INDIANAPOLIS — As a baby formula shortage continues to send parents across state lines in search of food for their babies or crafting unsafe DIY recipes, women's health experts are calling attention to longtime barriers that prevent American mothers from feeding babies with ease.
"This just makes it scarier. The postpartum time is an exhausting time for any woman. And so, to not know if they're going to be able to access the formula that they know they'll need, just makes it tiring," said Dr. Emily Machogu, a newborn pediatrician who helps new mothers implement feeding plans and strategies at Eskenazi Hospital in Indianapolis.
While The U.S. Dietary Guidelines for Americans and the American Academy of Pediatrics recommends exclusively breastfeeding babies for about six months, and continuing that process alongside the introduction of complementary foods until the child is at least one year old, that’s not a goal most American women are able to reach.
The timeframe in which women are expected to return to work after giving birth can be a massive reason why most American moms opt for formula.
“We expect women to have bodies like men when they go into the workforce, and so we don't accommodate the things that you need when you're a lactating person who loses access to your infant," said Hausman.
"I've taken care of moms that had to go back to work as early as two weeks after having a baby. It's too much stress to start breastfeeding when they know that they're going to be separated from their infants for long periods of the day, within a couple of weeks," Machogu said.
Studies show American mothers move to formula despite an initial desire to breastfeed. Numbers released in 2018 from the Centers for Disease Control and Prevention show while 83.2 percent of infants start out breastfeeding, only one-third still are when they reach their first birthday.
“We have, actually, a significant amount of breastfeeding intention in this country - the majority of women intend to breastfeed. But the numbers fall off very quickly, because the amount of social support is very low," said Dr. Bernice Hausman, a professor at Penn State’s Department of Humanities whose research centers on medical controversies in the public sphere and women's issues.
A study conducted by UNICEF in 2018 found the United States has the third-lowest number of breastfeeding women in the world of women. As the shortage continues though, shaming women for an option they turn to out of necessity "is not a good solution."
“What you have right now is all sorts of babies that are already being fed formula that needs to have something to eat right now. So, now is not a good time to be talking about why breastfeeding is superior to into formula feeding, because it doesn't help the problem,” said Hausman.
For decades, formula has provided a more convenient way for American women to mitigate barriers to breastfeeding.
Dr. Jacqueline Wolf is a professor of the history of medicine at Ohio University, and has conducted research centered on the cultural shift from breastfeeding to formula-feeding in the United States.
"Knowing the history of formula feeding and knowing how dangerous it was 100 years ago - let me say thank goodness we have safe formula. But it shouldn't be a growth industry. And it shouldn't be something that mothers have to rely on," Wolf said.
Her research similarly found “lack of mandated maternity leave," cultural attitudes discouraging breastfeeding, and disinvestment from resources like accessible lactation consultations are all variables cause American women to reach for formula at higher rates than other countries.
“Most mothers have babies under a year old and work outside the home. And they can't stay home with their babies and breastfeed. They have to go back to work,’” Wolf said.
Wolf’s research found families had few options for feeding newborns if a woman died during childbirth even into the early 20th century and estimates for every one breastfed baby who died, fifteen artificially fed babies died.
“Let me tell you very frankly, that if a baby wasn't fully breastfed before we had Pure Food laws, the odds of that baby dying were huge. It was a family tragedy,” Wolf said.
During the Civil War, some women began using canned milk preservatives as a way to supplement breastmilk. Pediatricians began writing mathematical formulas, almost like prescriptions for mothers with sick infants who were not able to breastfeed, and sending them to chemists in milk laboratories shortly after. By the 1870s, Nestle’s Infant Food was became available in the U.S. for 50 cents.
That happened a few decades before women were being sent out of the home to work in higher numbers at the turn of the century, at which point they started reporting lower breast milk rates. It was a phenomenon, Wolf said, was documented in “newspapers, medical journals and medical conferences" of the day.
Theories as to why women reported lower breast milk rates ranged from silly to outright sexist. Some in the medical community theorized a disease was manifesting physiologically in the bodies of women, or that women living in city environments were too far removed from the natural cycles of life to breastfeed effectively.
"My favorite explanation, there were also books written about this, that it was being caused by the over-education of girls. The theory was that if girls were in school when they were going through puberty, that their brains were competing with their developing bodies, and their brains were snatching all the energy," Wolf said.
In reality, Wolf's research found women were working within new, highly regimented schedules, which simultaneously separated them from babies, and did not always facilitate child caretaking.
“What was going on, when indeed the U.S. was urbanizing and industrializing, was that schedules for the first time became part of our culture. The mechanical clock was one of the biggest adjustments Americans had to make. Adults were having a very, very hard time with it," said Wolf.
Similarly to today, those formulas were there to fill the gap for working mothers. At the height of formula use in 1972, just 25% of children in the U.S. were being breastfed.
It wasn’t until the Affordable Care Act was passed in 2010 that workplaces with more than 50 employees in the United States were required by law to provide services like designated lactation rooms for breastfeeding women.
But not only are those measures unavailable or unsanitary for some women, social attitudes and stigmas around breastfeeding may be even harder to change.
"There still continues to be uproar when women breastfeed in public, as if they're engaged in some kind of lewd act. So across all these different sectors in society, it's it's very difficult," said Hausman.
As the shortage persists, experts hope the formula shortage reiterates ways new structures can be implemented to better support parents.
"I hope that the question we come back to is how can we better support women during pregnancy and after they give birth," said Machogu .