Seven months after a manufacturer in Michigan was shut down due to alleged contamination, baby formula shortages continue throughout the country though at a lesser extent than what caused a panic in the first place.

For the Kalamazoo Breastfeeding Coalition, however, the crisis dates back before the shelves were bare.

Its origins are decades old, when formula was first promoted as an alternative to breastfeeding – not as a supplement for when all else fails, but as an equal to breastmilk in nutrition, and as superior when it comes to reducing the amount of time a parent spends out of work with a new child.

“Our country simultaneously tells parents that breastfeeding is a public health imperative, while also not supporting those parents to heal from birth and breastfeed their babies,” said Katie Pearson, co-chair of the Kalamazoo Breastfeeding Coalition and a professional lactation counselor.

A suspected bacteria at Abbott Laboratories’ Sturgis facility led to the shutdown in February that took a third of the country’s formula production off the shelves, exacerbating an existing shortage. Parents were forced into formula options that weren’t best suited for their baby, or turned to unhealthy remedies like watered-down cow’s milk.

Formula isn’t inherently bad, and at times is necessary, made possible by the technology that has improved quality to meet nutritional needs specific to any given child, Pearson and co-chair Sokhna Heather Mabin said.

Breastfeeding as a crucial connection and sustenance between parent and baby, however, has been disrupted by formula industry commercialization, corporate pressure to get back to work, and even the medical profession itself.

Certain birthing procedures like induction, which is sometimes medically necessary, can delay milk production or the physical connection between baby and parent during the important first week after birth.

“That week, the first seven to 10 days, is a time when the lactating person quits because it’s so stressful,” said Mabin, something attributed to a dearth of conversations about biology and the reality of having a baby. “So where does it begin? Let’s go back to fifth grade, it should be in schools. It’s a physiological conversation.”

In some cases, doctors are peddling misinformation when parents say their babies aren’t following a storybook feeding schedule.

“I had two pediatricians tell two different clients that their milk didn’t have enough calories in it because their babies were so hungry all the time,” recounts Pearson. “Their babies were actually going through a growth spurt, and they were teething. … I’m like, ‘where are they getting this?’ That’s false information. Straight up completely false.”

Postpartum can already be a difficult time for parents of young children, and it takes an especially heavy toll on their mental health if compounded by poor information and suggestive commercialization.

That in turn makes it more difficult to breastfeed, which can then add to the stress in a self-reinforcing dilemma.

“Postpartum depression and anxiety, they go together,” Mabin said. “The hormonal balance of breastfeeding from the body is already a healthy circulation of hormones that can decrease anxiety and depression.”

Pearson says it’s important for young parents and their support network to advocate for themselves, while the societal approach has a course correction too that doesn’t make formula a solution to a much larger problem.

“For some moms, there’s kind of a mental health aspect with body autonomy. You’re being nailed down to the couch all day breastfeeding. It can feel overwhelming, and this fast-paced society can make it feel like a waste of time,” Pearson said. “You are feeding your baby this food that is perfectly developed for them. This is a symbiotic relationship.”

The following is a conversation with Pearson and Mabin that has been edited for length and clarity:

Your organization rang the alarm as early as February about the shortage. Why did it take months to make national headlines and talk, at least, of action by national leaders?

Katie Pearson: In the clinical setting like in our practice, we actually saw a crisis before COVID, years before. There have always been shortages here and there, not to this extent. This is unprecedented. There’s a lot of different kinds of formula, and it takes a dietician, a registered dietician or a nutritionist, to tell a person what kind of formula their baby needs. And if a baby’s born premature or if they have some kind of health issue, they might need another. So, there might be a shortage of a specific formula where then, they have to find that specific formula in a different source. We saw these crises happening before but on a much smaller scale. 

Sokhna Heather Mabin: We live in a capitalist society and they need their workers to go back to work. Women are 52% of the workforce. We need our workforce to get back to work. These are people of color [returning to work], and there’s this issue once again: misogyny. Then we’re going to get into racism. We’re going to get into a whole bunch of issues, but it’s not just people of color who use formula. As soon as a woman finds out she has any issue whatsoever that she cannot provide milk or the breastfeeding parent cannot, they come to us, like what do I do? I don’t want to give a baby formula, but that’s what we have.

Pearson: My personal opinion based on my experience is that there’s been a cognitive dissonance by health care providers. Parents have been struggling; they have been sounding the alarm, but you know, I still have health care providers, specifically pediatricians, that are recommending parents switch over to formula or start supplementing with formula. There’s a cognitive dissonance, there’s a disconnect.

