Author: Ellie MacGregor, MPH, CLC

According to the American Academy of Pediatrics (AAP), toddler “formulas” that are promoted as nutritious drinks for the older infant or preschooler are generally unnecessary and nutritionally incomplete, and the marketing practices that promote them are questionable.

The AAP has published a new clinical report, “Older Infant-Young Child ‘Formulas,'” that reviews the growing array of drinks aimed at children ages 6-36 months and observes that they lack standardization or regulatory oversight.

It is not new information that marketing efforts of breastmilk substitutes are consistently predatory and create a lot of confusion for the general public, along with undermining breastfeeding efforts of parents. However, this report, coming from an organization such as the AAP, highlights a corner of the market that is not often in the limelight – that of toddler milks and ‘follow-up’ formula.

The new report from the AAP concludes by recommending the following:

• For infants younger than 12 months, the liquid portion of the diet should be provided by human milk or standard infant formula that has been reviewed by the FDA based on the Infant Formula Act.
• For toddlers (children 12 months and older), caregivers should provide a varied diet with fortified foods to optimize nutritional intake. OIYCFs can safely be used as part of a varied diet for children but do not provide a nutritional advantage in most children over a well-balanced diet that includes human milk (preferred) and/or cow milk, and these products should not be promoted as such. OIYCFs have no specific role in routine care of healthy children and are more expensive than cow milk.
• Marketing of OIYCFs should make the clear and unambiguous distinction from standard infant formula in promotional materials, logos, product names, and packaging. OIYCF product name should not be linked in any way to infant formula (numerical, steps, sequential name) and should be labeled as something other than formula—for example, follow-on or toddler “drink” or “beverage” rather than follow-on or toddler “formula.” Product placement in store shelves of OIYCFs should not be alongside standard infant formulas.
• Education of families about OIYCFs by health care teams as part of well-child visits is encouraged.
• Medical providers and care teams should complete a focused nutritional assessment, with consideration of mineral- and iron-rich solid food consumption and offer adjustment of solid food intake and/or vitamin supplementation as needed.

The full report can be found here: https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-064050/194469/Older-Infant-Young-Child-Formulas?autologincheck=redirected

Geneva, Switzerland; June 20-22, 2023

Last month, INFACT USA joined the many other global representatives of the Infant Baby Food Action Network (IBFAN) and participated in the WHO/UNICEF first ever Code Congress.

More than 400 people came together at the WHO headquarters with a shared goal – to protect every mother and pregnant woman against predatory marketing practices of infant and young child feeding products, including infant formula. Throughout the three day congress, the same message was emphasized again and again: “The best way to support these women is to enact, monitor and enforce the International Code of Marketing of Breast-milk Substitutes.”

The World Health Assembly (WHA) in 1981 adopted the International Code of Marketing of Breast-milk Substitutes. Forty-two years later, formula milk manufacturing companies continue to violate these established principles and place commercial interests before children’s and families’ health. Subsequent WHA resolutions have repeatedly called upon national governments to enact, monitor and enforce the provisions of the Code.

“Over 70% of Member States have enacted legislation that puts in place at least some of the provisions of the Code,” said Dr Francesco Branca, Director of Nutrition and Food Safety at WHO. “But industries are still expanding to push an ever-increasing range of formula milk products on families, using insidious tactics to access their networks and influence their choices. Parents have the right to impartial information on infant feeding, which is actively undermined by exploitative industry marketing.”

WHO and UNICEF notably excluded commercial companies from participation at the Code Congress, much to the annoyance of the International Special Dietary Foods Industries (ISDI), who issued this Statement just one day after the start of the Congress in Geneva.

Here in the United States, there is an incredible amount of work to be done to advance the WHO Code and its subsequent resolutions. To date, the U.S. is one of three countries in the world that did not sign onto the Code back in 1981. While that step may never come for the U.S., there are other options and avenues to implement protections against predatory marketing practices of these commercial baby-food product companies.

The Cost of Not Breastfeeding Tool aims to provide policymakers and advocates with a user-friendly tool to generate estimates of the potential health, human capital and economic benefits of scaling up breastfeeding promotion and support strategies. Evidence generated from the tool will be integral to raising awareness with government, industry and donors for scaling breastfeeding in accordance with the Global Breastfeeding Collective’s seven recommended policy actions.

The Cost of Not Breastfeeding Tool was first developed between 2017 and 2019 by Dr. Dylan Walters and Alive & Thrive, with funding from the Bill & Melinda Gates Foundation. This tool was instrumental in advocacy at the global level, being used for the Global Breastfeeding Collective’s Investment Case, and at the country level directly supporting efforts to advocate for policy changes and increase investments in maternal and child nutrition in numerous countries. In 2022, Nutrition International updated and developed the second version of the tool in partnership with Alive & Thrive and Limestone Analytics, with funding from the Government of Canada. This new version of the tool contains updated datasets, new indicators, a new function to calculate results for different breastfeeding rate scenarios or targets, and online access to the results for more than 100 countries.

You may access the new tool here: https://www.nutritionintl.org/learning-resource/the-cost-of-not-breastfeeding-tool/

Original Source: 4 new WHO reports expose marketing by the $55 billion formula milk industry | Baby Milk Action

On 23rd February, WHO and UNICEF launched a hard-hitting multi-country report –How the marketing of formula milk influences our decisions on infant feeding. The report exposes the extent of marketing tactics that influence infant and young child feeding decisions. It finds that “exposure to formula milk marketing reaches 84 per cent of all women surveyed in the United Kingdom; 92 per cent of women surveyed in Viet Nam and 97 per cent of women surveyed in China, increasing their likelihood of choosing formula feeding.”

The report clearly recommends that governments everywhere adopt, monitor and enforce laws to prevent the promotion of formula milk, in line with the International Code and subsequent WHA Resolutions,  prohibit promotional claims, adopt parental leave and other policies to support breastfeeding.  It also recommends that health workers are banned from accepting sponsorship from companies that market foods for infants and young children for scholarships, awards, grants, meetings, or events.

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The Code does not need reform.  At the launch and in media reports some have suggested that the Code needs to be reformed.  We believe this to be a really bad idea that would be used by companies and industry-friendly governments to argue for more delay.  But there is no need.  The Code covers all forms of promotion – including e-commerce and cross promotion. Provided WHO provides its Member States with opportunities to adopt strengthening Resolutions and provided governments put these into law,  the Code can keep pace with marketing.  The Code is a global document and doesn’t address how governments legislate, prosecute and hold corporations to account. This is best done at national or regional level.

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IBFAN has been monitoring company practices and alongside WHO and UNICEF has been helping governments bring in strong effective legislation on the Code for the last 40 years.  After many failed attempts  to persuade baby food companies to voluntarily stop predatory marketing, it’s clear that there is no point chasing these companies for watered down here-today, gone-tomorrow promises or considering them to be  ‘partners’ in health.   This new report should leave no-one in any doubt: strong legislation is the best and only way forward.  Policy setting processes, including global trading standards (2)(3), must be safeguarded from commercial influence through effective transparency and Conflict of Interest safeguards.  

Repost from source: https://www.americanprogress.org/article/the-national-baby-formula-shortage-and-the-inequitable-u-s-food-system/

It is past time for policymakers to develop a long-term vision that addresses the infant formula crisis and focuses on building a more responsive, resilient food system and safety net for all.

