

In addition to those stories, business journalists have reported the harsh new realities parents had to deal with as they juggle the rigors associated with having a new baby during a formula shortage. Parents of 13-week premature twins weren’t given the customary formula samples when they left the hospital. Instead, they were left to worry and wonder how they were going to feed their newborns. Other parents were heavily criticized for relying on formula. As Newsweek reported, entertainer Bette Midler told new parents to “try breastfeeding. It’s free and available on demand.”

At its worst, out-of-stock rates of baby formula grew to 74% nationally. Ten states had out-of-stock rates at 90% or greater, according to reports by Bloomberg. Families that have been hit the hardest are those of low income.

WIC families and contracts

The special supplemental nutrition program for women, infants, and children known as WIC serves about half the infants of low-income families born in the United States, according to U.S. Department of Agriculture’s Food and Nutrition Service. In 2018, 6.87 million children, infants and women received WIC benefits each month.

Families that depend on WIC receive checks, electronic benefit cards, or vouchers each month to supplement their diets. According to the USDA, WIC promotes breastfeeding; however for women who do not or cannot breastfeed, WIC provides infant formula vouchers. Special infant formulas and medical foods can also be prescribed by doctors.

Requirements and formula lists differ from state to state and acquiring the correct formula covered under WIC benefits can be difficult when a shortage like this occurs. Especially when Abbott Nutrition is the sole-source contract of the majority of State WIC Agencies, who have been required to enter sole-source contracts to reduce program costs since 1989.

As a result, WIC families have had to hunt for listed formulas required by the USDA. Other WIC families were disappointed to learn that you couldn’t use WIC benefits to buy formula online. According to CNN, federal law requires that WIC recipients sign their name or enter a PIN number when they receive groceries. New systems have to be built for WIC shoppers to purchase products online.

“There’s no way to quickly move to online ordering at this point,” said Geraldine Henchy, director of Nutrition Policy and Early Childhood Programs at the Food Research and Action Center in Washington, DC., to CNN. “They can’t do it. It’s too complicated, and it’s a security risk. So, they can’t pivot to just go to online ordering for WIC.”

Young heard from some of these parents. During the earliest stages of the shortage, WIC families were one of her biggest concerns.

“You have a very limited option for WIC and you’re on WIC if you’re resource-limited,” Young said. “That’s where my heart went out and I was really trying to do advocacy because while your baby may tolerate another formula, you may not be able to afford it. Or, you may not be able to access it. Maybe it’s in the next suburb and you may not have your own transportation.”

To answer parents’ urgent questions, the Phoenix Children’s Hospital produced blogs and FAQs to distribute information. Questions ranged from: Are there safe alternatives to infant formula to what tips do I need to prepare imported infant formulas.

For Young, there was also a concern for children in need of specialized formulas, leading her to help pediatricians find local sources of suitable formula for their patients.

“I support a lot of pediatricians who were extremely concerned that their allergic infants, particularly on WIC, can’t get formula. That’s a dire, desperate situation,” Young said. “Occasionally, another brand of hypoallergenic formula that was never WIC approved would become available at a certain store. But we still had to support parents saying, ‘If you could get to that store, and pay out of pocket, you can get that one can.’ ”

Help is on the way

Congress passed the Access to Baby Formula Act in mid-May, which was signed into law the same week by President Biden.

The House Committee on Education and Labor issued a statement about the benefits of the legislation saying, “The Access to Baby Formula Act will grant the U.S. Department of Agriculture the authority to waive certain requirements to that vulnerable families can continue purchasing safe infant formula with their WIC benefits during extenuating circumstances, such as public health emergency or supply chain disruption. The bill will also ensure that WIC participants are better protected during a product recall.”

Prior to the legislation, the USDA was able to issue waivers to State WIC Agencies to allow product substitutions and exchange recalled Abbott formula for a comparable brand. Allowing WIC parents more flexibility to get the formula they needed and that was available to them.

In addition to the legislation, the FDA loosened up import regulations. According to the organization’s statement, it “offered a streamlined import entry review process” and “exercised enforcement discretion on minor labeling issues for both domestic and imported products to help increase volume of product available as quickly as possible.”

Baby formula imports have been the target of criticism for years. Pediatricians have said European baby formula carried risks. Foreign formula companies face high tariffs to import to the United States.

With limited imports, concerns of supply chain issues and the Abbott plant closing its doors in mid-February collided. It created a perfect storm for parents in the United States. Prior to closing, Abbott Nutrition controlled about 40% of the formula market in the country.

Hitendra Chaturvedi, Arizona State University business professor and expert on supply chain management considers Abbott’s control on the market an oligopoly.

“Oligopoly, in my opinion, is a glorified way of saying monopoly,” Chaturvedi said. “The issue here is we didn’t have a mitigation plan, compounded by very strict control of imports. There is no plan. We are putting lipstick on a pig.”

Abbot CEO Robert Ford offered an apology to American parents and explained what the company will do in moving forward in an op-ed with the Washington Post.

“… The past few months have distressed us as they have you, and so I want to say: We’re sorry to every family we’ve let down since our voluntary recall exacerbated our nation’s baby formula shortage,” Ford said in the article.

He added that the company has established a $5 million fund to help families with medical and living expenses associated with this issue. He then explained that the company has prioritized producing specialty formulas. Abbott’s other plants have also been used to produce infant formula.

It was originally reported that two children died and two were ill after consuming the formula from Abbott’s Sturgis, Michigan plant where the FDA found the bacteria Cronobacter sakazakii. Since then, the FDA has reported that it is investigating reports of as many as nine children that have died since early 2021.

Where are we now?

The Abbot plant opened in early June only to close again after rainstorms flooded the facility. Prior to the second closure, Abbott representatives reported that 8.7 million pounds of infant formula was produced during June. The second re-opening of the plant occurred July 1. It’s unclear how long it will take for the shortage to be remedied and store shelves to be re-stocked. Young, however, said she is seeing some improvement.

“Nobody should have to suffer — having a baby is really hard under the best-case scenario,” she said. Then added that the baby formula shortage, “is much better. It was scary for a while.”

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