Marie Abate’s son turned six months old last Wednesday, but the joyous milestone also marked a more anxious one: half a year of worrying about how to feed him.
Abate wasn’t just concerned about trying to establish breastfeeding or setting a feeding schedule. She has a more fundamental concern: will she be able to find enough formula to make sure he doesn’t go hungry?
“It’s very stressful,” said Abate, who lives in Towson, Maryland. “I just worry that we won’t have enough for him and he’s going to need to eat.”
The baby formula shortage in the US is not as dire now as when it began in 2022, when stock reached deep lows and triggered a political crisis for Joe Biden. But many families in America still struggle to find formula, facing empty shelves and unremitting stress. Stockouts of certain brands and limitations in stores persist, especially in rural areas with fewer options.
“I’ve been facing empty shelves, for sure,” Abate said. “It’s very rare that I can go into a store and purchase formula.” That was especially true when she was supplementing her breast milk for the first five months. Her son was born prematurely, and he needed a special formula for preterm infants. There are only two types of that formula available, and she never once saw them on the shelf.
Instead, Abate spent hours poring over medical supply websites. She asked friends and family to look in the formula aisle anytime they went to a store. She called pharmacies to see if they could special-order it, and her pediatrician set aside any samples that came into the office. Abate even bought unopened cans from manufacturers on eBay.
A month ago, struggling to find the special type, she switched to regular formula, which has been somewhat easier to find. Even so, stores limit how much she can buy at a time. One retailer recently changed their policy to allow two boxes per family instead of four – and that’s when it’s in stock. Abate still spends hours hopping from one store website to another.
“This was a big deal a year ago, and now no one seems to care or talk about it. And it’s still, for me, an issue every day,” Abate said.
In 2022, a whistleblower complaint led to an FDA investigation, the discovery of harmful bacteria potentially contaminating the formula, a recall, and the shutdown of Abbott Laboratories’ factory in Sturgis, Michigan, for several months.
The events sent shockwaves through the industry. At the time, Abbott’s formula accounted for 40% of the nation’s supply, and the Sturgis plant was the largest formula factory in the nation. Other manufacturers scrambled to meet demand amid nationwide shortages.
Now, more than a year later, Abbott faces increased scrutiny from regulators, and formula shortages persist, due in part to reverberating aftershocks from demand in 2022.
The maker of Enfamil, Reckitt Benckiser, said recently that shortages would persist this spring because of last year’s disruption.
Meanwhile, temporary measures meant to ease the crisis, like waivers for families receiving food assistance and lifted tariffs on international imports, have now expired, creating greater challenges for families – especially those with limited incomes.
Abbott, which makes commercial formula brands like Similac, is already under criminal investigation by the US Department of Justice, which began investigating the 2022 factory closure in November.
Now Abbott is facing investigation by the Securities and Exchange Commission and the Federal Trade Commission (FTC) – the second investigation by the FTC over the closure.
The new investigation comes after child nutrition experts called in the Lancet for closer scrutiny of “exploitative” marketing practices and aggressive lobbying from commercial formula makers.
“There’s a new opportunity to investigate some of these egregious practices” and to “hold companies accountable”, said one of the Lancet authors, Cecília Tomori, an associate professor at the Johns Hopkins University School of Nursing and the Bloomberg School of Public Health. “I think it’s extremely overdue.”
There were nearly 400 lawsuits pending against Abbott as of January, according to the company’s recent SEC filing. Some of the lawsuits allege that premature babies developed a life-threatening stomach condition, necrotizing enterocolitis, because their families were unable to find the specialized formula they needed.
As many as nine babies may have died from contaminated formula between early 2021 and 2022.
In January, the FDA announced it would overhaul its regulatory system for overseeing food, including a new unit on food safety, following the formula crisis.
There were concerns about Cronobacter sakazakii bacteria contamination and safety regulations at the Sturgis plant for years, and other companies have also worked to evade regulations, Tomori said. “We’re highlighting one that was an egregious actor, but I think it’s a big mistake to think that it is only happening with that company, because they actually all practice the same thing and they work together on undermining regulations.”
Companies have also made misleading claims, she said, about formula being similar to breast milk or boosting a child’s IQ.
“What we saw was just the tip of the iceberg,” Tomori said of the companies’ practices. “The inadequate amount of product on the shelves right now, I think, is really symptomatic of a much bigger problem.”
In July 2022, President Joe Biden signed legislation temporarily waiving tariffs on imported formula in order to ease the crisis. But that order expired at the end of December without being renewed, making imports more expensive again.
Temporary waivers, offered during the peak of the crisis to low-income families receiving food assistance, expired at the end of February. That means the families will have significantly fewer options for which formula they are able to buy.
As the short-term fixes have ended, lawmakers still haven’t grappled with longer-term issues, like regulatory shortcomings and the dominance of only a few companies in the market. Three companies – Abbott, Reckitt and Gerber – control nearly all of the US formula market.
“We want to end exploitative marketing. We want to have better support for breastfeeding. We want to scale up and expand access to human milk and donor milk. All of those things can still happen at the same time as we also improve regulations for safety of commercial milk formula,” said Tomori
Breastfeeding is a very important way to nourish children, experts say, but it’s impeded by significant challenges. Widespread inequities, including a lack of paid leave and resources and rampant bias within the medical system, often undermine breastfeeding in the US. More support is needed at all stages, Tomori said.
Parents who use formula have grown weary of those who ask why they don’t simply breastfeed during the shortages. “It’s not that simple,” Abate said. “I would have loved to have just been able to breastfeed him from the beginning.” She tried desperately to increase her milk supply from the time her son was born early, but it simply wasn’t possible.
Abate already felt like she had failed in her goals to breastfeed exclusively. “And then to be like, ‘I can’t even buy him formula,’ is very stressful and just makes me feel terrible sometimes,” she said. She grapples with guilt over something that is entirely outside of her control. “I wish the public would be a little more compassionate to mothers on this issue.”
Parents have also lost faith in formula makers.
“I don’t have trust that I can go to a store and get formula, and I hate that, and that causes me a lot of anxiety every day, honestly, until he’s off formula,” Abate said.