Introduction and summary

Food and nutrition are literally life-giving and life-sustaining, yet parents and caretakers in the United States who rely on infant and specialty formulas for their loved ones’ health and nutritional needs face high prices and severe shortages. As of May 2022, 43 percent of formula products were out of stock nationwide—a massive increase from the average out-of-stock rate of between 2 percent and 8 percent at the start of the year.¹ Some states, including Iowa, the Dakotas, Missouri, and Texas, are grappling with out-of-stock rates of more than 50 percent.² The cost of infant and specialized formula was already untenably high for many, but recent safety concerns, supply chain issues, and challenges related to the COVID-19 pandemic have raised the price of baby formula to alarming highs and driven stock frighteningly low.

Over the past year, the average cost of the most popular baby formula products went up by as much as 18 percent³ at a time when millions are still struggling to recover from the pandemic and resulting economic recession. Making things even worse are the actions of a few—those who purchase formula at retail stores and resell it online at a severe markup, both increasing costs for vulnerable families and driving up scarcity.⁴

But the formula crisis reveals major flaws in the U.S. food production and distribution system, especially in times of emergencies, as well as weaknesses in the country’s social safety net resulting in inequitable access to food and nutrition. This report looks at how the crisis emerged and considers the longer-term opportunities to make U.S. food production, supply, and distribution systems more responsive, resilient, and equitable to ensure that all individuals and families have access to life-saving food and nourishment. The Center for American Progress recommends interventions and reforms that prioritize access and affordability to key food and nutrition; ideas to reduce market concentration, thus increasing supply; workplace policies to support parents and caregivers; increased oversight on consumer health and safety; and the reauthorization of key legislation that gives Americans the opportunity to create a truly inclusive and equitable food system.

The baby formula crisis and the conditions that created it

The formula shortage stemmed from a product recall by an Abbott Nutrition facility in Michigan, where unsanitary conditions and contaminated products led the U.S. Food and Drug Administration (FDA) to temporarily shut down the facility. Abbott re-opened the facility in early June, under strict FDA oversight, but was forced to close the plant again on June 15 due to torrential rain and flooding in the area.⁵ The Abbott closure was the catalyst to a crisis that has been years in the making: Policies and legislation that have permitted market consolidation of formula production by just a few companies, ongoing supply chain issues due to the pandemic, and corporate profiteering made this national shortage possible.⁶

The formula crisis has resulted in huge inequities, leaving millions of the most vulnerable—such as infants and children, women, grandparents who provide care, people of color, people with disabilities and/or chronic illnesses, LGBTQI+ people, and the elderly—without access to affordable and sometimes life-sustaining food and nutrition in their communities.⁷ Furthermore, the crisis sheds light on just how reliant the U.S. food system is on a small number of big corporations that control the majority market share of everyday grocery items and links throughout the food chain—from seeds and fertilizers to agribusinesses and slaughterhouses to grocery stores and supermarkets.⁸

The Biden administration and Congress are taking steps to address the current crisis and ensure that infant and specialty formula are fully stocked on grocery store shelves.⁹ However, once the immediate crisis abates, many of the challenges that created it in the first place will remain—including market consolidation, supply chain issues, and a lack of policies that prioritize the needs of infants, working parents, and people with disabilities or other illnesses. What has been made abundantly clear during the national formula shortage is that there is a dearth of long-term solutions to create a more equitable, sustainable food system so that everyone across the nation has access to safe nutritious foods in their community.

Market concentration has made the formula market vulnerable to large supply shocks

The supply of baby formula in the United States is highly concentrated. Three brand-name domestic producers—Abbott, Mead-Johnson, and Nestlé—supply about 98 percent of all formula domestically.¹⁰ The remainder is supplied by Perrigo—a domestic producer of store brands¹¹ for several retailers such as Walmart, CVS, and Target—and a small amount is imported. The shutdown of the Abbott factory in Michigan, which accounted for approximately 43 percent of total consumption of formula according to the most recently available data,¹² has had devastating consequences.

The baby formula market has some important idiosyncrasies that appear to contribute to market concentration. About half of all infant formula is purchased by state agencies and distributed through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Federal law requires state WIC agencies to purchase formula via sole-source competitive contracts. Awards are based on the net price the agency must pay, which is the wholesale price charged to all buyers minus a rebate to the state agencies. These rebates are a large source of revenue for the WIC program—in the range of $1 billion to $2 billion annually—amounting to about one-quarter of all funding.¹³

A sole-source contract generates large spillover effects for the winning firm that compensate for the rebates paid to WIC. The guaranteed volume of WIC sales causes retailers to give the contract winner prominent shelf space and product placement, and widespread WIC usage may increase physician referrals for contract brands. A new contract winner in a state typically sees its market share rise by 74 percent, and the market share of the other suppliers declines by an equivalent amount.¹⁸ The privileged retail treatment given to contract winners appears to make it difficult for new entrants to generate much in the way of sales. Perrigo, for example, currently supplies store-branded, FDA-approved formula to several national retailers. This shows that profitable production for the sizable non-WIC market is possible. However, Perrigo does not sell its own branded products nationally and thus has a smaller market share than its larger brand name competitors.¹⁹

While producers in other advanced economies are capable of meeting FDA production and labeling standards, they do not have a significant presence in the U.S. infant formula market. Tariffs and quotas, along with the cost of transporting products with limited shelf life, may explain why they do not ship products from their home facilities. Tariffs can be as high as 17.5 percent, and there are quotas limiting imports from the rest of North America.²⁰ However, if tariffs are the obstacle, and there are profits to be made, more multinationals could follow the example of the three primary producers of formula in the United States—Reckitt Benckiser Group (United Kingdom-based owner of Mead-Johnson), Perrigo (based in Ireland), or Nestle (based in Switzerland)—and set up U.S. subsidiaries to avoid tariffs.

The Biden administration has taken several steps to increase supply in the short term. Foreign products that meet FDA standards are being airlifted to the United States, and the administration has invoked the Defense Production Act to give domestic producers priority for needed input components to manufacture more formula.²¹ Congress quickly passed the Access to Baby Formula Act to increase flexibility for WIC participants to purchase other formula products other than the sole-source contractor,²² and the FDA prioritized the safe reopening of the Abbott plant while expediting the evaluation of imports²³ to determine if foreign producers meet FDA safety, nutrition, and other requirements.²⁴

The formula shortage heavily affects the most vulnerable

The infant and specialty formula crisis offers an alarming commentary on this country’s priorities around food and hunger, particularly when it comes to ensuring that parents and caregivers have access to the safe, affordable, and nutritious foods needed for their infants’ healthy growth and development.

Effects of the crisis on low-income and working mothers

The effects of the national shortage are being felt by millions of families across the United States, since most parents feed their children formula at some point early in their lives.²⁵ However, it has taken a particularly significant toll on low-income working mothers.²⁶ All people should be able to choose the feeding method that is best suited for their family—whether that be breastfeeding, formula feeding, or a combination—but lower-income women often do not have the ability to make that choice, and they are more likely to rely on infant formula than breastfeeding or start their children on formula earlier.²⁷ There are a variety of reasons for this, including inadequate paid family and medical leave policies that prevent women from having the time and support to initiate and sustain breastfeeding; a lack of flexibility and privacy for mothers to breastfeed or pump while at work; and difficultly affording lactation consultants or breastfeeding equipment.²⁸ Instead, many low-income mothers—around 1.6 million in FY 2018²⁹—are covered by WIC because, while breastfeeding is difficult to maintain for the reasons listed above, baby formula remains prohibitively expensive. In fact, families can spend up to $1,500 per year on formula alone,³⁰ and prices have only continued to climb over the past year, with the average cost of formula products increasing by as much as 18 percent.³¹ WIC has played an important role over the years in making infant formula affordable and accessible to low-income families, but amid the current formula crisis, that access has become severely hindered.

