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Melissa Harris-Perry: This is The Takeaway. I'm Melissa Harris-Perry. The United States is entering its fourth month of an infant formula shortage, and disturbing new numbers released Friday show the situation hasn't gotten any better. According to data assembly, more than 70% of infant formula is out of stock across the country, affecting millions of families, and that's up from 43%, just a few weeks ago. In many states, the shortage is even more dire.

President Biden: There's nothing more stressful than the feeling you can't get what your child needs, he or she needs. It's why I've directed my administration to use every tool available to increase the supply, get more formula on shelves as quickly as possible.

Melissa Harris-Perry: That, of course, is president Biden. He was speaking yesterday at a virtual meeting with infant formula manufacturers. In February, Abbott Nutrition, the largest manufacturer of infant formula in the country, shut down one of its largest plants in Sturgis, Michigan, and recalled its products due to contamination problems. This exacerbated a preexisting pandemic supply chain issue.

Now the plant was shut down after four babies were reported having rare bacterial infections last fall, two of the infants died. The babies had reportedly consumed TCF formula from the Abbott plant, but after an investigation, the FDA found no conclusive evidence that the strains came from that plant. Last Wednesday, while testifying to a House of Representatives oversight panel, the head of the FDA detailed the "egregiously unsanitary conditions of Abbott Nutrition's plant in Michigan.

Robert Califf: Frankly, the inspection results were shocking. Standing water, cracks in the key equipment that present the potential for bacterial contamination to persist, particularly in the presence of moisture, leaks in the roof, a previous citation for inadequate hand washing, and current poor foot sanitation, bacteria growing from multiple sides, and many signs of a disappointing lack of attention to the culture of safety in this product that is so essential to the lives of our most precious people.

Melissa Harris-Perry: On Tuesday, Abbott announced that it will begin reopening its Michigan plant by June 4th, with some formula expected to start rolling out by the end of June, although full production of the plant will take even longer. In the meantime, President Biden's operation fly formula has announced its fourth additional shipment of infant formula from overseas. It's an effort to offer caregivers some relief during this continuing shortage, but for now, the desperate searching for infant nutrition continues for so many. We spoke to one mother.

Sarah Cosley: I am Sarah Cosley. I reside in Dubuque, Iowa. I am the original group administrator for the Infant Formula Shortage Support Group that we also started here out of Dubuque.

Melissa Harris-Perry: Sarah started to notice a shift in formula supply back in January, even before the Abbott Nutrition plant closed.

Sarah Cosley: The stores which are actually only two in my area that carry this particular Similac formula, they had zero stock on the shelves. I actually started to panic. I already had some pretty intense postpartum anxiety. I was dealing with a lot, especially because I almost didn't survive her birth. Not only was I facing health challenges, physical and mental myself, I was also taking care of a brand new baby and she was pretty. I was really, really, really freaking out when I could not find her food, and I realized that I had very low stock at the house.

Melissa Harris-Perry: In response to this dire situation, Sarah began to supplement her daughter's formula with ready-to-feed bottles. Now, these are the liquid versions of the powdered formula she used, but eventually, those two became hard to find. At the beginning of May, Sarah decided to start a Facebook group to connect with other parents, struggling to find baby formula.

Sarah Cosley: That was one of the main reasons why I started the group was because I couldn't feed my own child and I knew I wasn't alone. I felt compelled to do something. Currently, I have a mother out of California that has shipped me some of her own supply and is actually shipping me another can of an alternative, it's not even the original formula, it's a different branding, same type of ingredients. She's keeping me going right now. God bless her heart. That's where we're at.

Melissa Harris-Perry: Sarah's group now has more than 2,500 members, and it's only one of dozens of Facebook groups out there.

Sarah Cosley: We've got people from Texas, Florida, Maryland, Minnesota, Utah, California, Nevada, Iowa, Kansas, Nebraska, Tennessee.

Melissa Harris-Perry: Even now, nearly four months into the infant formula shortage.

Sarah Cosley: It is an intense struggle still at this point. I'm several months down the road from where I started. The only way that I am currently getting formula is through shipments from other moms. That's how I'm feeding my child.

Melissa Harris-Perry: Meanwhile, Sarah and other volunteers in the Facebook group are also moderating scammers who are posting in the group, trying to take advantage of this critical situation and of how distressed parents have become, but Sarah still finds hope in her group.

Sarah Cosley: It has brought me to tears almost every single day how amazing people really are. I could let the scamming bring me down just say, "That's it, I'm going to shut this down," but I'm not going to. I'm going to keep this going because the overwhelming response is positive, it is supportive, it is bringing hope to other moms, other dads, other family members that are in need.

It's bringing everyone so much comfort, and just to be able to talk about how frustrated you are, or to be able to come on and share and say, "Hey, look what's in this area, or look what I'm finding in this city at this store, if you're in the area, if there's something I can get you," we are all over the place and we are taking care of ourselves because no one else is taking care of us. We've been left to our own devices.

