With baby formula increasingly hard to find on store shelves, concerns are growing for Black and Hispanic parents and low-income families who have less access to the products — and in some cases, greater need — than their white counterparts.
In Connecticut, 88% of white parents start off breastfeeding their newborns, according to data from the Centers for Disease Control and Prevention. For Black parents, that number is 84%, and for Hispanic parents, it’s 85%.
The disparities between Black and white parents are wider at the national level. Nationally, 85% of white parents start off breastfeeding, while only 73% of Black parents do.
“The disproportionate way in which we have access to things that help us to be healthy, such as nutritional food, health care, dental care, all of those things — it becomes part of that anxiety,” said the Rev. Robyn Anderson, a pastor at Blackwell AME Zion Church in Hartford and co-founder of the Ministerial Health Fellowship, a health care advocacy network based in the state’s Black churches. “We’re in this place where we are already marginalized, not always getting access to things that white mothers or others can get access to, and this formula shortage is another way of creating more anxiety.”
Black parents had the lowest rates of breastfeeding initiation and continuation at six months and 12 months compared with all other racial and ethnic groups in the United States, a 2015 study found. Black mothers were 2.5 times less likely to breastfeed than white women and were more likely than most minority groups to provide formula supplementation by two days of life.
Although Hispanic mothers have some of the highest rates of breastfeeding initiation at the national level, they are slightly more likely than other racial and ethnic groups to provide formula supplementation as early as two days of life, the study found. Compared to white women, Black and Hispanic mothers are more likely to introduce solid foods before four months of age and have lower rates of exclusive breastfeeding.
Low-income families have also been disproportionately affected by the shortage. Parents who rely on the federal Women, Infants and Children (WIC) nutrition assistance program face limits on brands and types of formula and the retailers where they can purchase those products.
And low-income parents who do happen upon formula are less likely to be able to purchase a little extra.
“If you are in a situation where you have limited resources available to you, even searching for formula and looking around or getting formula online [is difficult]. You’re definitely leaving folks further behind,” said Tiffany Donelson, president and CEO of the Connecticut Health Foundation. “That’s why it’s important for us as community organizations as well as for the state … to get innovative about ways that we can ensure women have access. That’s the most important piece, just ensuring that we have access.”
Dr. Molly Markowitz, a pediatric hospitalist with the Yale School of Medicine and pediatrician at Fair Haven Community Health Care in New Haven, said many of her patients are having a hard time finding formula.
“I predominantly see Black and Hispanic families at Fair Haven. And I’m just seeing that, on a daily basis, families are really struggling,” she said.
Socioeconomic factors sometimes play a role in the ability to breastfeed. If a mother has to return to work quickly, she may be less likely to breastfeed, Markowitz said.
“A lot of our families don’t necessarily have jobs that allow for parental leave, and so they have to go right back. Maybe they took unpaid time off or used the little vacation time they had. Maybe they need the money and so they’re not able to take the time off,” she said.
“Of course, there are situations where breastfeeding supports are possible at work, but a lot of our families work in settings where that might not feel possible. … Breastfeeding takes work and time. And it’s not easy for everyone, especially if you have underlying medical conditions or other factors. We definitely see a big drop off over time.”
At a recent state forum on the formula shortage, Markowitz told legislators that the problem is a racial justice issue.
“This current shortage is not affecting everyone equally,” she said. “Black infants are much more likely to utilize formula and live in households with economic hardship, which, given the limited supply, is so challenging.”
“Some of the families who are looking for formula are able to purchase it online, but with the WIC Supplemental Nutrition Program, you can’t utilize your benefits to buy formula in that way, which is a barrier,” Markowitz said. “Economically vulnerable families can’t necessarily afford the time and gas that’s needed to drive around to multiple locations trying to find formula. I’m hearing stories about this over and over again. Families that utilize WIC are sharing that they’re confused over which types of formula are covered by their benefits.
“It’s vital that families have access to a safe supply of formula as lapses in needed nutrition can lead to lifelong developmental consequences.”
The formula shortage is a consequence of pandemic-related supply chain challenges and a nationwide baby formula recall by Abbott Nutrition. Abbott closed its plant in Sturgis, Mich., in February amid the recall and after multiple infants fell ill with bacterial infections following their consumption of powdered baby formula. Abbott issued a statement saying there was no “conclusive evidence” connecting its formulas to the infant illnesses.
Last week, U.S. Sens. Chris Murphy and Richard Blumenthal of Connecticut, Sen. Jeanne Shaheen of New Hampshire, Sen. Bernie Sanders of Vermont and others sent a letter to Abbott Laboratories CEO Robert Ford urging him to provide relief to state WIC programs and the people they serve.
“Mothers in our states have been left to scrounge to find formula for their infants, traveling longer and longer distances only to find empty shelves. According to the most recent data, more than 40% of stores in our states are currently out of stock of infant formula,” the senators wrote. “This situation is especially untenable for low-income mothers, who do not have the time or resources to enable them to access this depleted supply. Given that WIC is expressly intended to support low-income families and that this supply crisis is a direct result of contamination at an Abbott facility, Abbott must ensure states have sufficiently flexible WIC contract obligations during this time.
“In total, nearly 40,000 infants in our states’ WIC programs are either partially or fully formula-fed, and our states are restricted to Abbott-only formulas due to these contract obligations.”
The senators asked Abbott to extend rebates across all infant formulas at least through the end of the year. “Similarly,” they wrote, “once safety concerns over Abbott infant formulas have been remedied, Abbott should work with states to ensure WIC recipients and families trust in Abbott products before removing rebates for competitive products.”
Abbott has said it plans to reopen its plant by the first week of June but that it could take another six to eight weeks to get more product back on store shelves.
A bill that would ease the burden on low-income parents by allowing the WIC program, a major purchaser of formula, to source it from more foreign suppliers recently passed the U.S. House overwhelmingly and cleared the Senate with a voice vote, the Washington Post reported. President Joe Biden has signed it into law.
Another measure, which would provide $28 million in aid to the Food and Drug Administration to address the formula shortage, passed the House but faces a murky path forward in the Senate, the Post reported.
As state and federal leaders work to get more product back on the shelves, Anderson encouraged them to consider better access for all parents.
“We have neighborhoods that don’t even have access to full-service grocery stores,” she said. “A lot of people of color, they rely on the bodegas that are in their areas. And so if the grocery store doesn’t have [formula], you know the bodegas are not going to have it either. Will we think about supplying bodegas also, think about those areas and making sure formula is available?”