Effects of the crisis on disabled populations and parents

The formula shortage is equally challenging for infants and individuals with disabilities or other people with certain allergies, gastrointestinal conditions, and metabolic disorders who rely on formula for their nutritional intake and survival.³² There is limited research on the breastfeeding experiences of disabled people, but barriers can include issues with milk supply that limit breastfeeding and difficulties communicating with health care providers and lactation consultants due to accessibility or accommodation needs.³³ Additionally, infants with disabilities or medical conditions may be allergic to breast milk³⁴ or have nutritional needs that require specific formula brands that cannot be substituted.³⁵ Due to the disproportionate number of disabled people living in poverty,³⁶ accessing formula (often in person) is a large economic and accessibility barrier. According to a 2019 report from the National Disability Institute, the poverty rate for disabled adults is more than double that of nondisabled adults, and this is further exacerbated for disabled people of color.³⁷ In addition, people with certain medical conditions may be unable to breastfeed, including people who are being treated with chemotherapy or have other medical issues that lead to parent-child separation.³⁸

Due to the disproportionate number of disabled people living in poverty, accessing formula is a large economic and accessibility barrier.

Effects of the crisis on LGBTQI+, foster, and adoptive parents

The formula shortage also affects grandparents who provide care and LGBTQI+, foster, and adoptive parents who rely on formula for their infants’ healthy growth and development. LGBTQI+ families face unique concerns in the wake of this formula shortage.³⁹ An estimated 292,000 children⁴⁰ live in households with same-sex parents, and same-sex couples are seven times more likely to foster or adopt than opposite-sex couples.⁴¹ Parents who adopt or who have babies through surrogates, including many LGBTQI+ parents, may be more likely to rely on formula for feeding their children, significantly raising the stakes⁴² for these households if formula is not available.

In addition, due to employment discrimination, workforce exclusion, and other determinants of health, LGBTQI+ people collectively report higher rates⁴³ of economic insecurity than non-LGBTQI+ people, heightening financial barriers to accessing formula when there are supply shortages and price fluctuations. Compared with non-LGBTQI+ populations, LGBTQI+ communities also report higher participation rates in public benefit programs, including nutrition assistance programs.⁴⁴ For example, according to 2019 data from the Federal Reserve Board, LGBTQI+ households with children were almost twice as likely to receive assistance through the WIC nutrition program than non-LGBTQI+ households (14.8 percent compared with 8 percent) and through Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as food stamps (14.6 percent compared with 7.8 percent).⁴⁵

Health consequences of the formula crisis

Infant and specialty formula itself is often exceedingly expensive.⁴⁶ The high cost of baby formula, even when not amid a national shortage, forces some parents to modify or substitute formula, but this can lead to malnutrition and other serious health risks. The FDA has specific requirements for nutrient compounds in infant formula vital to children’s early development.⁴⁷ At-home fixes, such as watering down baby formula to stretch it longer, homemade alternatives, and the use of other milk types for infants less than one year old, such as cow’s milk or plant-based milk, do not contain the nutritional composition that babies need.⁴⁸ Additionally, if prepared in unsanitary conditions, these homemade alternatives can also contain foodborne illnesses, which can be fatal for young children.

Malnutrition takes a particularly high toll in infants, leading to slowed physical, cognitive, and neurodevelopment growth, including difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions.⁴⁹ Several children with medical conditions that require specific formulas were recently hospitalized in Tennessee when their families were unable to access needed formulas.⁵⁰

Malnutrition in infants takes a particularly high toll, leading to slowed physical, cognitive, and neurodevelopment growth, including difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions.

These alternatives are even riskier for infants with allergies or metabolic disorders who need specialized formulas to ensure they still get the nutrients they need. The Abbott plant in Michigan held a near monopoly on the production of specialized formulas that thousands of people rely on. The FDA recently announced new permissions for Abbott’s Michigan plant to release some specialty formulas on a “case-by-case basis” while the investigation into the safety concerns reported last year continued.⁵¹ The plant reopened on June 4, 2022, with a requirement to comply with regular external health and safety audits,⁵² but was forced to close again on June 15 due to flooding from torrential rains in the area.⁵³ It remains to be seen how this latest closure will affect the ongoing formula shortage.

WIC also contributes to young children’s healthy growth development. For every dollar spent on WIC services, the United States saves $2.48 in health care costs.⁵⁴ WIC clinics actively collaborate with other federal programs, health care providers, the food industry, and retail partners to strengthen community health infrastructure. Increased linkages—particularly with health care providers—can help address existing health disparities, including persistently high rates of maternal and infant mortality and morbidity. Proposed federal legislation focused on social determinants of health would create an interagency council to promote collaboration and coordination across federal programs.⁵⁵ It would also provide grants to support community-based, cross-sector collaborations to coordinate care and services in communities with significant unmet health and social needs with the aim of improved and equitable outcomes.

Finally, it is important to keep in mind the toll that being unable to feed one’s child takes on parents and caregivers, regardless of circumstance. As this crisis has shown, many are quick to judge parents—particularly women—for using formula in the first place as opposed to focusing on needed policy interventions that ensure all parents can keep their babies healthy. The backlash from some, asserting that parents should simply breastfeed, reveals the enduring stigma around formula feeding and a lack of understanding of the needs of disparate populations who rely on formula.⁵⁶

Recommended legislative and policy action

Access and affordability remain key challenges to all kinds of families, as well as for infants and babies who rely on specialty formula for their survival. In the long term, the United States needs to increase the number of suppliers of domestic infant formula to reduce the risk of supply shocks. Perrigo, one of the few companies supplying baby formula to U.S. grocery stores, expects shortages and increased demand for formula to last to the end of the year.⁵⁷ To mitigate enduring shortages, WIC contracting should be reconfigured to increase entry of more domestic producers. Financial incentives may also be needed to assure swift entry. To the extent possible, supply of foreign formula production that meets FDA standards should be encouraged. Policymakers might reconsider tariffs applied to reliable producers, or the FDA could be empowered to suspend tariffs on these companies in the event of a significant supply shortage.

In addition to policies that dilute market concentration and incentivize new market entrants to produce a range of formula products, as discussed above, Congress has an important legislative opportunity to address some of the limitations and inflexibilities of the WIC program, making it stronger and more responsive to future spikes in need. Federal child nutrition programs—which include WIC—have not been reauthorized since 2010.⁵⁸ These programs have continued operating through the annual appropriations process but have not been improved or strengthened in more than a decade. In 2021, congressional leaders in the U.S. House of Representatives and the U.S. Senate expressed interest in advancing the reauthorization but have yet to address the issue in 2022. Congress should reauthorize child nutrition programs and WIC this year with an eye to preserving the rebate program while incentivizing other entrants into the market to offer a wider range of products and lower costs.

