Profit companies

We were never good at feeding babies

Keeping a baby fed is a precarious task at the best of times, and for many American parents, circumstances have gotten pretty bad. Nutritional formulas are currently very rare in the United States, and in some markets more than half of all products are out of stock. For babies with health issues, as well as older children and adults whose lives also depend on access to specialized nutritional formulas, the situation is near disaster. Because it can take weeks for increased production to appear on store shelves – and because most factories were already operating near capacity – the shortage is likely to get worse before it gets better.

In an acute sense, this chaos was caused by the February closure of a major Abbott Nutrition manufacturing facility in Michigan and an associated product recall, following the deaths of at least two infants, who, according to the FDA, were linked to a contaminated Similac formula. The loss of manufacturing capacity at this particular plant would have caused supply issues no matter when it happened, but it came at a very delicate time: nutritional formula is one of many consumer products that have been periodically in short supply throughout the pandemic, leaving the market ill-equipped to deal with the sudden and prolonged closure of one of the country’s largest formula factories and, in the case of some specialty formulas, the one of the only factories in the country. (A representative for Abbott did not respond to a list of specific requests for the plant closure, but provided a statement saying the FDA had not provided conclusive evidence that its products were contaminated.)

The chronic problem, however, began long before the pandemic. Parents affected by recent shocks to the country’s infant formula supply were already in a difficult position, thanks to a threadbare social safety net and a history of trade consolidation. Infant formula is a lifeline for millions of families, but the industry that creates it has been showing signs of decay for decades.

In the past, if you came across a story about infant formula, it was probably because people were stealing it in bulk. Law enforcement and retail organizations often overestimate the risks posed to the general public by “shoplifting rings” and organized theft, but there is a thriving black market for baby formula. ‘opportunity. Buying through these channels is genuinely dangerous – falsified expiration dates and improper storage can turn the product into a health hazard. That parents nonetheless resort to feeding their babies formula from Craigslist or the Facebook Marketplace suggests long-standing and considerable desperation.

In a perfect world, parents wouldn’t need formula at all, as they could follow the common advice to breastfeed exclusively for six months and in tandem with other appropriate foods for at least a year. But breastfeeding cannot – and never has – fully met every baby’s nutritional needs. Some newborns latch on poorly or suffer from allergies. some mothers find breastfeeding physically or psychologically difficult; some babies are adopted. But one of the biggest hurdles new American parents face when trying to follow breastfeeding advice is man-made: In 2021, less than a quarter of working Americans had access to family leave. paid through their employer, and relatively few employers offer other types of leave. support for nursing mothers. “The shock of having to return to work six weeks after delivering a new baby is terribly disruptive to access to breastfeeding,” Steven Abrams, professor of pediatrics at Dell Medical School at the University of Texas. The results of these policies show up predictably in infant nutrition statistics: babies in wealthier families are more likely to be exclusively breastfed, and they are on average longer.

For families who have to go to work and feed their children, the main safety net is provided by the private sector food and pharmaceutical conglomerates. The Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, provides about half of all U.S. newborns with nutritional assistance through a federal program, but is administered by states, who sign individual agreements with manufacturers for exclusive rights to supply formula to state benefit recipients. This program has proven to be very effective in providing infant formula to low-income families, but it also exacerbates problems within the infant formula market.

Because of WIC’s scale, its exclusive statewide contracts encourage consolidation, according to Brian Dittmeier, senior director of public policy at the National WIC Association, an organization that advocates on behalf of WIC recipients and program workers. Manufacturers struggle to compete in markets where they don’t have a WIC contract, even for products that aren’t covered by program rebates. A recent analysis of retailer sales data from 2006 to 2015 found that when a manufacturer won a new WIC contract, their sales of eligible formulas increased by more than 300% in that state. And the researchers discovered what they called a “ripple” effect: Sales of the manufacturer’s non-discounted products also jumped significantly.

Over time, these exclusive contracts were won by a decreasing number of larger and larger manufacturers. In 2015, Abbott, the company whose plant closure triggered the current shortages, held WIC contracts in 23 states. Now the number is at least 31. “There are only a few manufacturing plants in the country, and there are four infant formula companies that control about 90% of the supply in the United States” , Dittmeier told me. “It’s a very concentrated market with very concentrated production capacity, so when a plant is out of commission for just a few weeks, you see those ripple effects across the industry.”

Formula makers, like all other for-profit companies, tend to do what’s best for their bottom lines. Entering into as many exclusive statewide contracts as possible helps to increase competition. Running fewer larger manufacturing plants is more cost effective than having more smaller plants across the country, although this redundancy would reduce the risk of catastrophic shortages. The extreme consolidation of the nation’s infant nutrition industry affects everyone, not just WIC recipients. “You have to ask yourself if there are implications for both the availability and the price of [the] product, if such a customer base is limited to a specific brand,” Dittmeier said. According to a 2004 study by the Department of Agriculture, when a manufacturer wins an exclusive WIC contract, it raises the prices of all of its products in that state.

The current plight of American parents could have been mitigated or avoided in different ways. A host of federal policy changes could reduce demand for infant formula or improve market fragility: Guaranteed paid parental leave – which every other wealthy country offers – would allow more mothers to exclusively breastfeed, if they choose . Universal antenatal care would better prepare low-income mothers to address common issues that prevent breastfeeding. Regulators could crack down on formula distributors, who have long used tactics that a United Nations report recently described as “pervasive, deceptive and aggressive” – and who use these tactics to sue low-income black mothers in particular. . The federal government could take a more active role in ensuring that reserves of vital goods are always available, or require manufacturers who win government contracts to guarantee certain types of redundancy in their supply chains. And reforming WIC contracts to allow multiple manufacturers to supply formulas at a discount in one state would encourage a healthier and more stable nutritional formula industry.

But even among people who have dedicated their professional lives to solving the country’s child nutrition and family security issues, what has happened in recent weeks has come as a shock. “I think everyone was surprised, especially by the sudden collapse of the whole system,” Steven Abrams told me. “No one predicted this.”