The 2022 infant formula shortage in the United States: An exploration of infant feeding policy changes, policymakers' attention, and the lived experiences of caregivers

Abstract

ABSTRACT Most infants (0 to 12 months) in the United States (US) are fed a combination of breastmilk and infant formula. In February 2022, contaminated formula at an Abbott Nutrition plant in Michigan catalyzed a shortage, which created hardships for families and exposed infant formula and breastfeeding policy gaps. The purpose of this research was to explore federal-level US infant feeding policy changes to assess policymakers' attention to these issues and the impact of the shortage on policy change; compare how infant feeding policies align with the expert policy recommendations provided by the Global Breastfeeding Collective (GBC); and explore the lived experiences of caregivers affected by the shortage. Three studies were conducted: 1) a scan and test of associations between infant feeding policy changes prior to and following the shortage, using Fisher's exact tests with post hoc comparisons; 2) a comparison of the policy changes made against GBC recommendations; and 3) a mixed methods study of caregiver behaviors, lived experiences, and impact of the shortage via a cross sectional survey (n=243) using descriptive statistics, Pearson's Chi-Squared tests with adjusted cell residuals, and semi-structured interviews (n=14) followed by qualitative content analysis. A statistically significant relationship was found between the shortage and policy changes on infant formula supply. Of the policy changes made, only 30% aligned with at least one of the of the GBC policy priority topics. Caregivers who changed their infant feeding practices due to the shortage were significantly more likely to rate themselves as being very affected. They reported detrimental effects on infant well-being, mixed experiences with social support, and tolls on their mental health. The pattern of policy changes suggests that policymakers attended to infant formula supply only. The lack of alignment between infant feeding policy changes and GBC recommendations suggests missed policy opportunities to support caregivers and meet