It should not take a national emergency for policy change to support parents and WIC participants. State flexibilities, such as allowing parents and caregivers the options of buying alternate formula products, alternate sizes, and brands of formula using WIC benefits, should be made widely available to better meet the needs of caregivers and to be more responsive, especially during times of emergencies or shortages. Furthermore, America needs family friendly policies that support mothers, in particular low-income mothers, in their decision to either breastfeed or use formula. These policies can include:

• Pursue permanent national paid leave legislation that covers all employees—including part-time and self-employed workers—and is inclusive of “chosen family”;⁵⁹ includes short- and long-term caregiving leave; and ensures adequate wage replacement for caregiving leave.
• Enforce existing workplace breastfeeding protections for covered employees—as stipulated under the Break Time for Nursing Mothers provision of the Fair Labor Standards Act—and expanding the types of workers not currently protected by the Break Time law.⁶⁰
• Enact regulations to ensure people enrolled in traditional Medicaid plans are not forced to pay out of pocket for breastfeeding counseling and equipment—a practice that is prohibited for most Medicaid expansion and private plans—and require federal and state Medicaid plans to cover at least one breast pump per pump type (electric, manual, or battery-operated).⁶¹

And finally, there needs to be increased oversight and accountability to become more responsive to future supply shortages and to address health and safety concerns, ensuring a food system that is equitable and resilient. Compounding supply shortages, regulators are also confronting enduring health and safety issues in powdered infant formula manufacturing. As such, the pandemic has pointed to the need to build the government’s capabilities to detect and prevent threats early, to respond quickly to health emergencies, and to ensure coordination across federal agencies to leverage communication and resources more effectively to address disruptions.

There is no comprehensive mechanism for detecting or investigating deadly bacteria, such as Cronobacter sakazakii, which has been linked to powdered formula and can cause serious brain damage, developmental disabilities, and even death in babies.⁶² While the U.S. Centers for Disease Control and Prevention (CDC) and FDA are working with state and local health officials to investigate a recent outbreak of the Cronobacter bacteria that resulted in several babies being sick and two passing away, the lack of regular testing and reporting makes it challenging to determine just how many people were affected. Currently, there is only one state that requires doctors and labs to report Cronobacter sakazakii cases to authorities.⁶³ And although the FDA established regulations in 2014 requiring formula makers to test samples from every product lot for Cronobacter, lots tend to vary significantly in size, making testing inadequate. As a result, the FDA is now seeking authority to require additional testing and reporting by formula makers to ensure greater health and safety standards.⁶⁴

These actions are critical, as chronic underinvestment in the nation’s public health system, including in the data systems and workforce needed to ensure that key functions such as food safety operate smoothly, has left the nation vulnerable. It highlights the need for timely information to assess risk and inform critical decisions and reveals the need for—and limitations of—the nation’s public health data for tracking and monitoring disease. President Joe Biden’s FY 2023 budget includes funding to strengthen the nation’s public health infrastructure and early warning capabilities, including funding for the CDC to develop workforce, laboratory capacity, and data collection, as well as for the FDA to expand and modernize its regulatory capacity and laboratory infrastructure.⁶⁵ Congress should pass these funding increases, among other necessary reforms.

Long-term reform of the nation’s food and nutrition system

Every child, individual, and community deserves a food system that delivers affordable, nutritious food that protects their health and well-being. But the infant formula crisis, along with the COVID-19 pandemic and resulting economic downturn, has exposed persistent and deeply damaging inequities in the U.S. food system that must be addressed as a country. In a survey conducted from April 27, 2022 to May 9, 2022, almost 34 million households reported that they sometimes or often did not have enough to eat during the week.⁶⁶ More than 11 million households with children under age 18 reported that they sometimes or often did not have enough to eat during the week. And almost 4 million households with children who were getting federal food benefits through SNAP still struggled with food insecurity and hunger during this time.⁶⁷ Food insecurity is felt most acutely by people of color, individuals with disabilities,⁶⁸ and LGBTQI+ people.⁶⁹

Despite the United States producing enough food to feed everyone within its borders,⁷⁰ millions of Americans rely on federal food benefits and programs—such as WIC, SNAP, or school meal programs—and food banks for their next meal. Such programs are intended to be emergency or supplemental aid for individuals or families struggling with temporary financial precarity and hunger. But increasingly, these programs have turned into a resource of basic survival for millions. Simply put, the U.S. food system does not meet the needs of all communities, especially rural, low-income, and communities of color.

America’s hunger crisis—both the infant formula shortage and more systemic food insecurity—should be a wake-up call to policymakers, forcing their attention to longer-term solutions rooted in the goal of fostering equitable and sustainable access to food and nutrition.

Policymakers can begin with two upcoming legislative reauthorizations that give Congress the opportunity to take meaningful action in fostering a food system that better meets the needs of all Americans:

• In 2022, Congress is due to reauthorize the Child Nutrition and Women, Infant and Children Act,⁷¹ which authorizes all federal child nutrition programs, including WIC, reaching millions of children and their families each day. While Congress is long overdue for reauthorizing the Child Nutrition Act, it must at minimum renew the programs’ funding in 2022 while using the broader reauthorization opportunity to rethink the country’s food and distribution systems, especially for the most vulnerable.
• In 2023, Congress will turn its attention to reauthorizing the Farm Bill, which includes SNAP, the largest anti-hunger program that supplements the food budget of needy families, enabling them to purchase healthy food and move toward self-sufficiency.

Both bills offer Congress an unprecedented opportunity to strengthen and coordinate food production, distribution, and supply systems in this country, while addressing emerging challenges that are affecting the national and global food systems—such as pandemics, the impact of climate change on food production, economic recessions, and more.

Secondly, the White House is hosting a conference on hunger, nutrition, and health in the fall of 2022, which presents an opportunity to reimagine the nation’s food system, focusing on sustainable, resilient productions, strong supply chains, adequate supply, and access to quality, affordable, and culturally and nutritionally diverse food for every person.

Simply put, the U.S. food system does not meet the needs of all communities, especially rural, low-income, and communities of color.

The domestic infant formula industry would also be subject to any changes made by way of new laws affecting the country’s domestic manufacturing and supply chain resiliency. Provisions in the House-passed COMPETES Act⁷²—currently being reconciled in a conference committee with the Senate-passed U.S. Innovation and Competition Act⁷³—would foster market entry, with additional incentives for small- and medium-sized manufacturers. If passed in a final package, these provisions could increase supplier diversity and expand the number of producers in the domestic infant formula market. However, these proposals may only have value to potential manufacturers if WIC single-source contracting evolves to increase access to market share by new producers that would otherwise be shut out of the preferential treatment previously described.⁷⁴

And thirdly, long-term efforts to rebuild the food production, distribution, and supply system in an equitable and sustainable way should be combined with intersectional policies that support and build stability for low-income and other marginalized communities. For example, instituting a livable minimum wage throughout the United States, coupled with paid family and medical leave and other worker protections—including those that allow parents the flexibility they need to breastfeed or pump—are imperative to ensuring that individuals and families have the means to care for themselves and their loved ones with dignity. Good jobs can give low-income individuals and families a step up to financial security and self-sufficiency, reducing poverty and reliance on emergency food resources. Similarly, investing in safety net programs—making them stronger, more resilient, and more responsive in times of crisis—can ensure that every person is fully supported during times of personal, national, and global financial precarity. An intersectional approach to addressing the systemic inequities in the country’s food system can be aligned with a whole-of-government approach to address food insecurity from multiple angles—from production to distribution to supply and access.