There’s an organization called WIC (Women, Infants, and Children). I think it’s like over 50% of the birthing population in the United States receives WIC benefits. Initially WIC was started to address the very high malnutrition rate of children in the 1960s. WIC was started in order to supplement giving formula to families. So, this has become normalized. WIC is actually very supportive of breastfeeding. They have lactation consultants and they’re very supportive of giving people lactation support. Ultimately, most people think of WIC as the formula program. You have over 50% of the population that’s dependent on WIC and WIC only gives you very specific kinds and amounts of formula. You can’t just go in and get any formula. That’s where part of the shortage comes from too. Now, since the crisis WIC has opened up their options as far as like what size and what types, but it all had to go through Washington, through a lot of bureaucratic red tape.

The maternity leave practices are inequitable too. The bottom line in my mind is that we as a culture and a society do not support families, we talk a good game. We talk about wanting to save babies by overturning Roe v Wade, but ultimately, we’re not doing the actual things that help families.

Mabin: Let’s all get together as parents and see what we can get that can be a better product because we can be healthier than this. We can be so much healthier than this. I believe that we can come up with something that is absolutely precious as a food supplement to give to our babies if properly formulated with delicacy and attention to what our humans need. We have all of the stem cell research. When a breastfeeding parent is giving them food, infant feeding from their body, they’re giving that baby stem cells, DNA exchange, antibodies made for them. Here we are giving this incredible substance, liquid organ, that we’re giving to a baby to help it grow. And it is specifically from that family lineage. That’s where my mind is like, you can’t make it in a factory, and this is what a woman’s body does.

When the news became mainstream that there was an acute shortage of formula, the loudest of the media framed it as two distinct camps: either you breastfeed or you formula feed. Is there a better way to understand the options for feeding young children?

Pearson: According to the CDC, breastfeeding is a “public health imperative.” What complicates things is that it is indeed a choice by mothers to breastfeed, and so cultural and societal norms can also dictate whether a person breastfeeds or not, and that family history and culture can make folks feel strongly one way or another. Added to that, we as a nation and society do not support birthing people and postpartum people and their babies very well. The US has some of the worst health outcomes for mothers and babies in the developed world, and even worse than some developing countries.

Our country simultaneously tells parents that breastfeeding is a public health imperative, while also not supporting those parents to heal from birth and breastfeed their babies.  The narrative that this is some sort of equitable “choice” is a false one.  Parents and lactating people are being put in an impossible position.

Why [people] end up not breastfeeding is usually because of barriers such as being lower income, so they must return to work right away after having their baby, health insurance tied to employment, little to no maternity leave, no paid maternity leave, unsupportive family members, lack of familial or community support, unnecessary or necessary birth interventions that lead to delayed milk coming in, or bad latch, bias from health care workers, myths surrounding breastfeeding, bad breastfeeding support, etc.

Before formula existed, many birthing people who had to return to work used donor milk or wet nurses to feed their babies. This fell out of favor once formula was invented. There was a common feeling that only poor people fed their babies with human milk, and formula feeding is what rich people did. Since the late 1960s, early 70s, the breastfeeding rates have slowly gone up, but they are definitely not where they need to be to have a healthy society. In this modern society, there are ways to feed our babies with breastmilk that is not just breastfeeding alone. The technology has made leaps and bounds when it comes to breast pumping. While the technology has come a long way, it still takes resources to provide breastmilk in this particular way, so that you may have the option to go back to work right away.

This is already a traumatic time for a mother, the very act of being pregnant and having a baby being a shock physically and mentally. For those who have never experienced this, can you explain the impact of pregnancy and birth on a mother’s mental health and impact on breastfeeding?

Pearson: There is the physicality of giving birth and lactating, the hormonal aspect and the mental aspect, which all interact with one another. The human body has evolved with the amazing and complex chain of reactions and interactions that it takes to reproduce and then feed our babies. In modern birth, even though we have technologies that can survive a baby born in extreme prematurity, and other technologies that can help babies to be born alive, such as Cesarean birth, ultrasounds, prenatal testing and screening, postpartum testing and screening, many of these lifesaving actions by big medical facilities create interventions that interrupt this delicate and natural process of birth and then lactating. Clinically in my experience, it seems to me almost every single client [of mine] has had an induction. Induction severely infringes on the natural process of the hormones that start the letdown process for lactation to be off to a good start. So, this is where more nuance and good lactation support is necessary.

