Parents scramble to find formula. Factories are working around the clock to do more. And military cargo planes are forms of air transport from abroad.
Often overlooked, however, in the race to fill the void left by the closure of a major formula plant due to suspicion of contamination is the most natural alternative: breast milk.
“If we did more to support breastfeeding, we wouldn’t be in this mess,” says Dr. Melissa Bartick, an assistant professor at Harvard Medical School.
The American Academy of Pediatrics recommends that most babies be fed exclusively breast milk for the first six months. But in 2018, only about one in four babies born in the United States have achieved this goal.
There are various reasons why families turn to complementary formulas or stop breastfeeding altogether. But Bartick says aggressive marketing from formula makers is partly to blame.
“The formula manufacturers would just give tons and tons of free formula to the hospital to try and sell their brand and ask the hospitals to send mothers home with gift bags full of formula, so s “They had a problem at home, they just got a ready-made bottle in the baby, and that made the mom addicted to formula,” says Bartick.
Some hospitals are now restricting gifts of infant formula in an effort to encourage breastfeeding. But the $55 billion formula industry is finding creative workarounds, both in the United States and abroad.
“Frankly, they have way, way more money than we do,” says Bartick, who has held leadership positions with the American Public Health Association and the US Breastfeeding Committee. “And we can’t fight that.”
Bartick began researching and promoting the health benefits of breastfeeding after giving birth and ran into obstacles in the hospital while trying to breastfeed her child more than two decades ago.
“I thought it would be some kind of maternity leave project, but here I am, 23 years later, still working on it,” she says with a sad laugh.
Half of the formula sold in the United States is paid for by the federal government to support low-income families through the Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children. Babies who receive this subsidized formula through the WIC program are less likely to breastfeed than those who do not.
In addition, the US government has fought for decades against restrictions on the marketing of formulas abroad. When the World Health Organization adopted a non-binding code of conduct to limit formula promotion in 1981, the United States voted against it.
This year’s shortage, however, has thrown a new spotlight on the formula industry. The The Federal Trade Commission has launched an investigation how a handful of companies came to dominate the market. And Agriculture Secretary Tom Vilsack, who oversees the WIC program, has recognized the need for a stronger supply chain.
“The challenge for those of us in government is to find ways to learn from this experience,” Vilsack told reporters last week as he greeted an Air Force C-17 carrying 78,000 rushed formula books from Switzerland.
“We are not as resilient as we should be,” he added.
Breastfeeding advocates say the best way to build resilience is obvious.
“Breast is the shortest supply chain,” says Kadee Russ, an economist at the University of California, Davis.
Russ is quick to admit that not every parent can breastfeed or wants to breastfeed. But while 84% of new mothers start breastfeeding, six out of ten quit sooner than they would like. Russ points to a variety of factors, including insufficient training by healthcare providers, too few pumping options at work, and too little paid family leave.
“It’s kind of demoralizing when you have a baby and you talk to your friends in these other countries and they’re going to have a year off to breastfeed their kids and you don’t,” Russ says. “It’s not easy to breastfeed. Mothers need support. It’s not an easy process. It’s hard work.”
Dr. Bartick argues that increasing breastfeeding rates would bring substantial savings in health caresince breastfed babies suffer less from ear infections, diarrhea, obesity and other ailments.
But Russ notes that making an economic case for breastfeeding requires a more inclusive kind of accounting.
“If you buy formula, that goes into GDP as a transaction,” she says. “Breastfeeding is not [included]. And in fact, what may show up in national economic statistics is that you may be working less.”
Russ says it’s myopic to count the economic cost of expanding paid leave, for example, without considering the offsetting benefits of increased access to breastfeeding.
“I think it’s important to understand that breastmilk is part of food systems,” Russ says. “It’s a supply chain in itself.”
Increasing breastfeeding rates will not solve the immediate shortage of formula. But the memory of empty store shelves may cause some families to revisit Formula’s original competition.
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