State and Federal Restrictions Make It Harder for Lower-Income Families to Get Infant Formula

A shortage of infant formula plaguing the nation has been difficult for all families that need it, but state and federal limitations have made it even worse for lower-income families in California that rely on government assistance.

Those families receive vouchers to pay for formula through the federal Women, Infants and Children program, which provides supplemental nutrition assistance to lower-income pregnant, breastfeeding and postpartum individuals, infants and children under 5 years old. But the program limits which brands families can buy, making an already scarce supply even scarcer for program participants.

California received a federal waiver in February, when the shortage began, to make changes to the program to ensure formula was still getting to families that need it. Still, it took three more months for the state to expand the list of approved formula brands because of federal restrictions.

Even with the latest loosening of the program regulations, families are still struggling to find formula. Families and advocates say the state should lift all restrictions and allow families enrolled in the program to purchase any kind of formula they can find.

“At this point, at this level of shortage and with zero alternatives and selection, they should loosen the restrictions to the greatest degree possible,” said Jennifer Kelleher Cloyd, CEO of First 5 San Jose. “The way our benefits systems work, they are not quickly nimble or flexible for situations like these.”

The California Department of Public Health said when the shortage began it tried to expand the list of approved formula but had to wait because of federal rules restricting which states were allowed to do so.

Earlier this year, inflation and supply chain delays had already curtailed formula distribution. Then in February, a recall of certain formulas and the closure of the nation’s largest formula manufacturing facility, Abbott Nutrition in Michigan, hampered the industry. Abbott makes the popular Similac brand of formula.

At first, the federal government allowed only states that contract with Abbott for their program formula to expand their list of approved brands.

California does not contract with Abbott, so it didn’t add brands and upheld its exclusive contract with Enfamil-maker Mead Johnson, according to the Department of Public Health. The limited federal waiver the state received in February allowed recipients to exchange formula, waive medical documentation for formula and allow differently sized containers of formula to be purchased. Recipients could seek permission to buy other brands if they got a medical prescription from their physician.

At the time the state got the waiver, Mead Johnson was making enough formula for families enrolled in the Women, Infants and Children program, according to an email from Ronald Owens, a public information officer at the Department of Public Health.

“Mead Johnson was fully operational at the time of the Abbott recall and able to supply enough contract formula to California,” according to Owens’ email. The agency denied a request for an interview and only provided written responses to questions via email.

But it wasn’t just lower-income families buying Mead Johnson formula; it was all families looking for any available brand. So as the shortage worsened, the Mead Johnson supply wasn’t enough.

On May 25, federal officials allowed states to work with their contracted companies to expand their lists of approved formula brands. In California, Mead Johnson agreed the state could add other brands to the list on May 26. The next day, the state released the list of alternative options for families on the program.

Owens wrote that the state moved to expand quickly because the rate of voucher redemption dropped significantly in May to 970,430 benefits used, from a high of 985,011 in March.

Despite the expanded list, with so little formula on shelves families are still struggling. The Women, Infants and Children program allows substitutions, but they are limited for many families.

“The shortage has been challenging for every parent, but absolutely devastating for families living in poverty,” said Kelly Sawyer-Patricof, co-CEO of Baby2Baby, a Los Angeles-based nonprofit that provides necessities, like formula and diapers, for lower-income children and families. “The families we serve don’t have the luxury of switching to a more expensive brand, buying in bulk, or driving to multiple stores to search for formula.”

Infants under 6 months old cannot eat anything besides formula and breast milk. Infants older than 6 months can have pureed and solid foods but also need breast milk or formula. Babies can’t digest cow milk until they are at least 12 months old.

In California, 50% of infants, those under 12 months of age, are in families enrolled in the program and 80% of them are solely formula-fed or use formula to supplement breastfeeding and chestfeeding, according to the state. Families purchase nearly a million cans of formula a month through the program in California.

When families are enrolled in the program, they are placed into categories for certain formulas. In response to the shortage, the agency created a new category called “powder formula,” which offers up to 16 brands. It covers 12% of program families.

As of last week, 44% of families are approved for Enfamil infant, 35% for Gentlease and 9% for other brands. Those approved for Enfamil infant and Gentlease now have more than 10 other brands to choose from, but others with more specific needs may have only one or a few options.

Owens wrote that families in limited categories can request to be moved to a broader category if it’s appropriate for their infants.

For families, it’s not just the formula voucher program that has been affected but the food stamps they rely on to feed their families. The Supplemental Nutrition Assistance Program, known as food stamps, gives families a certain dollar amount for food, including formula. Some parents have used their food stamps to purchase formula at inflated prices if they could not find the brand allowed by their vouchers.

But buying formula with food stamps cuts into a family’s food budget.

Starlyn Darby has been using food stamps to purchase the kind of formula her son Zelimir eats when she can find it. But that leaves her less to feed her other children.

“It has been more expensive and I would be lucky to find it,” said Darby, who has looked all over Oakland for the formula she needs. “Since there is a shortage of formula, I feel like they need to increase the food stamps to be able to buy the ones that are more expensive.”

Eight-month-old Zelimir also breastfeeds, but Darby said she doesn’t produce enough breast milk for her son, who is underweight. She’s been cutting back on his formula to stretch it and trying to breastfeed him more often, but she is anxious he may not be getting enough.

In Southern California, Stephanie Del Toro, a social work youth advocate for First Place for Youth, manages former foster youth as they are transitioning into adulthood. Many of them have babies and rely on her to help them find formula.

“Not having transportation, not having big circles of support, they have to figure it out on their own and that’s where my role plays a big part,” Del Toro said.

Former foster youth Jewell Stewart, 19, is counting down the months to when her 9-month-old, Ma’laya Sanders, will outgrow formula. Her most recent container of Enfamil Gentlease formula came from her partner’s family more than 60 miles away in Moreno Valley.

“I just keep thinking she’s not going to need formula for that much longer,” Stewart said. Her baby turns a year old in October.

Until then, the Department of Public Health is adding options, such as imported brands, to the expanded list as they become available, Owens wrote.

The state estimates it could be a couple more months before the shortage eases.

“Despite efforts to increase infant formula supply, it is unclear when parents and caregivers can see formula supply levels return to pre-recall levels,” the state wrote in an anonymous email response. “It could take another six to eight weeks before formula from the Sturgis, Michigan plant is available on grocery shelves.”