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Melissa Harris-Perry: All thanks to Sarah Cosley for sharing with us and for all the work that she's doing. I want to keep this conversation going. I'm joined now by Carla Cevasco, an Assistant Professor of American Studies at Rutgers University, New Brunswick, and author of Violent Appetites: Hunger in the Early Northeast. Thank you for being here, Carla.

Carla Cevasco: Thank you for having me.

Melissa Harris-Perry: I just have to start with the thing that is making me perhaps the most angry in this moment. We had even some of our wonderful Takeaway community call and say this, these folks who keep saying, "Why not just breastfeed?" Any chance you can respond to that?

Carla Cevasco: Sure. I'm a historian who studies the history of how people fed their babies and children. In doing my research, it's become very clear that people have always struggled with breastfeeding for a variety of reasons. Baby might be premature, or have trouble latching for various reasons.

In the past, maternal mortality rates were quite high up to one in 20 women, so sometimes there wasn't a birth parent there to breastfeed the baby. In the past, before modern antibiotics, problems like cracked nipples, or mastitis could actually be fatal. That's before you get into low supply, things like postpartum depression or anxiety, or other postpartum health issues that can make it very challenging for people to breastfeed.

Melissa Harris-Perry: Thank you. I appreciate you weighing in on that. I'm the mom of both a child that I had biologically, and a child who was carried for our family by gestational surrogate, and I breastfed one and it was obviously impossible to breastfeed the other because I'd not carried her.

Carla Cevasco: Yes, adoptive parents too. There are always going to be people who need alternatives to breast milk.

Melissa Harris-Perry: Thank you. I just wanted to make sure we were clear around that because it's hard for me to even get in touch with the level of panic I would've felt had we been unable to find the very specific formula that our early-born infant, who had severe lactose intolerance and would spit up everything except one formula, if that had not been on the shelves, I'm just not even sure how we would've been feeling in that moment.

Carla Cevasco: I think that's the reason that I started weighing in on this topic was because I was seeing people describe infant formula as some modern luxury, when it's essential. Babies need to eat.

Melissa Harris-Perry: Talk to us a bit about Modern Formula. It is certainly not a luxury. It is certainly a necessity, but the kind of formula that we have now is something quite different than folks who were, for example, trying to feed infants at the turn of the century. Tell us a bit about that.

Carla Cevasco: I'm a historian mostly of the 17th and 18th centuries. Before the 20th century, there are situations in which people are unable to feed their babies breast milk, and they're turning to alternative foods. These alternative foods would've been, as you can guess, softer liquid foods, the same textures that we feed babies today. The difference between these foods and Modern Formula is that these foods were not necessarily nutritionally complete to support a baby's development and they also weren't necessarily safe from a food safety standpoint.

Now, the problems that the Abbott facilities show how important it is to have really strict food safety standards around baby food. Until the middle of the 20th century roughly, parents could not rely on having a safe, nutritionally, complete alternative to breast milk. It was very common for babies to die of basically food poisoning, chronic diarrhea, digestive ailments, and also to die of malnutrition if they were not able to have breast milk.

Melissa Harris-Perry: I'll point out that into the 1970s, iIt's also true that women living in poverty often didn't have the capacity to feed their infants. The women infant and children's program, which we call WIC doesn't begin until 1974. I know that my own grandmother supplemented my dad and his siblings with basically like powdered milk, like pet canned milk because as a woman living in poverty, that was often all that she had.

Carla Cevasco: A lot of these substitutes are, again, not nutritionally complete. That's one of the aspects that I find frightening about this situation is that people are turning to these homemade substances to try to feed their children. People have been asking me, "What are historical formula recipes I can feed my kids?" I'm like, "No, talk to your pediatrician. This is not a situation to DIY even if in the past," the majority of the baby boom generation was raised on basically homemade formula. Nevertheless, we don't want to go back to that. We do not any longer consider that a safe alternative.

Melissa Harris-Perry: Okay. Carla, I want you to pause with me for a minute. We'll be back with more on the history of infant formula, but I really want to talk about how do we get to a place where just the shutting down of one plant can have this enormous effect.

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We've been talking about the ongoing infant formula shortage with Carla Cevasco, Assistant Professor of American Studies at Rutgers University, New Brunswick. Carla, I heard you say something before the break. You said, I decided to speak out on this to begin talking about it. What had been your initial reservation about doing so?

Carla Cevasco: Doing this research, I had always known that it would be able to have a public impact because, breast versus bottle, formula feeding versus breastfeeding is seen as one of the mommy wars, seen as one of these really controversial topics in American parenting, something that even lots of non-parents seem to have opinions on.