Conclusion

The infant formula crisis has made one thing clear: It is time for a wake-up call. No child or individual should go hungry in the wealthiest nation in the world. For too long, key parts of the U.S. food system have been underfunded, monopolized by a small number of key players, and dependent on systems that can easily be disrupted and/or are underregulated, resulting in food and nutritional inequities with dangerous implications.

Over the next year, the United States has a crucial, once-in-a-generation opportunity to improve the lives and health of millions of children and other vulnerable people by undertaking a coordinated cross-sector response across federal agencies, leveraging resources to build an equitable, sustainable food system that accounts for the needs of diverse communities. New policies can foster communities in which every person can not only survive but thrive and prosper. It is imperative for policymakers to take advantage of this opportunity, creating a society and economy that supports and works for all its residents.

Acknowledgments

The authors would like to thank Hailey Gibbs, Madeline Shepherd, Maggie Jo Buchanan, Seth Hanlon, Nicole Ndumele, and Emily Gee for their guidance. The authors also thank Justin Schweitzer, Anona Neal, and the CAP Editorial team for their valuable contributions to this report.

Endnotes

1. Datasembly, “Datasembly Releases Latest Numbers on Baby Formula,” Press release, May 10, 2022, available at https://datasembly.com/news/out-of-stock-rate-in-april-2022-copy/.
2. Megan Cerullo, “The nationwide baby formula shortage is getting worse,” CBS News, May 10, 2022, available at https://www.cbsnews.com/news/baby-formula-shortage-rationing-national-crisis/.
3. Ibid.
4. The White House, “FACT SHEET: President Biden Announces Additional Steps to Address Infant Formula Shortage,” Press release, May 12, 2022, available at https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/12/fact-sheet-president-biden-announces-additional-steps-to-address-infant-formula-shortage/.
5. Laura Reiley and Timothy Bella, “Abbott’s Troubled Baby Formula Factory Closed Again Due to Flooding,” The Washington Post, June 16, 2022, available at https://www.washingtonpost.com/business/2022/06/16/abbott-baby-formula-plant-closes-flooding-elecare/; Eduardo Medina, “Please Help: A Nationwide Baby Formula Shortage Worsens,” The New York Times, May 8, 2022, available at https://www.nytimes.com/2022/05/08/business/baby-formula-shortage-retailers.html.
6. Richard Howells, “Baby Formula Shortage Underscores Need for Supply Chain Resilience,” Forbes, May 19, 2020, available at https://www.forbes.com/sites/sap/2022/05/19/baby-formula-shortage-underscores-need-for-supply-chain-resilience/?sh=360d78599565; Jonathan Chang and Meghna Chakrabati, “The corporate monopolies behind the baby formula shortage,” wbur, May 19, 2022, available at https://www.wbur.org/onpoint/2022/05/19/the-corporate-monopolies-behind-americas-baby-formula-crisis.
7. Donna M. Owens, “Baby Formula Shortage is Particularly Painful for Foster and Adoptive Parents,” NBC News, May 19, 2022, available at https://www.nbcnews.com/news/us-news/baby-formula-shortage-particularly-painful-foster-adoptive-families-rcna29214; Mia Ives-Rublee and Christine Sloane, “Alleviating Food Insecurity in the Disability Community: Lessons Learned From Community Solutions During the Pandemic” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/alleviating-food-insecurity-in-the-disabled-community/; and Frances Stead Sellers, “Formula shortage is worse for low-income families, high-risk infants,” The Washington Post, May 18, 2022, available at https://www.washingtonpost.com/health/2022/05/18/baby-formula-shortage-impact/.
8. Nina Lakhani, Aliya Uteuova, and Alvin Chang, “Revealed: The True Extent of America’s Food Monopolies and Who Pays the Price,” The Guardian, July 14, 2021, available at https://www.theguardian.com/environment/ng-interactive/2021/jul/14/food-monopoly-meals-profits-data-investigation.
9. The White House “Fact Sheet: President Biden Announces Additional Steps to Address Infant Formula Shortage.”
10. Yoon Y. Choi and others, “Effects of United States WIC infant formula contracts on brand sales of infant formula and toddler milks,” Journal of Public Health Policy 41 (3) (2020): 303–210, available at https://pubmed.ncbi.nlm.nih.gov/32355331/; Victor Oliveira, “Winner Takes (Almost) All: How WIC Affects the Infant Formula Market,” Economic Research Service, September 1, 2011, available at https://www.ers.usda.gov/amber-waves/2011/september/infant-formula-market/.
11. Perrigo, “Frequently Asked Questions,” available at https://www.perrigopediatrics.com/faqs/default.aspx (last accessed May 2022).
12. Datasembly, “Datasembly Releases Latest Numbers on Baby Formula.”
13. Oliveira, “Winner Takes (Almost) All.”
14. U.S. Food and Nutrition Service, “Special Supplemental Nutrition Program For Women, Infants and Children (WIC): Monthly Data, National Level,” available at https://fns-prod.azureedge.us/sites/default/files/resource-files/37WIC_Monthly-5.pdf (last accessed May 2022).
15. Steven Carlson and Zoë Neuberger, “WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for More Than Four Decades” (Washington: Center on Budget and Policy Priorities, 2021), available at https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families.
16. Abby Vesoulis, “Washington Politicians Helped Create the Baby Formula Shortage. Can They Solve it?”, Time, May 17, 2022, available at https://time.com/6177128/baby-formula-congress-monopoly-abbott/.
17. Steven Carlson, Robert Greenstein, and Zoë Neuberger, “WIC’s Competitive Bidding Process for Infant Formula Is Highly Cost Effective” (Washington: Center on Budget and Policy Priorities, 2017), available at https://www.cbpp.org/research/food-assistance/wics-competitive-bidding-process-for-infant-formula-is-highly-cost.
18. Oliveira, “Winner Takes (Almost) All”; Carlson, Greenstein, and Neuberger, “WIC’s Competitive Bidding Process for Infant Formula Is Highly Cost Effective.”
19. Jessica DiNapoli, “Exclusive: Maker of Walmart, Amazon store-brand baby formula sees shortages through rest of 2022,” Reuters, May 13, 2022, available at https://www.reuters.com/business/retail-consumer/exclusive-maker-walmart-amazon-store-brand-infant-formulas-expects-shortages-2022-05-13/#:~:text=Of%20the%20total%20U.S.%20baby%20formula%20market%2C%20Perrigo,about%203%25%20in%20the%20first%20quarter%2C%2.
20. Myles B. Harmon, “Re: The tariff classification of infant formula from Holland,” Aug 23, 2013, U.S. Customs and Border Protection, available at https://rulings.cbp.gov/ruling/N245270.
21. Federal Emergency Management Agency, “The Defense Production Act of 1950,” available at https://www.fema.gov/sites/default/files/2020-03/Defense_Production_Act_2018.pdf (last accessed May 2022); Spencer Kimball, “Biden invokes Defense Production Act to boost baby formula manufacturing to ease shortage,” CNBC, May 18, 2022, available at https://www.cnbc.com/2022/05/18/biden-invokes-defense-production-act-to-address-infant-formula-shortage.html. 
22. Access to Baby Formula Act of 2022, H.R. 7791, 117th Cong., 2nd sess. (May 21, 2022), available at https://www.congress.gov/bill/117th-congress/house-bill/7791/text.
23. U.S. Food and Drug Administration, “FDA Encourages Importation of Safe Infant Formula and Other Flexibilities to Further Increase Availability,” Press release, May 16, 2022, available at https://www.fda.gov/news-events/press-announcements/fda-encourages-importation-safe-infant-formula-and-other-flexibilities-further-increase-availability.
24. U.S. Food and Drug Administration, “Regulations and Information on the Manufacture and Distribution of Infant Formula,” available at https://www.fda.gov/food/infant-formula-guidance-documents-regulatory-information/regulations-and-information-manufacture-and-distribution-infant-formula (last accessed May 2022).
25. Amy Joyce, “The baby formula shortage is the latest blow to parents,” The Washington Post, May 12, 2022, available at https://www.washingtonpost.com/parenting/2022/05/12/formula-shortage-parents/.
26. Beth Almeida and Maggie Jo Buchanan, “Ensuring Women’s Economic Security Requires More Than a Return to Pre-pandemic Status Quo” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/ensuring-womens-economic-security-requires-more-than-a-return-to-the-pre-pandemic-status-quo/.
27. Sellers, “Formula shortage is worse for low-income families, high-risk infants.”
28. A Better Balance, “Breastfeeding Moms Benefit from Paid Leave,” August 17, 2018, available at https://www.abetterbalance.org/breastfeeding-moms-benefit-from-paid-leave/#:~:text=Papua%20New%20Guinea.-,Paid%20leave%20is%20an%20essential%20tool%20in%20establishing%20and%20sustaining,mothers%20who%20stay%20home%20longer; George Mason University College of Health and Human Services, “New Study Finds High Rates of Formula Use with Low-income Infants, Recommends Changes,” Press release, May 1, 2019, available at https://chhs.gmu.edu/news/2019-05/new-study-finds-high-rates-formula-use-low-income-infants-recommends-changes; and Janine A. Rethy and others, “Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme,” Public Health Nutrition 22 (9) (2019), available at https://www.cambridge.org/core/journals/public-health-nutrition/article/sociodemographic-predictors-of-exclusive-breastfeeding-among-lowincome-women-attending-a-special-supplemental-nutrition-program-for-women-infants-and-children-wic-programme/AF7D3DEF57.
29. U.S. Food and Drug Administration, “WIC Frequently Asked Questions (FAQs),”available at https://www.fns.usda.gov/wic/frequently-asked-questions (last accessed May 2022).
30. Office of the Surgeon General, “Breastfeeding: Surgeon General’s Call to Action Fact Sheet,” HHS.gov, available at https://www.hhs.gov/surgeongeneral/reports-and-publications/breastfeeding/factsheet/index.html (last accessed May 2022).
