The national shortage of baby formula in the U.S. that began in February of 2022 cast an urgent spotlight on the difficulties parents can face in meeting basic nutritional needs of their babies. Strains on formula supply chains induced by the COVID pandemic were greatly exacerbated by a voluntary formula recall by Abbott Nutrition and the months-long closure of a major formula production facility in Sturgis, Michigan. The crisis not only raised questions about the regulation and market structure of the formula industry but also prompted calls for broader reliance on breastmilk and to increase supports available to breastfeeding parents, especially given the gap between recommendations and practice. For example, less than a quarter of U.S. infants meet the American Academy of Pediatrics’ recommendation of exclusive breastfeeding for the first 6 months of life. However, the narrow focus on the supply of infant formula, or on specific AAP recommendations, does not shed light on the full scope of economic tradeoffs families face when deciding how to best ensure nutritional health of their infant.

Infants who do not consume the necessary micronutrients early in life may face risks to healthy development. While the nutritional value of breastmilk is high and mothers seem to have internalized the “breast is best” mantra, this recommendation is wildly in conflict with policy support available for mothers (and, families more broadly), and also not aligned with industry drivers for the production and marketing of infant formula. Many working families do not have paid parental leave, protections for lactating parents to express milk at work is limited, and availability of lactation consultants and cost coverage for breastfeeding supports (e.g., pumps) is far from universal. Even though over 90 percent of births occur in hospitals, birthing hospitals offer mixed support for breastfeeding. Infant feeding choices are particularly constrained for low-income mothers who work in jobs where they are unable to pump, which may explain some of the stark inequities in breastfeeding rates by race and socioeconomic status. A majority of U.S. babies rely to some extent on formula to meet their nutritional needs and, as the recent crisis highlighted, further action is necessary to ensure the safety of the product and the resiliency of the market to future supply shocks.

by Stephen A. O' Connell

by Marianne Bitler and Ann Stevens

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