Brian Lehrer: Brian Lehrer on WNYC. Parents across the country are grappling with a nationwide baby formula shortage that's hitting some states much harder than others. An analysis by Datasembly, a startup that provides retailers with real-time product data, has found that in the last two weeks alone the percentage of out of stock baby formula in the US went from around 30% up to 40%, and 40% is really high being out of stock of something, with some states hitting higher than 50%.

This story began, at least in part, back in February when Abbott Nutrition, the leading manufacturer of baby formula, recalled lots of Similac, Alimentum, and EleCare powder formula after at least four babies were hospitalized with bacterial infection and at least two babies died. Joining me to discuss what's behind the nationwide shortage of baby formula and how parents can seek help is Helena Bottemiller Evich, senior food and agriculture reporter at Politico. Helena, thanks so much for coming on. Welcome to WNYC.

Helena Bottemiller Evich: Thanks for having me.

Brian Lehrer: Listeners, we're going to open up the phones right away on this. Is anyone listening right now experiencing the shortage personally? If so, how do you compensate for it and what advice would you give other parents who might be struggling? 212-433-WNYC, 212-433-9692. Help us report the story of the baby formula shortage with your stories and advice, if you have advice, 212-433-WNYC, 212-433-9692. What's the scope of the shortage? You recently tweeted, "The severity of the shortage appears to differ greatly based on where you live and which retailer you shop at." Where's it concentrated?

Helena Bottemiller Evich: It's such a good question. I think everyone is experiencing this supply chain stream differently. For example, I live on Capitol Hill in Washington, DC, and my Safeway is about 60% to 70% stocked. For sure, if you're looking for a particular type or brand of formula, if your baby has a dairy sensitivity or some allergies, you're having a really tough time finding exactly what you need, but there is no formula on my neighborhood grocery store shelves.

As you mentioned, these are not normal stocking rates. Pre-COVID, you would expect 95% of the skews in an infant formula section to be stocked. That would be considered normal. We've really had a strange supply chain with infant formula for many months on and off throughout COVID, but really since last summer, stocking rates started to go down. They were quite bad over the holidays. Then you mentioned this really massive recall in February from Abbott Nutrition, which makes Similac, the number one brand of infant formula in the US. That recall really tipped this over the edge.

Now that plant, which is in Sturgis, Michigan, the one tied to the bacterial infections, that plant has been shut down for three months. It was a really sizable chunk of the whole US infant formula supply. FDA and Abbott say they're essentially negotiating how to reopen that plant, but it has really strained an already difficult supply situation.

Brian Lehrer: You recently tweeted that, in light of the formula shortage, "One thing I'd bet we will hear more about, the infant formula industry is extremely consolidated, but it's often left out of the anti-trust conversation." How consolidated is it and do we know why?

Helena Bottemiller Evich: Yes, there are four companies, Abbott, Mead Johnson, Nestle, and Perrigo that really control about 90% of the market. That's pretty consolidated. I think the top two, Abbott and Mead Johnson controls something like two-thirds. It's really quite concentrated. There are a lot of reasons for this, I think one is probably that infant formula is one of the most highly regulated food products that we have in the US. I think people understand why, it's a vulnerable population.

There's also some other things at play here, the WIC program, which gives free formula to low-income families. About half of all babies in the US qualify for WIC. They do exclusive contracts at the state level. States are often either a Similac state or Mead Johnson state. There are definitely analysts who think that that program has probably helped fuel some of this consolidation. I'm looking for a more up-to-date analysis on this to try to suss some of that out.

As you mentioned, infant formula is often left completely out of these anti-trust conversations. We tend to hear a lot about another food component, which is the meat processing industry. We hear about that a lot. There's a lot of debate about that. We tend to not hear much at all about this industry, which is interesting.