31. Cerullo, “The nationwide baby formula shortage is getting worse.”
32. Helena Bottemiller Evich, “‘I don’t know how my son will survive’: Inside the dangerous shortage of specialty formulas,” Politico, May 7, 2022, available at https://www.politico.com/news/2022/05/07/i-don’t-know-how-my-son-will-survive-inside-the-dangerous-shortage-of-specialty-formulas-00030787.
33. Erin E. Andrews, Robyn M. Powell, and Kara B. Ayers, “Experiences of Breastfeeding among Disabled Women,” Women’s Health Issues 31 (1) (2021): 83–89, available at https://pubmed.ncbi.nlm.nih.gov/33051056/.
34. Harvard T.H. Chan School of Public Health, “Navigating infant formula shortages,” available at https://www.hsph.harvard.edu/nutritionsource/2022/05/17/infant-formula-shortage/ (last accessed May 2022).
35. Amanda Morris, “2 Children Have Been Hospitalized Because of Formula Shortage,” The New York Times, May 17, 2022, available at https://www.nytimes.com/2022/05/17/us/baby-formula-shortage-tennessee-hospitalized.html?campaign_id=9&emc=edit_nn_20220518&instance_id=61659&nl=the-morning&regi_id=84818549&segment_id=92576&te=1&user_id=4bda173c118bfdc6532b17624fe21010.
36. Rebecca Vallas and Shawn Fremstad, “Disability Is a Cause and Consequence of Poverty,” TalkPoverty, September 14, 2014, available at https://talkpoverty.org/2014/09/19/disability-cause-consequence-poverty/.
37. Nanette Goodman, Michael Morris, and Kelvin Boston, “Financial Inequality: Disability, Race and Poverty in America” (Washington: National Disability Institute, 2019), available at https://www.nationaldisabilityinstitute.org/wp-content/uploads/2019/02/disability-race-poverty-in-america.pdf.
38. Andrea Peirce, “Can I Breastfeed During Cancer Treatment,” Memorial Sloan Kettering  Cancer Center, August 2, 2016, available at https://www.mskcc.org/news/can-breast-feed-during-cancer-treatment.
39. Nathan Bomey, “FDA under fire as baby formula shortage grows,” Axios, May 11, 2022, available at https://www.axios.com/2022/05/11/fda-baby-formula-shortage-abbott-nutrition-recall.
40. Danielle Taylor, “Same-Sex Couples Are More Likely to Adopt or Foster Children,” U.S. Census Bureau, September 17, 2020, available at https://www.census.gov/library/stories/2020/09/fifteen-percent-of-same-sex-couples-have-children-in-their-household.html.
41. UCLA School of Law Williams Institute, “Same-sex parents are 7 times more likely to raise adopted and foster children,” Press release, October 27, 2020, available at https://williamsinstitute.law.ucla.edu/press/lgbt-parenting-media-alert/.
42. Elizabeth Chuck, “Baby formula shortage has anxious parents stalking shelves nationwide,” NBC News, May 12, 2022, available at https://www.nbcnews.com/news/us-news/baby-formula-shortage-anxious-parents-stalking-shelves-nationwide-rcna28460.
43. Aurelia Glass and others, “New Opportunities for the Biden-Harris Administration to Create Good Jobs for LGBTQI+ Workers” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/new-opportunities-for-the-biden-harris-administration-to-create-good-jobs-for-lgbtqi-workers/.
44. Caitlin Rooney, Charlie Whittington, and Laura E. Durso, “Protecting Basic Living Standards for LGBTQ People” (Washington: Center for American Progress, 2018), available at https://americanprogress.org/issues/lgbtq-rights/reports/2018/08/13/454592/protecting-basic-living-standards-lgbtq-people/.
45. Spencer Watson, Oliver McNeil, and Bruce Broisman, “The Economic Well-Being of LGBT Adults in the U.S. in 2019” (San Francisco: Center for LGBTQ Economic Advancement & Research, 2021), available at https://lgbtq-economics.org/wp-content/uploads/2021/06/The-Economic-Well-Being-of-LGBT-Adults-in-2019-Final-1.pdf.
46. Office of the Surgeon General, “Breastfeeding: Surgeon General’s Call to Action Fact Sheet.”
47. U.S. Food and Drug Administration, “FDA Advises Parents and Caregivers to Not Make or Feed Homemade Infant Formula to Infants,” February 24, 2021, available at https://www.fda.gov/food/alerts-advisories-safety-information/fda-advises-parents-and-caregivers-not-make-or-feed-homemade-infant-formula-infants.
48. Steven A. Abrams, “Is Homemade Baby Formula Safe?”, HealthyChildren.org, available at https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Is-Homemade-Baby-Formula-Safe.aspx (last accessed May 2022).
49. Janina R. Galler and others, “Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective,” NeuroImage 231 (1) (2021), available at https://www.sciencedirect.com/science/article/pii/S1053811921001051.
50. Morris, “2 Children Have Been Hospitalized Because of Formula Shortage.”
51. NBC New York, “FDA to Allow Closed Abbott Plant to Release Baby Formula Supply Amid Shortage,” May 11, 2022, available at https://www.nbcnewyork.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/3682564/
52. Matthew Perrone, “FDA chief: COVID, mail mix-up delayed action on baby formula made in Michigan,” CRAIN’s Detroit Business, May 25, 2022, available at https://www.crainsdetroit.com/manufacturing/fda-chief-details-delays-inspecting-abbott-formula-plant-michigan#:~:text=After%20detecting%20positive%20samples%20of%20bacteria%20in%20multiple,the%20company%20to%20regularly%20undergo%20outside%20safety%20audi.
53. Laura Reiley and Timothy Bella, “Abbot’s troubled baby formula factory closed again due to flooding,” The Washington Post, June 16, 2022, available at https://www.washingtonpost.com/business/2022/06/16/abbott-baby-formula-plant-closes-flooding-elecare/.
54. National WIC Association, “2019 Child Nutrition Reauthorization Priorities,” June 2018, available at https://s3.amazonaws.com/aws.upl/nwica.org/2019-cnr.pdf.
55. Social Determinants Accelerator Act of 2021, S.B. 3039, 117th Cong., 1st sess. (October 21, 2021), available at https://www.congress.gov/bill/117th-congress/senate-bill/3039?s=1&r=5#:~:text=Introduced%20in%20Senate%20(10%2F21%2F2021)&text=This%20bill%20establishes%20the%20Social,attainment%2C%20and%20place%20of%20residence.
56. National WIC Association, “2019 Child Nutrition Reauthorization Priorities,” June 2018, available at https://s3.amazonaws.com/aws.upl/nwica.org/2019-cnr.pdf.
57. DiNapoli, “Exclusive: Maker of Walmart, Amazon store-brand baby formula sees shortages through rest of 2022.”
58. Congressional Research Service, “Child Nutrition Reauthorization (CNS), An Overview,” available at https://crsreports.congress.gov/product/pdf/IF/IF10266 (last accessed May 2022).
59. Lindsay Mahowald and Diana Boesch, “Making the Case for Chosen Family in Paid Family and Medical Leave Policies,” Center for American Progress, February 16, 2021, available at https://americanprogress.org/article/making-case-chosen-family-paid-family-medical-leave-policies.
60. Heidi Shierholz, “Millions of working women of childbearing age are not included in protections for nursing mothers,” Economic Policy Institute, December 10, 2018, available at https://www.epi.org/blog/break-time-for-nursing-mothers/.
61. Jamille Fields Allsbrook and Osub Ahmed, “Building on the ACA: Administrative Actions to Improve Maternal Health” (Washington: Center for American Progress, 2021), available at https://www.americanprogress.org/article/building-aca-administrative-actions-improve-maternal-health/.
62. Amanda Morris, Christina Jewett, and Nicholas Bogel-Burroughs, “Baby Formula Shortage Reveals Gaps in Regulation and Reporting,” The New York Times, May 23, 2022, available at https://www.nytimes.com/2022/05/23/us/abbott-baby-formula-sturgis-regulation.html.
63. U.S. Food and Drug Administration, “FDA Investigation of Cronobacter Infections: Powdered Infant Formula (February 2022),” available at https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022 (last accessed May 2022).
64. Morris, Jewett, and Bogel-Burroughs, “Baby Formula Shortage Reveals Gaps in Regulation and Reporting.”
65. The White House, “FACT SHEET: The Biden Administration’s Historic Investment in Pandemic Preparedness and Biodefense in the FY 2023 President’s Budget,” Press release, March 28, 2022, available at https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/28/fact-sheet-the-biden-administrations-historic-investment-in-pandemic-preparedness-and-biodefense-in-the-fy-2023-presidents-budget/.
66. U.S. Census Bureau, “Week 45 Household Pulse Survey: April 27 – May 9, 2022,” May 18, 2022, available at https://www.census.gov/data/tables/2022/demo/hhp/hhp45.html.
67. Ibid.
68. Kyle Ross and others, “The ARP Grew the Economy, Reduced Poverty, and Eased Financial Hardship for Millions” (Washington: Center for American Progress, 2022), available at https://www.americanprogress.org/article/the-arp-grew-the-economy-reduced-poverty-and-eased-financial-hardship-for-millions/.
69. Taylor N. T. Brown, Adam P. Romero, and Gary J. Gates, “Food Insecurity and SNAP Participation in the LGBT Community” (Los Angeles: The Williams Institute, 2016), available at https://williamsinstitute.law.ucla.edu/wp-content/uploads/Food-Insecurity-SNAP-July-2016.pdf; Rooney, Whittington, and Durso, “Protecting Basic Living Standards for LGBTQ People.”
70. Zach Conrad and others, “Capacity of the US Food System to Accommodate Improved Diet Quality: A Biophysical Model Projecting to 2030,” Current Developments in Nutrition 2 (4) (2018), available at https://doi.org/10.1093/cdn/nzy007.
71. National Center for Homeless Education, “Child Nutrition and WIC Reauthorization Act of 2004,” available at https://nche.ed.gov/legislation/child-nutrition/#:~:text=The%20Child%20Nutrition%20and%20WIC,to%20healthy%20and%20nutritious%20foods (last accessed June 2022).
72. United States Innovation and Competition Act of 2021, H.R. 4521, 117th Cong., 2nd sess. (May 5, 2022), available at https://www.congress.gov/bill/117th-congress/house-bill/4521.
73. Ibid.
74. Ibid.

