In 2022, when an Abbott plant closure triggered a nationwide infant formula shortage, Congress moved with unusual speed. Lawmakers treated formula as critical infrastructure. The Access to Baby Formula Act of 2022 gave USDA permanent flexibility to waive WIC rules so families could obtain whatever formula was available. Supplemental appropriations delivered emergency funding to the FDA. The broader Food and Drug Omnibus Reform Act provisions embedded in the Consolidated Appropriations Act of 2023 designated infant formula a “critical food,” required manufacturers to notify the FDA within five business days of any production interruption or permanent discontinuance likely to cause a meaningful disruption, created an Office of Critical Foods, mandated a national strategy for supply-chain resilience, and allowed expedited premarket processes during shortages. Subsequent efforts, including proposals such as the Infant Formula Made in America Act, have focused on domestic manufacturing capacity and tax incentives for smaller producers.
These laws demonstrate something important: when Congress decides a product is essential to infant survival and national security, it is willing to expand FDA authority into supply-chain monitoring, create new offices, appropriate targeted funds, rewrite program rules, and treat interruptions as public emergencies. Formula access for mothers was protected. Babies’ access to breastmilk was not.
That asymmetry is a problem. It actively undermines the very supply it claims to supplement.
Breastfeeding (the Biological Supply Chain), Is Being Systematically Disrupted
Breastmilk is produced by a living, responsive system: the mother-baby dyad. Milk volume is governed by frequent, effective removal. Anything that reduces frequency, confidence, or contact reduces supply. Perceived insufficient milk supply (PIMS) is one of the most common reasons mothers stop breastfeeding or introduce formula. Research consistently shows that PIMS is strongly shaped by external suggestion, delayed initiation, early supplementation, low breastfeeding knowledge, and low self-efficacy. When a mother is told - explicitly or by implication - that her body is likely to fail, that formula is “as close as possible,” that mixing is harmless, or that separation for work or childcare is inevitable, her supply is placed at risk. The physiological feedback loop is real: fewer feeds lead to less milk, which confirms the original doubt.
The formula industry’s business model depends on converting that vulnerability into market share. Its tactics deliberately target the conditions required for milk production. These include:
Engineering and amplifying perceived insufficient milk supply (PIMS) by suggesting to mothers that their bodies are unlikely to make enough milk
Claims that formula is “close to breastmilk” “settles baby” or “boosts brain growth”
Promotional materials that frame normal crying or cluster feeding as problems that formula can solve
Hospital discharge bags and free samples
The normalization of mixed feeding
Government and structural policies, even when not intended as commercial strategies, further disrupt the biological supply. These include:
Lack of paid parental leave of sufficient duration
Workplaces without effective lactation accommodations
Government-subsidized childcare that does not prioritize or compensate for breastfeeding dyads
The fact that WIC purchases more than half of all infant formula sold in the United States. This massive government purchasing power functions as a continuous, publicly funded advertisement that normalizes formula use and shapes both market concentration and cultural expectations around infant feeding
The political signal that formula shortages trigger emergency legislation and dedicated offices while breastfeeding rates and support systems do not — a message that itself erodes maternal confidence and treats the commercial product as more critical than the biological one
The scale of public spending on formula through WIC should be matched or surpassed by equivalent investment in high-quality breastfeeding education, skilled lactation support, and the structural conditions that protect the dyad. Anything less continues to subsidize the disruption of the primary supply while treating the secondary product as the priority.
Protecting formula without protecting the conditions for breastmilk production therefore does not merely leave a gap. It tilts the field. The very act of treating one as critical infrastructure and the other as optional private effort, undermines breastfeeding.
What Parallel Protections Would Look Like
If the government treated mothers’ milk with the same seriousness it treats formula, the rules would focus on protecting the dyad for at least the first two years - the period for which continued breastfeeding is recommended by major health authorities. The following elements mirror the structure of the existing formula protections while addressing the actual production system:
Notification and response for disruptions to the breastfeeding support infrastructure
Just as manufacturers must report production interruptions that threaten formula availability, hospitals, state public health agencies, and major employers receiving federal funds or contracts could be required to notify HHS of material reductions in lactation support capacity, including:
Closure of hospital lactation programs
Elimination of IBCLC positions
Failure to maintain Baby-Friendly standards
Large-scale loss of workplace lactation space and break time
Triggered notifications would require rapid public reporting and corrective action plans, similar to the shortage-distribution mechanisms already created for formula.
