Why Breastfeeding Isn’t the Answer to the Formula Shortage

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Before having her third child last month, Joelyz Lugo had planned to breastfeed, but her daughter’s difficult birth derailed such plans. While in the neonatal intensive care unit, her baby needed to be fed formula, and when the pair finally tried breastfeeding, the baby struggled to latch.

One month later, with a baby formula shortage making it all but impossible for Ms. Lugo to give up breastfeeding, she has settled into a grueling routine. Every three hours, she hooks herself up to a breast pump to try and boost production, but her milk supply remains low. Ms. Lugo gets less than an ounce of breast milk per pumping session — a fraction of what her daughter needs.

Between breastfeeding and pumping and searching stores around her home in New Britain, Conn., in search of formula, she spends hours every day simply trying to ensure her baby has enough to eat.

“I have been crying about it because I’m trying my best, and nothing is working,” said Ms. Lugo, 31, who in two weeks is committed to returning to her job as an assistant kindergarten teacher after six weeks of parental leave. “When am I going to pump then?”

The worsening nationwide formula shortage has exacerbated an already fraught health care issue in the United States. According to the American Academy of Pediatrics, babies should be breastfed until they are 1 or older, and the Centers for Disease Control and Prevention states that breast milk is the best source of nutrition in those early months. But the medical and economic realities of new parenthood in America can make that one-year finish line an impossible goal for many mothers. By six months, the majority of new mothers give their babies some formula, for reasons ranging from problems with latching and milk supply to the demands of work outside the home.

Now the formula shortage is forcing many new mothers to push themselves harder to breastfeed, even looking for ways to start again after having stopped — a difficult, if not impossible, pursuit since breasts stop producing milk soon after a baby stops feeding from them.

“I have been crying about it because I’m trying my best, and nothing is working,” Joelyz Lugo said.Credit…Yehyun Kim for The New York TimesMs. Lugo gets less than an ounce of breast milk per pumping session — a fraction of what her daughter needs.Credit…Yehyun Kim for The New York Times

And along with the physical demands are emotional ones. Mothers who already may have been beating themselves up for no longer breastfeeding — an activity deeply bound together with the maternal ideal — now have the added burden of fearing that their child won’t get enough nutrition. They are also afraid of being judged.

“I’ve felt a lot of guilt, and I’ve felt a lot of anxiety that he’s not going to get what he needs,” said Sarah Roy, 33, a stay-at-home parent who cannot breastfeed her 5-month-old son because she takes a daily chemotherapy treatment for leukemia that would be dangerous for her baby. “I have blamed myself. You just think, ‘If I could, if I could, if I could,’ but it’s just kind of out of your hands. A lot of people don’t understand that.”

Read More on the Baby Formula Shortage

Understand the Shortage: With just a handful of companies making infant formula for the U.S. market, the shutdown of an Abbott Laboratories plant had an outsize effect.Missing Safeguards: The shortage has revealed regulation gaps that make it hard to monitor the deadly bacterium that led to a recall.A Desperate Search: As the United States faces a baby formula shortage, some parents are rationing supplies, or driving for hours in search of them.A Misleading Narrative: Amid the crisis, Republicans have suggested that the Biden administration is sending baby formula to immigrants at the expense of American families.An Emotional Toll: The shortage is forcing many new mothers to push themselves harder to breastfeed, with some even looking for ways to start again after having stopped.

Ms. Lugo said she has tired of reading comments online that tell mothers just to breastfeed. “It’s easy to say, ‘Breastfeed,’ but it’s not easy to go through with it,” she said.

In recent years, public health campaigns to educate parents about the importance of breastfeeding have been successful: Eighty-four percent of babies start out being breastfed, up from 58 percent in the mid-1990s. Hundreds of “baby-friendly” hospitals nationwide employ strategies aimed at promoting breastfeeding, by encouraging mothers and babies to have uninterrupted skin-to-skin contact right after delivery and not allowing formula, except in cases of medical need.

In many ways, society has also become more accommodating of breastfeeding with lactation rooms in some offices, airports and other public settings.

But many parents cannot or do not breastfeed. Though some adoptive or foster parents do induce lactation — a process that requires the use of hormone-mimicking drugs — many do not. Mothers also face significant physical challenges, from cracked and bleeding nipples to clogged ducts and low milk supply. Mastitis, when breast tissue becomes infected, affects anywhere between 2 and 20 percent of breastfeeding moms.

There are also mental health challenges. Research shows that women who have painful early breastfeeding experiences are more likely than others to suffer postpartum depression.

“I can’t tell you how many women walk through our doors and say, ‘It started with breastfeeding,’” said Paige Bellenbaum, founding director of The Motherhood Center, of the mothers who come to her New York City-based perinatal mood disorder treatment facility.

As if that isn’t enough, there is now a nationwide formula shortage, driven by supply chain problems and exacerbated by the closure of a major production plant in February and the recall of select infant formulas sold under the Similac, Alimentum and EleCare brands. Currently, more than 40 percent of baby formulas are out of stock, and President Biden has called on the Federal Trade Commission to investigate reports of price gouging.

Ms. Roy’s son has gastroesophageal reflux disease that requires him to be on a specialized amino-acid based formula, and it has frequently been out of stock at stores near her home in Southington, Conn. Without it, her baby cries, vomits and twists his body in pain.