Original source: http://www.babymilkaction.org/archives/34098

Global trading standards must follow WHO in restricting harmful marketing

75^th World Health Assembly, Geneva, 22-28^th May, 2022

IBFAN, the global network that has helped governments stop harmful marketing of baby feeding products for the last 40 years, attended the 75^th World Health Assembly (WHA) in May. With so many difficult political issues on the Assembly agenda  –  emergencies,  military conflicts, decisions on pandemics, the climate crisis, the need for sustainable WHO financing to name just a few – infant health and the global trade of baby feeding products seemed to some a small topic that had to take its turn.

Most governments know that the unethical marketing of baby feeding products contributes to the annual toll of 800,000 baby deaths from unsafe feeding and that many more do not reach their full potential because they are not breastfed. However, with the pressure to join multi-stakeholder initiatives,  health-harming corporations are being accepted as legitimate ‘partners’ and funders in health and are gaining increased access to policy-making processes at all levels, including at WHO.  Risky technologies and products claiming to protect and solve all manner of problems are being promoted,  obscuring the fact that for infants and young children, breastfeeding is a resilient practice that provides food, care, immune support and protection, even from the worst of emergency conditions. It also protects against malnutrition in all its forms.  However, breastfeeding needs strong legal protection from predatory marketing.(1)

In 1981 the World Health Assembly – the world’s highest health policy setting body – passed the first consumer protection tool of its kind –  the International Code of Marketing of Breastmilk Substitutes followed by 20 subsequent Resolutions  This ‘code’ is a minimum obligation for all governments and the global baby-feeding products industry (whose US $55 billion turnover is led by the corporate giants Nestlé, Danone, Abbott and Mead Johnson/Reckitt) must also comply with it. 144 countries have adopted laws based on the Code since 1981, however, because of undue commercial influence, too many have legal loopholes that allow harmful marketing to flourish. The corporations are never held financially responsible for the harm they cause and all the ‘costs’ are externalized to governments, families and babies. Indeed the financial cost of sub-optimal feeding is especially important at this time of global inflation following the pandemic.

