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Existing health disparities are creating a bigger disadvantage for Black and low-income families and babies during the U.S. baby formula shortage.
The U.S. baby formula shortage negatively affects all babies who rely on formula; however, the shortage increases existing disparities that Black and low-income families and babies face. A recall from Abbott, a maker of one-third of U.S. baby formula, has halted production and caused a shortage in the U.S.
Epidemiologist and professor at George Mason University Dr. Amira Roess studies the differences in breastfeeding between Black and non-Black mothers and conducted a national study of infant and toddler eating patterns. Her recent research highlights the disparities for Black mothers enrolled in DC’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Roess shares insights on how the formula shortage is disproportionally affecting Black and low-income babies and is available for further comment.
Does one population rely on baby formula more than another?
The baby formula shortage is leading to a serious risk of undernutrition among Black and low-income infants. U.S. data shows that Black infants are breastfed less than other racial groups and that families on WIC are less likely to breastfeed as well. This means these populations are more likely to rely solely on baby formula. Additionally, Black infants already are at an increased risk of mortality and morbidity and this is in part due to access to quality health care. The baby formula shortage may further this health gap.
Why can’t more people breastfeed their babies?
Breastfeeding does not come naturally to every new mom, and it is a lot of work. It often requires the support of partners, the medical system, and possibly lactation consultants. Not everyone has access to all these resources or the time needed to pump breast milk. Mothers with low income are especially burdened by this lack of resources. Black mothers in the lowest income groups often struggle with basic needs. This can lead to high stress which can cause lower milk production, higher risk for postpartum depression, and poorer health outcomes for mom and baby.
How does structural racism play a part in this?
In the U.S., breastfeeding was historically viewed as something that poorer moms did. For example, slave owners often had black wet nurses. In the 1940s and on, there was a push to promote formula and other alternatives to breast milk and pediatricians and other health care providers pushing for formula use often received payments from formula companies. This meant that over time breastfeeding was looked down upon. In addition, as more women went to work outside of the home anything related to child-rearing was generally frowned upon as something that would hinder career advancement. It was not until the 1970s that we saw a significant push by moms and breastfeeding advocates to promote breastfeeding again. Slowly with time breastfeeding became something that more privileged moms would do. Unfortunately, the damage from the previous decades was done and we are still dealing with the repercussions of that.
For these and a variety of other socio-economic and societal reasons, Black and low-income mothers rely more on formula today. More Black mothers have hourly jobs where there is no access to places or time for pumping or refrigeration for storing milk. They often work further away from their home, which translates to less time with their infant and sometimes a lower supply of breastmilk.
Will any families and babies be affected more than others by the shortage?
Families who rely on formula and cannot afford the increased price will be more at risk for adverse outcomes. We have seen an increase in hospitalization and a few deaths due to families rationing formula. Families on WIC are vulnerable because they were not able to access the imported formula using their WIC vouchers until recently. There has been an effort to allow WIC vouchers to be used for any formula, however, in reality, there is still a lot of confusion at the point of retail with both moms and retailers. Some retailers are unable to accept the WIC vouchers for the formula brands not under the initial contracts. At least two infants have died and many more are at risk for undernutrition. It is unconscionable that in the U.S. in 2022 this has happened and that we are facing a situation where low-income Black babies remain at higher risk for malnutrition.
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Dr. Amira Roess is a professor in the Department of Global and Community Health at George Mason University's College of Health and Human Services. Her expertise includes infectious diseases epidemiology, evaluating interventions to reduce the transmission and impact of infectious diseases, and infant health. Dr. Roess holds a PhD in global disease epidemiology and control from Johns Hopkins University. Prior to joining academia, Dr. Roess served as the Science Director for the Pew Commission on Industrial Food Animal Production at Johns Hopkins, and was an Epidemic Intelligence Service (EIS) officer at the CDC.
Additional studies from Dr. Roess:
- Social Support for Breastfeeding in the Era of mHealth: A Content Analysis
- Food Consumption Patterns of Infants and Toddlers
- Limitations of Workplace Lactation Support: The Case for DC WIC Recipients
- Determinants of Breastfeeding Initiation and Duration Among African American DC WIC Recipients: Perspectives of Recent Mothers
- Disparities in Breastfeeding Initiation Among African American and Black Immigrant WIC Recipients in the District of Columbia, 2007–2019
Additional peer-reviewed and CDC sources on breastfeeding disparities:
- CDC: Racial and Geographic Differences in Breastfeeding — United States, 2011–2015
- Seminars in Perinatology: Racial and ethnic disparities in U.S. breastfeeding and implications for maternal and child health outcome
- Journal of Obstetric, Gynecologic & Neonatal Nursing: Barriers and Facilitators for Breastfeeding Among Working Women in the United States
- Pediatrics: Racial and Ethnic Differences in Breastfeeding
- Breastfeeding Medicine: Comfort with the Idea of Formula Feeding Helps Explain Ethnic Disparity in Breastfeeding Intentions Among Expectant First-Time Mothers
- Pediatrics: Addressing Racial Inequities in Breastfeeding in the Southern United States
For more information, contact Michelle Thompson at 703-993-3485 or mthomp7@gmu.edu.
About Mason
George Mason University, Virginia’s largest public research university, enrolls 39,000 students from 130 countries and all 50 states. Located near Washington, D.C., Mason has grown rapidly over the last half-century and is recognized for its innovation and entrepreneurship, remarkable diversity, and commitment to accessibility. In 2022, Mason celebrates 50 years as an independent institution. Learn more at http://www.gmu.edu.
About the College of Health and Human Services
The College of Health and Human Services prepares students to become leaders and to shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. The College enrolls more than 1,900 undergraduate and 1,300 graduate students in its nationally-recognized offerings, including 6 undergraduate degrees, 13 graduate degrees, and 6 certificate programs. The college is transitioning to a college of public health in the near future. For more information, visit https://chhs.gmu.edu/.
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