Looking at the history of infant feeding, it became very clear to me as it is very clear to the parents experiencing the shortage now that this is a matter of life and death and that we should not take for granted the existence of a safe, alternative to breast milk. We should not take for granted the existence of safe food to feed babies, because that's something that parents before about a hundred years ago could not take for granted. Many of them had to live through the pain of losing a child because they didn't have access to safe, adequate nutrition for their child.

Melissa Harris-Perry: Let's talk a bit about Abbott and this shutting down a single plant, having such a long-term rippling effect. Even as we were telling the story coming in, I guess of the two, I'm sure struggling in ways that many folks are, you want a safe plant for this formula to be crafted on the other hand, shutting it down altogether, or at least parts of it has created this enormous shortage. Why does one manufacturer's single plant have such a big effect?

Carla Cevasco: The infant formula industry is very highly regulated and has been since the 1970s, 1980s. That means that there's only a handful of plants in the United States that can meet the specifications to in order to produce this formula. Unfortunately, the Abbot plant wasn't actually meeting those specifications come to find out, but it means that having just one plant shut down has these massive effects on the formula supply in the United States. There were already supply chain issues due to the pandemic early in the pandemic, there were a lot of parents scrambling for baby items, including formula.

Melissa Harris-Perry: We see that the Biden administration here is trying to take some steps to address the shortage. I'm wondering if there's any previous times in US history where the federal government has stepped in to try to address questions of the availability of infant nutrition for families.

Carla Cevasco: Well, so during World War II, at that point, the original meaning of formula was that it was basically your pediatrician handed you a piece of paper. My mom still has this piece of paper that said what, proportions of evaporated milk and maybe corn syrup and water you were supposed to mix together to make formula for your baby. It was supposedly calibrated to a specific child. During World War II, when babies were being fed this homemade formula, there was a shortage of cans because cans were going to the war effort.

The historian, Janet Golden just wrote a piece about this for the Washington Post. The US government stepped in recognizing that the canned, the canned milk supply was an essential homefront supply for parents of infants. Especially as lots of women were going into working in factories, there was a huge need to have the supplies to make formula. That was a moment where the US government did step in to ensure that this domestic supply of canned milk was available to parents.

Melissa Harris-Perry: I'm sorry. I am still reeling, are you saying that pediatricians were handing moms an actual formula, like suddenly, why we call it formula struck me. Is that where that comes from?

Carla Cevasco: The reason it's called formula is because it was basically a recipe, a formula, the proportions to mix together to make your own.

Melissa Harris-Perry: Of corn syrup.

Carla Cevasco: Things, including corn syrup. Yes.

Melissa Harris-Perry: oh, I'm sorry. I am suddenly amazed that any of our elders made it, this is fairly stunning actually. Talk to me then in this moment, you said that some folks have asked you for your 17th century, 18th-century knowledge of homemade formulas, that does sound to me like there's a distress and anxiety about this capacity to feed one's child. I'm wondering if that is then related to health family, mental health, infant health in the long term. Do we know anything about that?

Carla Cevasco: I think I'm a historian, but the social science research is clear that families that face various forms of resource scarcity. The mental load of just trying to figure out how you're going to be able to afford formula, how you're going to be able to find it under these circumstances does take a toll on children's mental health as well. I wanted to say about WIC that WIC provides nutrition to women, infants and children, but it's also a very restrictive program.

People on WIC can only buy certain kinds of food in certain package sizes, and often only at certain stores. When you put a supply chain crisis on top of that level of restriction, some states have relaxed their regulations on what formula WIC recipients can buy in light of this crisis. These are populations that are already jumping through a lot of hoops to feed their families and that this crisis comes on top of what is a very challenging system to navigate?

Melissa Harris-Perry: How does our past around these issues of child mortality of maternal mortality and health? How does it inform this present moment?

Carla Cevasco: I think that there is a tendency in our political discourse a lot to look back to this imagined American past when everything was great. This imagined American past when everyone breastfed and it was easy and people today just can't live up to that past. I want to make it very clear as a historian that we do not want to return to a pre formula past. There will always be people who need formula for a variety of reasons.

Even if the United States had the most supportive social safety net in the world and had paid parental leave, which would studies show enable more parents to breastfeed and to keep up breastfeeding longer, if they so chose, there would still always be people who need or want to use formula. To venerate an imagined past when in the actual past, the foods that were available were not safe and not nutritionally complete is a really dangerous idea when we're faced with this crisis.

This is on top of parents of small children have faced an incredibly challenging time during the pandemic. Children under five are still not eligible for vaccination. Parents have been dealing with massive disruptions to the childcare industry and access to childcare. To add on top of that, inability to feed your child on a daily basis, it is really breaking a lot of people right now.

Melissa Harris-Perry: Carla Cevasco is an Assistant Professor of American Studies at Rutgers University, New Brunswick. Carla, thanks so much.

Carla Cevasco: Thank you.

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