Brian Lehrer: On the advice that parents are seeking, if they're coping with a baby formula shortage that's actually leaving them short, maybe we should start with some unsolicited advice that they may be getting, "Just breastfeed." Can you help unpack why this is not a reality for some parents as an option?

Helena Bottemiller Evich: Yes. I tweeted this yesterday, I'm personally a big supporter of breastfeeding. I was lucky enough to be able to breastfeed my child. This is just not an option for a lot of people and it's also not a preference that a lot of people have. To tell parents that they should breastfeed in a country that doesn't have paid leave or access to lactation support or all the other things you would need to make that happen is, I think, really unfortunate. I think it really puts a lot of shame and responsibility on parents when they truly lack that support.

There are many reasons why a family might not be using human milk, it could be a medication that doesn't jive, it could be maybe the mom had breast cancer and can't breastfeed, maybe their mental health issues, health concerns. Some women just don't make enough milk. I think it's such an important point that even if you are a big, big supporter of breastfeeding and want more women to have support, you can still understand why large swaths of the country are not going to do that.

Formula is how we feed the majority of our infants in this country. I think it's just the reality that we have to face it. This is a lifesaving product. The fact that many families are having difficulty accessing it right now is really urgent and the response cannot be, "Oh, you just need to breastfeed." It's just not a reasonable response.

Families who are short, if you truly are short, you cannot find supply, the number one tip that the Academy of Pediatrics is giving families is to get in touch with your pediatrician or another doctor and start there first. Before you seek making your own formula, watering down formula. The first call should really be to a pediatrician or other healthcare provider who can help you navigate what safe options are. Hopefully, local grocers, parents groups, Buy Nothing social media, there are ways that parents can try to connect with other parents to get what they need right now.

Brian Lehrer: Well, I'm going to take that advice to connect with a pediatrician because we're getting a caller from Tenafly, Dr. Brian Rudolph, who says he's a pediatric gastroenterologist. Dr. Rudolph, thank you for calling in. Hello.

Dr. Brian Rudolph: Hi. Thanks so much for having me. I just wanted to point out a couple of things. First of all, there are a lot of formulas that are designed for children and even adults with certain genetic or metabolic diseases. These are people who need these formulas to survive. They can't eat regular foods or drink regular milk, for example. For these children and many adults as well, this is really all that they have. It's quite dangerous and concerning for them.

I'm hearing stories from colleagues all around the country are having issues with this. Again, I wanted to point out it is older children and adults as well. There are substitutes for some of these formulas, but many of them don't have many equal substitutes, they really are limited in what they can have and these are lifesaving medications for them.

Brian Lehrer: What are you telling your patients who are getting in touch with you about these shortages? I hear you about the people who are on adult and older child liquid diets, I guess, these nutritional formulas for whatever medical reasons. How are you helping them? How can you help them?

Dr. Brian Rudolph: There's a couple of things. In the short-term, we try our best to reach out to vendors and suppliers that may have the formulas that can help find where they are and point parents in the right direction. Obviously if there are appropriate substitutes, we can direct families to those options as well. We do keep some stores, if we can, of different formulas and we can hold people over until they're able to find what they can in some situations, but it's not easy.

On the longer-term, there's federal legislation that's pending called the Medical Nutrition Equity Act that was introduced in Congress that seeks to solve some of these issues. It seeks to force insurance companies to pay for these formulas for children with these genetic and metabolic diseases that aren't able to take regular foods, and hopefully, will have a long term impact. We always encourage people to contact their local congressional members and advocate for these families.

Brian Lehrer: Thank you. Thank you, Dr. Thank you so much for calling in. Laneya, in Brooklyn. You're on WNYC. Hi, Laneya.

Laneya: Hi. Can you hear me all right?

Brian Lehrer: I can you hear just fine.

