US imports formula to help end supply shortage – what parents need to know

Efforts by industry and the federal government to alleviate the shortage of infant formula in the United States are intensifying, with the importation of foreign brands supplementing the increase in domestic production.

This follows a crisis in which mothers, fathers and caregivers across the United States have had to scramble to find scarce supplies or travel long distances to buy formula.

But are the efforts enough to overcome the supply problem – and prevent it from happening again in the future? The Conversation asked Dr. Steven Abrams, a leading pediatric health expert at the University of Texas who has advised both the formula industry and the government on infant nutrition, what parents should know about imported infant formula.

Remind me, what caused the shortage?

First, we had a supply chain issue that affected all kinds of merchandise since the pandemic began. Then, in February 2022, a major infant formula manufacturing plant in the United States closed.

The U.S. Food and Drug Association has closed Abbott Nutrition’s Michigan plant after Abbott’s nationwide recall of several brands of formula due to concerns about bacterial infections.

The Michigan plant is the largest producer in the country, so when it went down, it put additional strain on the entire US formula distribution system.

Are there still shortages?

The situation is beginning to improve in some parts of the country. People are reporting fewer incidents of going to stores and not finding any formula on the shelves. But it’s spotty – urban areas seem to do better than rural areas with one store serving one area.

I see the supply problem easing further in the coming weeks. This is due to three factors: first, domestic production of infant formula has improved. Second, imported formulas — part of the Biden administration’s Operation Fly Formula mission — have helped complement domestic brands. Finally, there seems to be anecdotal evidence of a decrease in hoarding by panicked parents over time. All of this will contribute to alleviating the shortage.

A shipment of infant formula delivered as part of Operation Fly Formula.
Nathan Posner/Anadolu Agency via Getty Images

The good news is that more help is on the way. The factory that closed had already been given permission to release its stock of specialist formula for babies with severe allergies. And starting June 4, it also restarted production of specialty formulas after receiving the green light from the FDA. However, it is expected to take 6-8 weeks for more common formulas to be produced from this factory and hit store shelves.

On top of that, more shipments from the UK and Australia will add to the specialty formula shipments from Europe that we have already seen from Nestlé. Additional shipments from Nestlé’s Mexico of routine formula are also expected in the coming weeks. We are expecting two deliveries in the next few days. It will take a few days to hit stores, but parents should start seeing them on the shelves soon.

What should American parents know about imported formula?

Formulas from Europe, Australia and Mexico are labeled differently: as “stage 1” formula for newborns up to 12 months and “stage 2” for babies over six month.

And their mixing instructions are different. For starters, the EU and Australia formula uses milliliters rather than ounces. Some, but not all, will have significantly different powder to water ratios. Parents should pay attention to this. Anyone preparing an imported formula will need to take careful note of the mixing instructions – too much powder and you will concentrate the formula too much, risking too much salt. Too much dilution will mean too little salt and nutrients.

In addition, two of the imported brands will include goat milk protein formulas – Australian company Bubs and UK company Kendamil. It’s not uncommon in the rest of the world, but in the United States, all infant formula of animal origin is made from cow’s milk.

That’s not a bad thing. Some scientific evidence suggests that goat’s milk is more digestible for babies than cow’s milk.

The other thing to note is that we are still waiting for the FDA to know which of the imported formulas will be approved for distribution through the federal food program called WIC. WIC provides formula to the majority of babies in low-income families.

How has the shortage affected low-income families?

The majority of all parents will feed their babies formula at some point to meet their nutritional needs, especially older infants. At birth and in the days immediately following, about 80% of babies receive all their nutrition through breast milk. But by the age of six months, the majority of babies receive at least formula milk. The proportion of one-year-old babies receiving formula milk is even higher. This is largely the result of social dynamics and pressures – mothers returning to work after giving birth, but not receiving sufficient support to produce and store sufficient quantities of breast milk.

But the shortage has affected some parents more than others. And unsurprisingly, the parents most affected are those with the lowest incomes.

During the shortage, some families traveled long distances to find stores selling infant formula. Obviously, this is more difficult to do for the poorest families, because it entails costs. Similarly, more affluent parents were able to purchase more expensive, so-called elite-brand formulas.

The other thing to note is that the shortage has affected both regular infant formula and specialty versions. Regular or standard formula is the type most families are familiar with, and about 95% of formula-fed babies are given the standard type.

The specialized formula is for babies with unusual needs, due to allergies, damaged intestines or special nutritional needs.

Why is it so important to have enough infant formula?

For the first six months, babies should only have breast milk or formula – anything given to them will be nutritionally incomplete. So there is a risk that a shortage will mean babies are not getting the nutrition they need to thrive. This could lead to a series of health issues affecting their physical growth and brain development.

Then there are fears that parents will use dangerous alternatives, such as diluting their baby’s formula. People have been known to try to make their own milk by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives nutritionally incomplete, they may not be entirely sterile. Indeed, we have seen cases of babies being hospitalized after being fed homemade formula.

After six months, things improve a little once the infant is able to start eating solid foods. But even then, formula or breast milk is still the main source of nutrition. There may therefore always be a risk of nutritional deficiencies, such as iron deficiencies.

Are there viable alternatives?

Beyond six months of age, for reasonably short periods of time, parents can feed infants whole cow’s milk and seek iron supplements.

This is not ideal and only applies to older babies. For children under six months, cow’s milk is a real problem. It doesn’t have the right mix of protein for babies and contains virtually no iron, which puts very young babies at risk of anemia. Cow’s milk also has a mineral imbalance, especially for younger babies.

What can be done to prevent this situation from happening again in the United States?

First, we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making homemade brew formulas – the worst would be if those who switched to homemade formulas continue to do so once stocks are stocked.

Next, we need to see how to ensure that a single faulty plant does not affect the whole system. The feds can’t store infant formula the way they could store oil, because infant formula has a shelf life. But diversifying infant formula production is a possibility. This would involve ensuring that multiple factories and companies manufacture the formulas this country needs. Competition could potentially drive prices down. One of the positive aspects of the shortage is that it introduces new entrants to the US market. Meanwhile, it is now recognized that the United States needs to diversify its infant formula production.

I believe America needs to look at the nation’s breastfeeding support system as well. Don’t get me wrong: some parents will always need formula. But those who want to breastfeed must do everything to support them. This includes better family leave policies and help for low-income mothers who want to pump and store milk while they work.

Editor’s note: This is an updated version of an article originally published on May 12, 2022.

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