The formula crisis puts Black infants at risk for severe undernutrition

In the U.S., the data is very clear — white moms, more affluent moms and moms with higher education breastfeed more. One of the saddest things about the baby formula shortage news is that it is leading to a serious risk of undernutrition among Black, Hispanic and low-income infants.  

Black infants are already at an increased risk of mortality and morbidity when compared to their babies from other races/ethnicities and the baby formula shortage may further that health gap. There are stories being shared about the desperate measures families are taking to make their supply of formula last or locate stores with formula in stock. Only time will tell how significantly the 6-month-old baby seen for a well-child visit will be impacted by the forced decision her parents have had to make to give mostly table food and limit the number of bottles of formula given to one or two per day. Her increased risk for developing obesity has already become apparent. 

In the news, we are hearing a lot about the baby formula monopolies and discussions about how granting exclusive contracts to specific formula companies may have led to the current shortage. There is fear of price gouging, which will undoubtedly disproportionately affect the populations most in need of formula. What has not been discussed in detail is how the current situation is a case of structural racism at multiple levels.   

First, we know that Black, Hispanic and low-income moms depend on formula more than their white counterparts. In part, this is because our societal structure translates into more Black, Hispanic and low-income moms having to work hourly jobs. For example, an office cleaner doesn’t typically have easy access to rooms for pumping or refrigerators for storing pumped milk. They often travel further to go to work and the time away from their infants can translate into a lower breast milk supply for their infant.  

We also see in our studies that Black moms in the lowest income groups struggle to meet basic needs. High amounts of stress can lead to lower milk production, higher risk for postpartum depression and poorer health outcomes for mom and baby. And when you are in a situation where basic rights to food, shelter and health care are not attainable, unfortunately, the last thing on your mind is often breastfeeding.  

Many new moms will tell you that breastfeeding is hard work. For a lucky few it is “natural” and intuitive, but for many, it is not. You need the support of partners, the medical system, lactation consultants and others. Remember that in many countries where the majority of moms have historically breastfed, they had the support of their mothers, sisters, aunts, cousins and neighbors. This is far from the reality of many moms in the U.S., particularly those with the lowest income.  

The U.S. medical system certainly does not support minority women and we are finally acknowledging this reality in the U.S. For example, there is significantly higher maternal and infant mortality among Black individuals. To say that moms should breastfeed and present that as an easy and “natural” solution to the current problem is dismissive of the complex realities that our culture has created.   

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest purchaser of formula in the U.S., and, like any federally administered program, it cannot be quickly pivoted to pay for a formula that is not authorized. Thus, bringing in formula on military jets does nothing for this population who needs help accessing formula most.  

The current situation presents an opportunity for the U.S. to do something different. Prioritize getting safe formula to the women and families who need it the most, at no charge — this means prioritizing families enrolled in WIC for free formula from European companies. Don’t make this another example of the haves versus the have-nots.  

Amira Roess, Ph.D. is an epidemiologist and professor of global health and epidemiology at George Mason University. She has previously worked at the Centers for Disease Control and Prevention as an epidemic intelligence service officer. One of her most recent studies in the AJPH looked at differences in breastfeeding between Black and white moms enrolled in WIC. She also worked on a national study on this topic.

Editor’s note: This story was updated on May 29 at 7:32 a.m.