Ms. Roy has been heartened by the way families have come together during the formula shortage, starting local Facebook groups to share cans of formula and time-stamped photos of what they see on store shelves. But she finds it “scary” that a day might come when she would be unable to find any formula for her son — and unable to offer her son breast milk.

Navigating the Baby Formula Shortage in the U.S.

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A growing problem. A nationwide shortage of baby formula — triggered in part by supply-chain issues and worsened by a recall by the baby food manufacturer Abbott Nutrition — has left parents confused and concerned. Here are some ways to manage this uncertainty:

Checking your supplies. Abbott Nutrition has recalled several lots of its Similac, Alimentum and EleCare formulas after at least four babies became sick with bacterial infections. To find out whether a formula in your home may be affected by the recall, check the lot number on the Abbott website. If you learn that you fed your child a recalled product, contact your pediatrician.

Finding formula. If your baby’s formula was not affected by the recall, but is still not available, you can try calling local stores to ask when they expect to get it back in stock. You may also be able to buy it online. If your baby is on special formula, reach out to your doctor’s office: They might have samples in stock.

Picking a new formula. If you typically use a name-brand formula, look for its generic version. Alternatively, seek a new formula that matches the ingredients listed in your usual one. If your baby is on a special formula for health reasons, check with your pediatrician before switching.

Transitioning to a new product. Ideally, you will want to switch your child gradually. Start by mixing three quarters of your usual formula with one quarter of the new one and gradually phase out the old product. If you can’t transition gradually because you’ve run out of your usual formula, that’s OK, although you might notice more gassiness or fussiness during the transition.

What not to do. If you can’t find your baby’s usual formula, don’t make your own — homemade formulas are often nutritionally inadequate and at risk of contamination. Don’t try to “stretch” your formula by adding extra water, and don’t buy it from unvetted online marketplaces like Craigslist. For a baby less than 1 year old, don’t use toddler formula.

As the shortage worsens, other mothers who cannot breastfeed say they feel as though they just need to try harder. Jane Varghese Williams, 27, has felt guilt over not breastfeeding her son, who has a feeding disability, since he was born last November.

During the baby formula shortage, Caitlin Joyce, 22, has been searching online moms’ groups for tips on restarting milk production.Credit…Kayana Szymczak for The New York Times“They always say, ‘Breast is best,’ but you know, sometimes the breast isn’t performing as it should be,” Ms. Joyce said.Credit…Kayana Szymczak for The New York Times

“It definitely makes me feel like an inadequate mom, especially because before I had my son, I thought I would breastfeed for at least the first year,” said Ms. Williams, who is a stay-at-home parent in Atlanta. “I was in denial that he couldn’t breastfeed, and he ended up losing 10 ounces from his birth weight. That was the wake-up call we needed to get him on formula.”

But finding her son’s preferred formula has been difficult, and having to switch between various brands makes him fussy and uncomfortable, the combination of which has renewed pressure on her to find a way to breastfeed.

“I have considered trying to relactate,” said Ms. Williams, referring to the difficult process of trying to restart breastfeeding after it has been stopped for weeks or months.

Caitlin Joyce, 22, is also researching relactation after spending hours every week searching for formula. Last week, she and her mother drove for two hours up and down the South Shore of Massachusetts, scouring every Target, Walmart or supermarket they saw along the way — “and they didn’t have anything,” Ms. Joyce said. Though she has not breastfed her baby in six months, she has been searching online moms’ groups for tips on how to restart milk production.

Dr. Casey Rosen-Carole, director of the breastfeeding and lactation medicine program at the University of Rochester Medical Center, said the physiology of breastfeeding “is not especially resilient, in that once it’s over it’s very hard to build it back.” The prospect that women may be attempting to relactate in response to the formula crisis concerns her, she said, because mothers could compound stress by pushing their bodies to do something that is difficult, if not impossible.

Dr. Alison Stuebe, an OB-GYN and distinguished scholar in infant and young child feeding with the University of North Carolina’s Gillings School of Global Public Health, said the idea that every woman can produce all of the breast milk her baby needs “is not predicated on reality. Every person can’t make all the insulin they need. That’s why there’s a disease called type 1 diabetes — and we don’t say, ‘Well, if you just tried harder, you wouldn’t need that medicine.’”

Staring down the prospect of being without formula, some mothers are mulling alternate ways to feed their babies. When her daughter was born, Zumely Ebanks, 23, had to be separated from her because of medical issues and could not breastfeed. Her baby got used to formula, she said, and at 3 months old has not breastfed at all. Ms. Ebanks, who lives with her mother and baby in Houston, called the shortage “alarming.” “If there isn’t any formula, I would not know what to do,” she said.

So far, she has been able to find her preferred formula at her local H-E-B grocery store, but if that changes she plans to turn to “previous traditions,” like rice water and atole, a corn-based drink. Health experts have warned parents against resorting to homemade baby formula, but women are worried they may have no other options.

As the formula shortage continues, breastfeeding experts remain concerned not only for the babies but for the mental health of mothers.

“When it’s about your kid and when it’s about, you know, your newborn — your baby — and being able to feed them and put food in their mouths, it’s hard,” Ms. Roy said. “You feel like you’re a bad mom.”

Maria Jimenez Moya and Colleen Cronin contributed reporting.

Audio produced by Kate Winslett.