This is not simply a question of if plan A does not work out, we switch to plan B. There is no lactation infrastructure to help support birthing people, especially with the interventions that make lactation support necessary. We, the collective we, are asking parents to navigate these body, hormone, and mental changes all on their own, or trivialize these changes by not giving them the support that they need. Comprehensive lactation care, good follow up postpartum care with mental health screening, familial support, and paid time off to adjust to a newborn is necessary for everyone to have an equitable start to life. This is not what we currently have for everyone. As a Certified Lactation Counselor, I try to meet lactating people where they are wherever their journey takes them, because I know we, the collective we again, have put birthing people in an impossible position.

How does a mother get informed and make the decision on feeding infants/young children – both best practice and in these trying times? What are they forced to endure in this process? Can you describe it based on your experiences working with mothers?

Mabin: Well, hopefully during their pregnancy, they are starting to investigate how they like to feed their baby. As a clinician, I asked families,how are you planning to feed your baby before the baby is arrived. It should be a conversation that they’re having with their provider from the first day. When I’m working with folks, I tell them your baby’s gonna be born, the only class I want you to take is the breastfeeding class. You’re only gonna get the basic steps when you take a class. It’s not real if you haven’t done it before. [Then the] breastfeeding person goes home [with the baby]. That week, the first seven to 10 days is a time when the lactating person quits because it’s so stressful. It wasn’t easy after all. I needed a village, and I got no support. My family doesn’t believe in it, my partner thinks that my breasts are for their pleasure and they’re dripping milk. And I’m engorged. So where does it begin? Let’s go back to fifth grade, it should be in schools. It’s a physiological conversation. Yes, it’s sensual, but this is where it should begin.

Pearson: We really try to focus on [prenatal breastfeeding education] because studies have proven that if moms get those classes or at least talk to a lactation consultant it really does make a difference. But [also] realistic expectations. You have to slow down to breastfeed, and sometimes it can be boring. I mean, sometimes the baby breastfeeds for 45 minutes because breastfeeding on demand is the baby regulating the milk supply. Babies don’t feed on a schedule, and when they regulate the milk supply it’s all dependent on are they teething, are they going through a growth spurt. The first few days babies cluster feed. That’s a huge surprise for a lot of the parents I work with. I hear, they’re hungry again. My milk’s not good enough. I had two pediatricians in the last day tell two different clients that their milk didn’t have enough calories in it because their babies were so hungry all the time. Their babies were actually going for growth spurt, and they were teething. This just happens to be two different people with two different pediatricians. I’m like, where are they getting this? That’s like false information, like, straight up completely false. So healthy expectations but also realistic expectations that are supported by healthcare providers too. And I know, for some moms, there’s kind of a mental health aspect with body autonomy. You’re being nailed down to the couch all day breastfeeding. It can feel overwhelming, and this fast-paced society can make it feel like a waste of time. But it’s about a reframing of you are feeding your baby this food that is perfectly developed for them. This is a symbiotic relationship. My purpose as a lactation consultant is to develop self-efficacy with my clients so they can make their own decisions based on the gut feelings and their confidence and they feel empowered.

Data show that Black and Indigenous people have a higher infant mortality rate than white people. Is there a correlation, at least in part, between how society and corporations pressure mothers to feed a certain way, the support that mother’s need, and the infant mortality rate?

Pearson: Being a white woman I don’t want to just tell you what I think, but let’s think about this for a minute. Who were workers? We know, historically, that African-American women typically weren’t stay-at-home moms. At least, you know, most of them were working: domestic work, factories. In this country, at least. And so, just from that perspective, when you have to work, it’s really hard to breastfeed. Now in the olden days, people relied on donor milk and wet nurses. That was very commonplace. We know that from Black women [who] were feeding white babies, but oftentimes, they were wet nurses for the women in the fields too. And then, even during the industrial revolution, poor immigrant communities had wet nurses. It was very common there’d be this one mom who fed all the babies. It sounds crazy, but that’s what people did because they didn’t have any alternatives. Then the advent of formula. That is really what ramped up folks getting into the workforce and not having to be tied to their babies. From that thinking of who is working? Who were stay-home parents? I would say too that from kind of a bigger idea of like self-efficacy and being empowered and communities who have been long marginalized communities, breastfeeding can be a very empowering act of direct action.

You mentioned empowerment and self-efficacy. How do you encourage women, who have been taught to be passive and depend on doctors, to advocate for their child’s needs and their own?