A national strategy and dedicated capacity for the biological supply
Congress has already required a national strategy on infant formula resilience. An equivalent strategy for breastfeeding would:
Set measurable targets for exclusive breastfeeding at six months and continued breastfeeding at twelve and twenty-four months
Identify gaps in skilled support, workforce training, and paid leave
Coordinate across HHS, USDA, Labor, and Education
An Office of Human Milk or expanded Office of Women’s Health function could house this work, paralleling the Office of Critical Foods.
Funding and program flexibility that prioritize the primary supply
The Access to Baby Formula Act gave WIC flexibility during shortages. Parallel authority should allow states to:
Redirect resources toward breastfeeding support
Expand peer-counselor and IBCLC coverage
Prioritize breastfeeding support without administrative barriers when local rates fall or when support infrastructure is disrupted
Emergency appropriations mechanisms used for formula oversight could be mirrored for rapid scaling of lactation support during crises that separate mothers and babies (disasters, pandemics, or economic shocks that force early return to work).
Domestic capacity building for the support workforce and human milk supply
The Infant Formula Made in America proposals seek to expand manufacturing capacity. Equivalent investment would:
Expand the pipeline of International Board Certified Lactation Consultants, peer counselors, and trained maternity staff, particularly in underserved areas
Fund community-based models that keep mothers and babies together
Strengthen and expand nonprofit donor human milk banks and systems for safe, equitable distribution of donor human milk, treating banked human milk as a critical bridge when a mother’s own milk is unavailable or insufficient rather than as an afterthought to formula
Protecting the supply of banked human milk
Donor human milk is the closest available alternative when a mother’s own milk cannot meet her baby’s needs, particularly for vulnerable infants in neonatal intensive care. Yet milk banks operate with far less structural protection than formula manufacturers. A serious approach to human milk supply would require notification of significant disruptions or capacity reductions at milk banks, dedicated funding to expand collection, screening, and distribution capacity, integration of donor milk into hospital and public health systems as a preferred option over formula when mother’s own milk is insufficient, and policies that support milk donation rather than treating it as a marginal activity. Protecting banked human milk is not a substitute for protecting the mother-baby dyad; it is a necessary complement that keeps babies on human milk when the primary supply is temporarily interrupted.
Marketing and information rules that stop the deliberate seeding of doubt
Formula already faces compositional and labeling requirements. Parallel rules would:
Prohibit claims that formula is nutritionally equivalent or “as close as possible” to breastmilk in marketing directed at the general public
Ban the use of idealizing imagery and language that implies formula is an equivalent to breastmilk
Require clear statements that breastmilk is the biological norm and that almost all mothers can produce sufficient milk with adequate support and frequent feeding
Require labelling that states that formula use is associate with diminished breastmilk supply and can create a dependency
Full, enforceable implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent WHA resolutions would close the largest remaining gap. The United States still lacks comprehensive legal measures on the Code; that absence is itself a policy choice that favors commercial disruption of the biological supply.
Structural protections against separation
Supply resilience for breastmilk requires protecting contact. This means:
Paid parental leave of sufficient duration and flexibility to allow frequent feeding or pumping without income loss
Enforceable workplace lactation standards with meaningful remedies
Childcare policy that either enables on-site or near-site care for breastfeeding dyads or provides additional compensation and priority access for families maintaining breastfeeding
Government-subsidized childcare that effectively requires early, prolonged separation without lactation support is a supply interruption.
Public messaging that does not itself undermine supply
When elected officials and agencies respond to formula ‘shortages’ with emergency language and legislation while remaining silent on the far more common disruptions to breastfeeding, they reinforce the perception that formula is the reliable option and breastmilk is precarious. Official communications should treat protection of the dyad as the primary public-health objective and formula as the necessary alternative when breastfeeding is not possible or sufficient.
The Practical Path Forward
None of these measures require inventing new science. The physiology of lactation, the impact of early supplementation and separation, the role of marketing in shaping PIMS, and the documented health and economic returns of higher breastfeeding rates are already established. What is missing is the political decision to treat the biological supply with the same seriousness already shown to the commercial one.
Congress has proven it can move quickly when formula shelves empty. The same institutions can require notification of support-system failures, fund a national resilience strategy for human milk (including donor milk systems), restrict marketing that seeds doubt in mothers minds, and remove structural barriers that separate mothers and babies for the first two years. We must stop subsidizing the disruption of breastfeeding (the primary supply) while pouring resources into formula (the last resort back up).
Until that symmetry is restored, every new formula-specific protection continues to send the same message: the commercial product is critical infrastructure; the mother’s body is not. That message is costly. It is itself a disruption of supply.