The nationwide shortage of baby formula is probably hitting rural families hardest. Here's what they need to know.

Families nationwide are scrambling to find baby formula amid a widespread shortage. Rural families are likely having an even harder time since there are fewer local places to buy formula, and because families who use federal assistance can only buy certain formulas. It's even more difficult to find certain medically necessary specialty formulas. Here's what you—and your readers—need to know:

What happened: In February the Food and Drug Administration ordered Abbott Nutrition, the nation's leading formula maker, to shut down its plant in Sturgis, Michigan, after four infants were hospitalized with bacterial infections from contaminated formula and two of them died. The FDA issued a voluntary recall on three products (Similac, Alimentum, and EleCare) and warned customers not to use certain specialty formulas produced at the facility, but the warning didn't get much public attention, so parents didn't know to stock up. Formula was already low in stock since at least December because of inflation, supply-chain shortages and product recalls. 

How bad is it? Formula stockpiles in stores are 43 percent lower than normal, compared to 30-40% short in April, says retail data tracker Datasembly. Only about a quarter of children are exclusively breast-fed up to the age of six months, so most parents and caregivers depend at least partially on formula. 

Why not buy another brand? Almost all formula in the U.S. is manufactured domestically because of strict FDA standards, and 90% of the nation's supply comes from four companies. Abbott makes over 40% and Perrigo Nutritionals, Mead Johnson, Gerber (owned by Nestlé) combined account for another 50%. Perrigo makes store-brand formulas for stores such as Walmart, Kroger and Walgreens but that formula can't be purchased by people using federal assistance through the Women, Infants and Children nutrition program, which pays for about half of all formula. In addition, many babies require specialty formulas and can become very sick if they switch.

Why not breastfeed? Many babies who require specialty formulas can also get sick from drinking breast milk. Adoptive families and many others also have difficulty accessing or affording a reliable supply of breast milk, and some survivors of sexual violence may find it traumatizing. Some mothers find it difficult to maintain a steady supply of milk, and others can't breastfeed at all because they must take medications that would taint the milk. Though state and federal laws protect women's right to breastfeed in public—including at work—many women are embarrassed, intimidated, or even discouraged from the practice, and many women are not knowledgeable about the health benefits of breast milk.

Is homemade baby formula a safe alternative? No. Homemade formulas can be too high in sodium, too low in calcium, contaminated, and/or lack critical nutrients. Babies can suffer long-term damage after using homemade formula alternatives or straight cow's milk for even a few days, according to the National Committee on Nutrition for the American Academy of Pediatrics. It's also dangerous to dilute baby formula with too much water. If there is absolutely no other alternative, formula made for toddlers can be ok for a few days for infants who are close to a year of age. 

How long could the shortage last? At least 10 weeks. On Monday the FDA agreed to allow Abbott to reopen its Sturgis plant within two weeks, as long as it passes a safety inspection. After that it will take six to eight weeks for formula to hit store shelves. However, inspectors say there are still problems at the plant. In the meantime, Abbott says it's shipping in formula from its FDA-registered plant in Ireland on a daily basis. The FDA has been allowing more formula imports meant for the U.S. since February, and is now allowing some formula meant for foreign markets to enter the U.S., but only after a safety evaluation.

Could this have been prevented? Growing evidence indicates the FDA failed to act quickly about warnings of safety violations at the Sturgis plant. A whistleblower at the plant warned the FDA in October about safety problems, weeks after the children were hospitalized with bacterial infections, but the agency didn't interview the whistleblower until December and didn't inspect the plant until Jan. 31. That dovetails with a recent Politico investigation that revealed deep-seated issues with the FDA's plant inspections. Current and former employees described the agency as slow to make decisions and lacking enough staff or budget for years to deal with the modern food system even as its regulatory responsibilities have grown.

What the government is doing now: The FDA is expediting and streamlining some of its approval processes to speed up production. The Biden administration and lawmakers from both parties are also urging the Federal Trade Commission and state attorneys general to keep an eye out for price-gouging and increase formula imports to increase the domestic supply. The House Appropriations Committee will hold a hearing this week before introducing an emergency supplemental funding bill to help address the shortage. Late Monday, Abbott and the FDA announced an agreement to reopen the plant, but the company said it would be well over a month before new product ships from the site.

 

What the administration is not doing: Some right-wing politicians and pundits have blamed the Biden administration for the shortage, but no single politician or administration is causing the problem. Biden has also been accused of stockpiling baby formula for undocumented immigrants being detained at the border while American families go without. In fact, the Biden administration is following the law in shipping a limited supply of formula to infants at the border, as the Trump administration did. 

In the meantime, if you need formula, here are some do's and don'ts:

• Check with your church or local nonprofits to see if they have any.
• Shop online from reliable sources. 
• Don't make your own.
• Don't hoard formula.
• Network with other families on social media.