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  • Dr. Bow Tie

Fed. Is. Best.

You have probably heard by now that there is a formula shortage in the United States. Abbott Nutrition, one of the biggest formula manufacturers in this country, had to shut down a major production facility. This came after multiple babies were sick after drinking formula made there, due to inadequate compliance with quality and safety regulations resulting in possible bacterial contamination. They had to perform a massive recall resulting in a nationwide shortage.


Parents all over the country are scrambling to find formula for their little ones. Social media is full of posts from parents asking others to look out for their preferred formula. Meanwhile, private sellers are stockpiling formula and ratcheting up prices (as if I didn't already have grounds to be furious at the world).


To put this into perspective, we are having a formula shortage at the same time as conservative politicians and SCOTUS justices are preparing to force pregnancy and birth on American parents. They are trying to strip people's choices while there are insufficient resources to deal with the consequences.


By the way, do not fall for the myth that "they're taking formula away from American babies in order to send a stockpile south of the border." The border patrol is required to keep some formula there to feed the babies trapped there, but caring for refugees and immigrants is NOT what brought about this shortage. We'll talk more about that later.


First, on a frustrating note, some folks are using this opportunity to shame parents for using formula. They use phrases like "Well, breastfeeding is free!"


DON'T DO THIS.


In the past there was a push with slogans like "Breast is best" and stuff like that. The evidence that we have found since then? Fed is best. Breast milk or formula (that meets regulations) doesn't matter as long as the baby gets the nutrition they need.


Breastfeeding has been posed as "natural" - a word which, like in other arenas of life lately, has been co-opted by people who like to spread misinformation about modern medicine and healthcare. People like to snarkily talk about how before modern formula, breastfeeding was all babies needed. Dr. Carla Cevasco, a historian who studies infant breastfeeding, wrote an excellent Twitter thread highlighting why that is a flawed statement. She discusses the historically high rates of death in childbirth, lack of childcare, difficulties with breastfeeding such as cleft palate and other issues on the baby side, and of course, being sent back to the fields by their enslaver right after finishing delivery (during a certain period). If breastmilk wasn't available, they tried alternate versions of "milk" in various forms, many of which weren't safe. With all of these factors, a lot of babies died. This seems like ancient history, but it really is not. We have better control of some of these issues now, but access to care is still an issue for so many people.


Furthermore: Breastfeeding is most certainly NOT free. Not everyone is able to breastfeed. Some have trouble with it physically, others lack the time due to work or other schedules, some lack the equipment for storage and space. Here's a great infographic from Momful, which is a company that promotes breastfeeding, but this is a realistic look at it.

Alt text: Storage bags & parts $250, Professional support (Lactation consults, doctors' offices) $200, Breast pump $150+ (even if partially covered by insurance), Bottles & accessories $40, Nipple & Breast care $40, all per year, and all probably underestimates.


This was eye-opening for me. I knew there were costs (monetary and otherwise) involved, but there is so much more to it. Still, I am a cishet man who never plans to breastfeed, and my wife and I are not parents yet. But friends of mine felt comfortable enough to share their own breastfeeding stories with me, and gave me permission to share them with you.


These are just two of what I know are SO MANY stories. We all know someone with such an experience. If you follow me on social media, you saw me share the public story of Emily Calandrelli (@thespacegal) MIT aerospace engineer, author, and host/co-executive producer of Emily's Wonder Lab, who went to LAX to travel without her baby and brought her breast pump and ice packs to keep the milk cold. Despite TSA rules specifically allowing it (on their website), three male TSA agents would not allow her to take her ice packs in her carry-on, meaning she could not pump and store during her flight or until she was able to get her checked luggage. So even though we want everyone to breastfeed instead of using formula, and we don't have formula to use, we make it harder to breastfeed.


How did we get here? Well, like most American systems, our formula supply was on a knife's edge. Most of the country's formula comes from four companies. Abbott (which controls half the market, and whose products were recalled), Nestlé USA, Perrigo, and Mead Johnson Nutrition. In addition, the USA makes it incredibly difficult to import baby formula due to technicalities and certain regulations (these have been in place for years). With all of this in place, if one company's product falls, it leaves a large void. So we're caught between formula being essential for parenting in the United States (and the world) and, like so many institutions in the US, its production and distribution being mired in unfettered capitalistic greed.

