As worried parents across the country scramble to secure formula for their babies amid a nationwide shortage, Black parents, who are less likely to breastfeed, might be bearing the weight of the panic disproportionately.

In recent weeks, stores across the country have been scrambling to keep up with demand for baby formula, pushing some retailers to limit sales as the U.S. Food and Drug Administration and the White House struggle to address the worst powder formula shortage in decades.

The shortage is a result of the supply chain disruptions that began in the midst of the COVID-19 pandemic — slowing production of a wide array of consumer products — combined with a catastrophic formula recall in February. Abbott Nutrition, the nation’s largest baby formula manufacturer, recalled all baby formula produced at its Michigan plant and halted production after four babies fell ill with bacterial infections. Two of those four children died. The FDA is continuing its investigation into consumer complaints and warning consumers against using Similac, Similac Alimentum, and EleCare powdered infant formulas. 

Abbott could resume production within two weeks, meaning the product could be back on shelves in six to eight weeks, the company said in a statement. But that’s subject to approval by the FDA. 

When Abbott shut down its factory in February and recalled its products from shelves, a large portion of the nation’s supply was lost. And because Black families are more likely to use formula to feed their babies, experts worry they’re facing disproportionate impacts as a result. 

The overall prevalence of breastfeeding newborns is nearly 85%, according to the U.S. Centers for Disease Control and Prevention. For Black families, it’s about 73%. The Black parents who do start off breastfeeding are more likely to stop at an earlier age.

“I can’t imagine some of the fear these mothers have,” said Dr. Valeria Cohran, a pediatric gastroenterologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, where she often treats  infants with feeding difficulties and digestion issues. “Feeding your child is one of the fundamental things, as a parent, that people do. To not know where you’re going to get formula from, or if you can get formula, has been very stressful for families.”

 And for families whose children require specialized formulas, the stakes mount. 

“Some of the formulas are made for kids with a variety of different medical conditions. Some children may have difficulties breaking down the proteins that are in milk or are simply allergic to different products in the milk,” said Cohran. “This resulted in some kids even getting admitted to the hospital until their families could get formula for their children.”

The cost of cans, particularly the specialty products, add additional barriers for parents. 

“Some families were unable to pay the money” to get substitutes, said Cohran. “Some of these formulas can cost thousands of dollars a month.”

The shortage reflects larger systemic issues that perpetuate disparities persistent across health care. 

“There are these bigger systemic issues that are leading to both the disparity in breastfeeding and the compounded impact that this shortage might be having on Black families,” said Tisha Felder, an associate professor at the University of South Carolina’s College of Nursing. She’s calling for more comprehensive regulations on formula production to prevent recalls and combat future shortages, she said. 

“Policies, instructions and processes need to be addressed,” she added.

The systemic issues Felder describes, along with medical racism and targeted marketing, are among the reasons why Black parents might be more likely to opt for formula over breastfeeding. 

“Some of it is racism in the medical field,” said Andrea Freeman, author of Skimmed: Breastfeeding, Race, and Injustice. “When [Black parents] are in the hospital, the baby’s given formula without being asked or they’re in a hospital that doesn’t encourage breastfeeding.” 

She also cites other factors such as limited parental leave from work and paid breaks for feeding or pumping. 

And then there’s the history of formula companies marketing to Black parents, a trend that began in the 1940s with the Fultz sisters. 

The identical Black quadruplets — the world’s first recorded quads — were delivered in North Carolina in 1946 by a white doctor who conducted vitamin C experiments on them and then negotiated a deal with the milk company, Pet Evaporated Milk, to feature the children in formula advertisements. The ads, which the girls appeared in until their teenage years, explicitly targeted Black consumers, who, until that point, were not loyal consumers of formula. 

The ad campaign, unique in that it was marketing something other than alcohol, tobacco, or beauty products directly to Black women, was an enormous success for Pet Milk, as Freeman wrote in Skimmed. It convinced Black women that formula was an equal, or even better, alternative to breast milk.

It’s history that experts say bleeds into the high rates of formula use within Black communities — one that is linked to the current shortage. 

“The formula shortage is a Black issue,” said Freeman. 

And it’s one with no immediate solutions. Pediatricians and health experts have warned against parents making their own formula, diluting what they have to make it last longer, or introducing cow milk too soon, all of which can be dangerous to babies or lack necessary nutrients.

“When you dilute formula, you not only dilute the nutrients, you dilute the different electrolytes that are in the formula and it may cause health problems for the child,” said Cohran. “I can see how families would consider diluting it, but that can be very dangerous, particularly for a younger infant.”

Without reliable workarounds, and with the threat of no formula on the shelves, parents are left with few options to safely feed their babies. 

Until formula production is back on track, the best thing to do is consult with your pediatrician on the most appropriate alternatives when formula isn’t an option, Cohran said. “All of this needs to be done under the care of your health provider.”

Margo Snipe is a health reporter at Capital B. Twitter @margoasnipe