Four WHO reports published this year look at the global nature of the corporate strategies, with the report on digital marketing explaining how companies target new mothers with algorithms and celebrity influencers that reach millions with single postings.(2)

Over 45 countries spoke on the Maternal, Infant and Young Child Nutrition Agenda Item when it came up, many stressing the importance of protection against deceptive tactics that idealise and mislead all parents about the safety and nutritional value of baby feeding products.(8)

Ensuring that global trade rules do not harm infant and young child health:

High on IBFAN’s list of concerns (3) was the need for policy coherence between global trading standards and WHO decisions – a critically important matter that some exporting countries would prefer not be raised at the WHA. WHO and the Food and Agriculture Organisation (FAO) are the funders and ‘parents’ of the Codex Alimentarius Commission, the food standard setting body with the dual mandate of protecting health and ensuring fair practices in trade. All Codex work is subject to approval FAO and WHO and the Codex Code of Ethics for International Trade requires observance of the Code and Resolutions. (4) Clearly Codex should follow WHA decisions, not the other way around as suggested by the USA in its intervention:

“It is also critical that the [digital] guidance does not infringe upon the work and mandate of other international bodies, especially Codex Alimentarius given its leading role in developing science-based safety standards for food products.”

Since 1995 IBFAN has advocated the incorporation of WHA resolutions into baby food standards and guidelines and has witnessed how often decisions are not based on credible scientific evidence but on politically influenced consensus that favours the interests of agri-food industry and exporting countries. In March 2023, Codex will make an important decision on the revision of the Codex Follow-up Formula standard: should companies be allowed to freely promote the unnecessary, sweetened, flavoured, ultra-processed milk drinks for young children 12-36 months that fuel the obesity epidemic and add to the environmental burden? Or should the standard follow WHO guidance that clearly states that these products – confusingly cross-promoted with infant formulas for newborn babies ­– function as breastmilk substitutes and should not be promoted anywhere, but especially where breastfeeding into the second year is a lifeline for babies.(5,6)

‘Cross Promotion’ or ‘brand stretching’ is a well-known, deceptive marketing technique used to expand the sale of products such as alcohol, tobacco, soft drinks and baby formulas. In June 2022 the Brazilian Institute for Consumer Protection (Idec) filed a Public Civil Action (ACP) against Nestlé Brasil, Mead Johnson Brasil and Danone, claiming that the Cross Promotion strategy causes confusion, deception and harm, especially for fathers, mothers, caregivers and young children.

While all governments have a sovereign right and duty to adopt health-protective laws to protect citizens, a weak industry-friendly Codex standard could dissuade some. Aware of these risks, several countries called on WHO for help with trade and marketing matters, to ensure that health takes priority over trade concerns.

Bangladesh delivered a strong statement on behalf of eleven Member States of South East Asia, reminding the meeting that breastfeeding is a “socio-cultural component of human heritage binding the newborn with the mother after their birth through skin-to-skin contact” and calling for stronger implementation and monitoring of the Code.  As Bangladesh,  the delegate also asked WHO to:

“mobilize global support … to  address trading and export standards, guidelines and regulations in compliance with the International Code of Marketing of Breastmilk Substitutes and subsequent WHA Resolutions and … to promote gradual phasing out of the cross-branded products that function as breastmilk substitutes within the Codex Alimentarius revision of the draft standard for Follow-up Formula.”

Thailand supported Bangladesh’s call for curbs on digital marketing and cross-promotion and asked WHO to:

“collaborate with the World Trade Organisation (WTO) or other relevant trade agreement bodies to ensure our global efforts to catch up with this modern marketing into this guidance. Otherwise, this will be another piece of paper without implementation … impossible for us to follow.”

Mexico regretted the marketing that is leading to a reduction in breastfeeding across the world and picking up on the WHO EU policy brief, called on the WHO Secretariat:

“to strengthen the document, EB 150.7 to provide assistance to Member State so that guides, regulations and standards on marketing correctly implement the International Code of marketing of breastmilk substitutes  …  the adoption of legal frameworks that cover all children, children’s food and related products, as well as covering all foods that are taken by pregnant women.   We see that there is a conflict of interest, so we need to ensure that we have proper policies for children, following the 10 steps for the  promotion of breastfeedi

 

Photo above: Maternal milk promoted in Timor-Leste Danoné Lactamil, misleadingly and confusingly cross-promoted with infant formula for newborn babies. Is this for the mother or the baby? This ultra-processed product targets breastfeeding mothers, undermining confidence in breastfeeding and normal family foods.

Argentina regretted the high early suspension of breastfeeding, stressed that health teams should make  decisions and that Member States should base their sanitary or phyto-sanitary measures on standards, international guidelines or recommendations.

Dr Francesco Branca, WHO Director of Nutrition and Food Safety, speaking after the debate, appreciated the requests from Bangladesh and committed to identify actions to address those concerns, and help ensure the strongest possible safeguards for child health , including in the discussion of the forthcoming Codex standards

IBFAN highlighted the cruelty of expecting poorly-resourced countries to tackle cross-border marketing problems alone. Babies in these countries stand to suffer the most when breastfeeding is undermined. Exporting nations such as the USA, Canada, New Zealand, Australia, Europe, Japan and China all profit from formula sales, yet take no responsibility for their companies.

The European Union is often outspoken on food safety matters at Codex, including on baby feeding products and  growth hormones. But they are weak on the issue of promotion of  Follow-on formulas. In 1992, in an attempt to address problems with the EU’s enormous export of breastmilk substitutes to Africa and other developing countries, an EU  Council Resolution was passed, calling on EU-based companies to comply with the Code when marketing in importing countries. The Resolution also outlined monitoring, reporting and accountability proposals.[7]  It’s high time this idea was revisited, strengthened and converted into binding EU Regulation.

Although the USA expressed support for breastfeeding as a priority programme area, it made no reference to the contamination in the Abbott factory apart from mentioning the critical importance of safe breast milk substitutes. No mention was made of the lack of US Code legislation and mandatory paid maternity leave that has underscored and exacerbated the current long-running infant formula shortage.

The draft Decision approved by the January Executive Board meeting (EB150/7) was adopted without amendment.  It calls on the WHO Director General to “develop guidance for Member States on regulatory measures aimed at restricting the digital marketing of breastmilk substitutes, so as to ensure that existing and new regulations designed to implement the International Code of Marketing Breastmilk Substitutes and relevant Health Assembly resolutions subsequent to its adoption adequately address digital marketing practices..” and to report back in 2024.

-END-

________________________________________­­­­­­____________________________________________

For more: Elisabeth Sterken (elisabethsterken@gmail.com), Dr Magdalena Whoolery (missmagda@hotmail.com), Ellie MacGregor (ellie@alpp.org), Alison Linnecar (alinnecar@gmail.com), Maryse Arendt (maryse.arendt@pt.lu ) Patti Rundall (prundall@babymilkaction.org)