(Before I lose you...I understand that capitalism has had a place in forming our society, but unregulated capitalism lands us in situations like this. People will talk about socialism and its breadlines, but we don't employ that system here and yet we struggle.)


And of course, when a bill (HR 7791) was proposed to ensure formula access to low-income parents and children, 9 representatives voted no. On HR 7790, the Infant Formula Supplemental Appropriations Act 2022, 192 Congresspeople voted against $28 million to alleviate the formula shortage. Those 192 people all belong to the same party that, earlier in the day, held a press conference blaming President Biden for the formula shortage.

Speaking of which, President Biden has just invoked the Defense of Production Act in order to import formula from other countries, thankfully.


SO WHAT DO WE DO IN THE MEANTIME?

  • Despite what you may hear, do not make your own formula. Formula is made to adhere to strict nutrition standards (the nutrition standards are good, the import standards are rough) to provide enough for babies, and without meeting those standards, it can result in nutritional deficiencies which can cause major illness. Just because it worked for your parents in the 1970s doesn't make it safe.

  • Do not dilute formula or breastmilk, which can result in similar nutritional deficiencies.

  • Do not hoard formula. Get what you need for your family, but remember that others are just as in need, so we need to ration for now.

  • Do not give children raw milk or raw milk products - pasteurized products only!

  • Do not give cow's milk if your baby is <6 months! It doesn't have enough iron or vitamin E, and too much protein and certain minerals for their digestive systems. If over 6 months, the AAP states you can give cow's milk for a short time if needed, but iron supplementation may be required. Before you do that...

  • DO TALK TO YOUR PEDIATRICIAN/FAMILY PHYSICIAN! Please talk with them. They may have samples or resources to get you out of a jam. They can also speak to your baby's specific needs.

  • Do check convenience stores and pharmacies as well as grocery stores, or the Human Milk Banking Association of America for local resources.

  • Do consider donating if you are not in need - HMBANA or Baby2Baby are two examples, or your local mutual aid organization.

A LITTLE COVID TALK

Finally, because I just can't help myself, I should address a question that was posed in the comments of one of my previous posts (from February, whoops). A friend asked about protection an infant gets from breast milk if the mother is vaccinated. The answer is yes! There are antibodies passed on in breast milk (and, conversely, there are NO parts of the vaccine detectable in breast milk). Again, this is not a reason to shame those utilizing formula - whether breastfeeding or not, you must take other precautions to protect your baby from COVID, including having others mask near them and ensuring vaccination status and rapid-testing prior to seeing the baby. Below I'll link to several articles including one from University of Rochester which summarizes the findings.


As usual, I welcome your questions.

The Guardian Article on the Formula Shortage: https://www.theguardian.com/us-news/2022/may/18/baby-formula-shortage-why-is-there-none-what-to-do-causes-explained

Dr. Cevasco's Twitter Thread: https://twitter.com/Cevasco_Carla/status/1524534926430904320?s=20&t=tH1MHiZ6BS9zy-AewgOdDA

Dr. Cevasco's Article: https://www.theatlantic.com/ideas/archive/2022/05/baby-formula-breastfeeding-history/629889/

Emily Calandrelli's Thread About her LAX Experience:

https://twitter.com/TheSpaceGal/status/1523985735673597955?s=20&t=tH1MHiZ6BS9zy-AewgOdDA

https://www.instagram.com/p/CdWne-wLvqL/?utm_source=ig_web_copy_link

Unbiased Science Podcast's Post on Homemade Formula: https://www.instagram.com/p/CdgPtTdr8Dv/?utm_source=ig_web_copy_link

Human Milk Banking Association of North America: https://www.hmbana.org/

Baby2Baby: https://baby2baby.org/

Antibodies in Breast Milk:

https://www.urmc.rochester.edu/news/story/new-study-finds-evidence-of-covid-antibodies-in-breast-milk-of-vaccinated-mothers

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2786219

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2789947

https://journals.lww.com/greenjournal/fulltext/2022/02000/neutralizing_antibodies_and_cytokines_in_breast.6.aspx

https://www.sciencedaily.com/releases/2022/01/220110103326.htm

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