Why Is There a Shortage of Infant Formula?

If you’re a parent in the United States, you know that a shortage of infant formula has accumulated in the US over the past year. The shortage is expected to continue for the rest of the current year and while it built up gradually from various factors the main trigger was the shutting down of one factory. Located in Michigan, the factory belongs to Abbot Nutrition, which makes several brands of formula, including the well-known Similac. Abbot stopped production, because of concerns about possible contamination. The concern is due to rare cases of bacterial infections in infants, which led to two infant deaths. It’s not certain whether the bacterial contamination came from the factory and no match has been found between strains found at the plant and infants that got sick or died. It’s a precaution for safety, but the resulting shortage has brought attention to the fact that just a few companies manufacture all of the infant formula. With this in mind, it makes sense to discuss the basics infant formula: what is in it and why is it used.

As a parent of a baby or of young children, you may know that the US Centers for Diseases Control and Prevention (CDC) has said that babies should not receive cow milk until they are 12 months old. But you may also know that the American Academy of Pediatrics (AAP) says that most infants (those without allergies, nor other health issues pertaining to food) can start having some cow milk after reaching just 6 months of age. What’s very clear with no wiggle room is that infants below 6 months of age must not have cow milk. For most parents, this makes sense, until they learn that much of the major components in the infant formula power that they mix with water to put in the bottle actually derives from cow milk. Often the protein is casein, from cow milk, often it is whey protein, whey being a product of cheesemaking, which also begins with cow milk. Other formula types use soy for protein and soy is not from cows, nor are the fats in formula, which typically are from vegetable oils. As for the carbohydrates, they come from many different sources, most of them derived from plants, but the most common infant formulas for babies without digestive problems contain lactose (milk sugar) among the carbohydrates. Lactose comes from cow milk, but that doesn’t matter because it’s only the protein component of cow milk that can have particular biological effects that are dangerous. Infant formula companies solve this problem by processing the protein to differing degrees, depending on whether the formula is just the regular kind or is a special kind for infants who cannot tolerate even a little bit of cow milk. In some cases, the protein source, whether casein, whey, or soy is hydrolyzed so that it exists only as the amino acid building blocks, in which case it doesn’t matter how the protein started out.

While the culture in which we live weighs heavily toward a “breast is best” mentality, it’s not best for all mothers, all families, and all situations. To be sure, breast feeding may benefit the mother’s health and breast milk contains immunoglobulins (IgA antibodies) and there are some studies suggesting that breastfed infants are less prone to infections. But these are isolated studies, and when assessing a health issue we must consider the bulk of scientific studies taken together. When studies are controlled to account for possible confounding factors —situations that could be linked both to the condition being studied and to the supposed outcome being measured— it turns out that the scientific literature, taken as a whole, does not show a clear benefit. A strong benefit does not show up, whether in health, education, or some other outcome, that cannot be attributed to some confounding factor. This is not to say that it’s not beneficial to breast feed, but it does mean that the benefits of breast feeding are often hyped to the point of shaming women who feed their babies with formula all the time, either because they cannot produce their own milk, cannot produce enough of their own milk, or because they find nursing or pumping inconvenient.

While many new mothers do nurse early in the life of their infants, by the age of six months, most infants are receiving at least some formula, and thus depend on it. In recent weeks, fascinating stories have come out about women organizing to donate breast milk to milk banks to help those who depend on formula and cannot obtain it, though health authorities have warned about potential dangers of receiving unscreened breast milk.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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