Supply chain issues started the formula shortage, but it went into a crisis mode when formula supplier Abbott Laboratories recalled its products and halted production at its plant following reported illnesses of four infants and the deaths of two due to possible contamination of the products. 

For parents who rely on baby formula, this presents a grave challenge to maintaining proper nutrition for their babies. 

“I honestly first learned about [the crisis] from my patients,” Hill said. “One of my patients came in, she’s currently pregnant and she said, ‘look, this is my third pregnancy. I’ve tried breastfeeding. I already know that this right breast is not going to produce enough milk. And I have had to use formula for each of my babies. What am I going to do, Dr. Hill? How am I going to feed my baby?’ And there are several mothers who literally are not able to reach their breastfeeding goals because they have challenges one way or another with milk production.” 

There’s also the issue of family medical leave not being a universal thing in America.

“We don’t have a great family medical leave policy — that’s universal. There really is no paid leave in the United States of America,” Hill said. “And so people who have had children, return to the workplace sooner and have those additional burdens of trying to now pump and provide milk for their baby while going back to work. And so that formula shortage is a true area of fear of ‘how am I gonna feed my baby?’ Because literally when your baby’s born, they cannot chew food. They need milk as their primary source of nutrition.”

While mothers took to social media to voice their concerns, some people responded callously, assuming that these mothers might just consider breastfeeding their children. But, that just isn’t always an option. In some cases, women are medically unable to feed their children in that manner.

Hill said mothers who are HIV positive are told not to breastfeed since the chance of transmission is too high. Mothers with galactosemia, a metabolic condition, are also advised against breastfeeding. Aside from those two major reasons, other issues might prevent a woman from feeding with breast milk, including the need to be away from the baby at certain times for things like work. 

“If you’re going back to work, you’re not near your baby 24/7, then the natural kind of mechanism of your brain telling your breasts to produce enough milk that supply and demand need is not going to be met when you’re separated from your baby,” Hill said. 

Then, there are issues with severe pain that may cause a woman not to be able to produce as much milk as needed. 

“Some of it is pain-related, right? So you’ve got a baby who’s gotta attach and latch onto the nipple and if there’s severe pain, a woman may have nipple trauma,” Hill said. “They may then not be able to have a proper letdown reflex because of the severe pain. And so then if that milk does not let down, then they’re not gonna have enough volume to feed the baby.”

Hill said that sometimes the baby has feeding issues that make bottle and formula feeding the best option.

“From a baby standpoint, there are things called lip ties. There are things called tongue ties that may also prohibit a baby from latching properly and then adequately transferring enough milk to get enough calories. And so the use of a bottle can sometimes overcome some of those feeding difficulties,” she said. 

Other things can limit breastfeeding opportunities like previous breast surgeries, such as mastectomy, reductions or even implants. Nipple piercings, past or present, can also affect breastfeeding.  

“Any of these things that alter breast anatomy may also impact your ability to breastfeed in the same way,” Hill said.

Unsolicited advice generally tends to present issues, but in this case, the advice is incredibly harmful due to its inaccuracy and because it scars the emotional well-being of mothers who may have reached their breaking points. 

“The ability to breastfeed your child in so many ways is a privilege — it means that you are able to be with your child 24/7, that you have support around you for proper nutrition for the mother, proper hydration for the mother and a safe place to be able to consistently feed your baby,” Hill said.

“You need to be able to be there consistently with your baby and for the vast majority of American women, this is just not reality. And for the vast majority of American women who want to breastfeed, it is not for lack of trying that they’re not able to meet their breastfeeding goals. And so you’re then essentially, I would say, shaming a woman, if she has literally been doing everything right, and still not able to produce enough milk for her baby, and it’s already stressful. And it can be [physically] painful. And so the added layer from other women judging kind of your value as a mother being assigned to this one sliver of motherhood, which is breastfeeding.”

Supplementing breastfeeding with formula is a common occurrence for many mothers. According to the CDC, by the six-month mark, only about 58% of infants were still breastfed. Hill said that means that 42% are supplemented since babies are unable to have any other food substances as infants.

Sometimes the argument for not being able to breastfeed is met with non-FDA-approved recipes from years gone by. Often these recipes are complemented with a “my mother fed me like that and I turned out fine.” However, Hill noted that many of the unofficial formula recipes from older generations didn’t include important nutrients like vitamin D and are likely the cause of conditions such as rickets, which might cause what many know as bowlegs. 

“I’m not saying everybody with bow legs had rickets, but rickets is a condition where you have softer bones because of vitamin D deficiency, and homemade formula is notorious for being low in vitamin D,” Hill said. 

She also cautioned that formula is considered a food and so it has to be regulated by the FDA. 

“Where you get into trouble with these homemade recipes is that they tend to be deficient in [vitamins and nutrients] and there can be really bad outcomes for babies,” she said. “Calcium is often low in homemade formula. And we always think about calcium as affecting the bones, but actually, it has roles in your heart [and] brain. So you can see infants having seizures and also even going into cardiac arrest because they don’t have enough calcium from some of these homemade recipes. Then, the other part is honestly why this one formula company got shut down, and it’s foodborne illness. So if you are giving your infant, for example, raw goat milk or unpasteurized milk to supplement human milk or a homemade formula, you’re at risk for foodborne illness, salmonella [and] E. coli. And that is also what the FDA is helping to regulate.”

Parents might also put themselves at risk of having their children taken away by Child Protective Services. Pediatricians are mandated reporters, so if they notice a child is severely lacking nutrients or appears to be malnourished, they are required by law to file a report.

Even though some of the advice is harmful, there is still a need for parents to build solid support systems and have villages of concerned and thoughtful people, outside of the naysayers. 

“I will say one thing I think women need to do, and what we tend to do well is really lean on each other as a community,” Hill said. 

Members of the mama village might also include milk donors or even just a woman who inherently understands what mom is going through. 

“So, this is me speaking through my mama hat — one of my colleagues and I were talking about my own struggles. I have a 13-month-old baby and literally breastfeed as much as I could when I was around baby. And then breast pumping as much as I could when I’m not around baby, but I was still falling short,” Hill said. “I was noticing that my supply was dipping despite literally all of my best efforts. And so I was confiding in another breastfeeding mom and lo and behold, she is a super producer. Had I not been open and vulnerable with sharing my story, I never would’ve known. We literally developed a bond where she became a milk donor for me.”

According to the American Pregnancy Association, donated breast milk comes from “mothers that have pumped more milk than their own baby can eat.” As such, these women, known as super producers, may opt to donate their excess milk. This can be done safely through donor banks that test the milk before processing donations. 

“I’m not saying every milk donation experience is gonna come like that, but I think as women if we can stop judging one another and really lean into being a community and helping one another, we can come up with creative, safe solutions,” Hill said.

“Really working on [building] community, supporting one another legislation-wise. I think we need to come up with better family medical leave policies, so moms have more time to be at home with their babies to establish good breastfeeding, and then we really need to push back on these companies — they need to get it together and get this formula out.”

Hill, speaking as both a mother and doctor, said that it’s key to remember that while breastfeeding is important, it’s equally essential to support a mother’s mental health. 

“I think the big take-home point that I just want to get out there is that yes, breastfeeding is important, but we need to do more to support mothers 360,” she said. “It’s May — it’s also Mental Health Awareness Month. And a lot of moms have really undo societal pressure to solely breastfeed their babies. And we’re just not often able to support them as much as possible. And I think that this is going to really impact some moms who have a genuine need for formula as a way to sustain their babies.”