Pearson: I come from a peer perspective, so very positive but not toxic positivity either, like very realistic and positive. At the same time, I do email folks lots of resources. My goal is to work with people several times, so that way, it’s like a relationship that’s developed over time. I come from that peer perspective, like, you know, I breastfed too and I had to work and I went to school. I’ve been there. I know it’s hard, and I’m gonna give you these resources that might help you. I tend to uplift folks and really focus on the things they’re doing well, even if they’re not providing a full milk supply. There’s no shaming involved, I’m gonna lift them up for what they’re able to do and say this is amazing.

One of my taglines that I say to moms is: you are your child’s protector. You are your child’s caretaker. You are your child’s best expert, and you make the decisions for your child. That’s your responsibility. I tried to instill that in them, that nobody can tell you. You can take people’s advice and guidance, but ultimately, you’re the one that makes decisions for your child.

What are the best tools, options, services to assist new mothers with mental health, in particular, in the area of breast and formula feeding?

Mabin: That can link to the oxytocin because oxytocin is that hormone that brings that relaxation down and releases your breast milk, so people who are naturally feeding their babies from their bodies have lower risk of anxiety and depression because that hormone is flowing through them. Postpartum depression and anxiety, they go together. Anxiety is there before the depression sets in. That’s a signal. Anxiety is a signal that there can be something else coming on. It does not start postpartum. Generally, it starts around four to five months in pregnancy. There are signs that person is going to have issues later. And then we’re looking for differences between baby blues, anxiety, depression, and psychosis. The hormonal balance of breastfeeding from the body is already a healthy circulation of hormones that can decrease anxiety and depression. Being with your baby, bonding, looking at each other seeing that they look different. There’s so much that goes in with that skin to skin [contact.]

What do you do with parents who already come in with depression and anxiety who have struggled with that their entire lives?

Pearson: Legally, I have to refer them to a healthcare provider that provides that. However, what I do actually is I will refer them, but with the caveat of just be very assertive that you want to breastfeed. If you’re very goal-oriented about breastfeeding, I remind them to tell their health care provider. Just like I remind all pregnant women that I work with to be assertive and to stand up for their rights when they’re in the hospital giving birth too.

Mabin: Because they are going to need medication, which can be extremely helpful, then there are medicines that are safe for breastfeeding.

How can individuals and communities support the mental health of mothers in these situations – especially during the first year of their child’s life, who are choosing or have chosen between breastfeeding and formula, whether during “normal” times or when there’s a supply shortage, during times of amplified stressors?

Pearson: [Sokhna] often says COVID is the great revealer. I think there is an awakening going on with supporting parents. The reason that there is a labor shortage, I mean, one of the reasons is that – Sokhna mentioned it earlier – that over 50% of the workforce are birthing people. And not only is there a formula crisis, but there’s a childcare shortage.

The reason  [Europeans] were able to ship all that formula is because in Europe, they have universal health care. They have paid maternity leave. They have a different culture surrounding breastfeeding. There are people that don’t breastfeed in Europe, but culturally it is more normalized. They also have some of the best health outcomes for moms and babies. The barriers to breastfeeding are the same barriers that people face that lead to those high infant mortality rates too, like lack of transportation, living in a not ideal rental situation, all these other issues, and then, of course, low breastfeeding rates.

Again, not the parents fault. Sokhna and I, we really meet people where they are, when we provide lactation support. We are not judgmental. They’re trying. We can personally understand those barriers. Even though I was a successful breastfeeder, I faced a lot of barriers. I was just very strong and persevered through it. I had a lot of fortitude. I don’t fault anybody for not having that kind of fortitude because we don’t make it easy, the collective “we.”

How much of the issues facing mothers of young children – access to high quality formula, support for breastfeeding, outside pressure to do one or the other – were present prior to the current shortage?

Pearson: Before COVID, it was already a shit show, and a lot of that has to do with how things are structured, our policies, how we support as a community. It’s like one of those things where policy affects behavior. Not of individual people, I’m talking about like companies that employ people.

We need policies that help support working families, and if you want 50% plus of the workforce who are birthing people to still have babies and still work then we have to incorporate some of those policies that are going to help people. In Canada, a friend of mine is a lactation consultant, and she’s the only one for a hundred miles because they don’t need them. We’re trying to structure things so Sokhna and I don’t need a job. We only tackle the really hard cases of like tongue tie and complex feeding issues, not basic stuff that people should just be able to do.  When people’s basic needs are met, they do what’s biologically normal. This is in all aspects of life.

Equating it to a newborn baby, when a newborn baby’s basic needs are met, they’re gonna grow; they’re gonna form brain synapses and they’re going to be healthy. It’s the same with birthing parents too. They’re going to be able to breastfeed without the pressure, with less barriers. There could be barriers. There could be challenges, but they have us to help them through that.