Laneya: Great. Just wanted to say thank you for talking about this issue. I recently had twins prematurely and it's been very difficult to get the NeoSure, which is a Similac product made from the Abbot facilities formula. You try shopping online at Amazon. A lot of the stores also like target and Stop & Shop that are supposed to carry it will still list it as being available, but then you actually go there and show up and there isn't any there, it's pretty difficult to get. I am breastfeeding in addition to doing the formula, but like whether or not I will have enough supply for two babies as they continue to grow is- [crosstalk]

Brian Lehrer: It must be so anxiety producing.

Laneya: Yes, a bit.

Brian Lehrer: What are you doing? Anything in particular to obtain formula outside of your local Target and Stop & Shop?

Laneya: We did get an initial case from the hospital after I shared with them how I was unable to find it. We were able to get a case when they came home from the NICU, but beyond that, I'm not sure. I know switching formulas can be difficult and there's only some that are really rated for pre-meds. We'll be talking with our pediatrician about that, but beyond that, I might just give up on using the formula and breastfeed, but I know that's not-- I'm lucky that I've never had issues with milk supply and that I have the time and I'm supported at work for breastfeeding when I do eventually go back to work, but that's not a reality for most people and generally trying to work and breastfeed in this country is very difficult.

Brian Lehrer: Laneya, thank you for your story and good luck with your twins. Alex in Greenwich Village, you're on WNYC. Hi, Alex.

Alex: Oh, that's me. Hi. I was wondering if your guests knew of any local networks that were trying to fill in the gap with breast milk, like a Buy Nothing milk banks. I was surprised that the milk banks didn't get coverage in the Times story that was very long and only about the formula. I'm wondering if your guest can talk about that, like substitutions that-- we will need to substitute because the formula just isn't available.

Brian Lehrer: Thank you, Alex. Helena, do you know about this?

Helena Bottemiller Evich: Yes, it's a good question. Milk banks for the most part are used actually in NICU, I believe. They're highly regulated and moms can donate extra milk and it's screened for a lot of different things because there is some research that shows, in the NICU, donor milk can be helpful for improving outcomes. I don't think that that is an option at the scale that we would need to help replace formula. Certainly, there are informal groups of moms that share breast milk, but that is something that makes public health folks pretty nervous because there's just no regulations around it, there's no safety check. That is not really something you see endorsed by by major health groups.

Certainly, communities of moms can choose to do that on their own. There is a lot happening sharing formula on parents groups on Buy Nothing, Facebook groups that are dedicated to neighborhoods, or Nextdoor. On Instagram, there is an account called The Formula Mom, and she has some resources, including like an actual exchange set up for parents all over the country to connect with each other like, "Oh, I have an extra can of this kind, I can send it to you here." There is a lot of that stuff happening to try to support parents to parents, which I think is great. So far, I'm seeing a lot of people give formula away.

One of the interesting things here is these companies are still sending out marketing, like promotional cans to families unsolicited. I'm seeing a lot of those cans get given away to families. [crosstalk]

Brian Lehrer: Wait, we just have about 30 seconds left, but some of the other things that I see doctors and the American Academy of Pediatrics are recommending against. One is watering baby formula down to make it last longer, because it won't have enough nutrition. Also, making homemade baby formula. The CDC recently reported that at least three infants were treated over the past year or so in separate emergency departments in New Jersey, Pennsylvania, and Delaware. I guess the last question, we just have 15 seconds for an answer is, when can the babies go to cows milk or other solid food?

Helena Bottemiller Evich: I think once your kid is over six months, you can lean a lot more heavily on solid foods. You can start introducing solid foods as early as four months if your child so shows signs of readiness, but they really recommend against switching to cows milk until the baby is over six months, really closer to [unintelligible 00:16:58]

Brian Lehrer: There we have to leave it-

Helena Bottemiller Evich: Yes. Talk to you doctor.

Brian Lehrer: -with Helena Bottemiller Evich, senior food and agriculture reporter at Politico on the baby formula shortage. Thank you so much. Very informative.

Helena Bottemiller Evich: Thank you.

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