Rosa Ninahuanca stands outside the Homeless Prenatal Program with one can of baby formula for her 3-month old. It’s enough for just a few days—if that.
The restaurant worker doesn’t know when she’ll be able to re-up, which she can’t afford on her own as long as she’s off work to nurse her infant.
And the Potrero Hill nonprofit serving homeless and low-income mothers can no longer give out formula in large quantities: Cans can cost between $17 and $55, depending on size, brand and mix, and a nationwide shortage has made it exceedingly hard to come by.
“I know it’s not going to last me,” Ninahuanca said in Spanish translated by a staffer from the Homeless Prenatal Program. “I’ve become very worried because I have another child. I don’t have the money.”
Since Abbott recalled its baby formula due to a bacterial contamination investigation and plant closure in February, parents nationwide have scrambled to maintain supplies to feed their babies.
The pandemic had already disrupted the few companies—including Abbott—that make infant formula in the U.S.
In early May, baby formula scarcity peaked in San Francisco with a 32% out-of-stock rate while the country hovered at 43%, according to the latest numbers from retail data service Datasembly. That compares to 16% at the beginning of the year in the city, before the formula recall.
San Francisco is in better shape than other parts of the country, like Nashville with a 58% out of stock rate and Washington, D.C. at 54% out of stock.
Until the shortage, Homeless Prenatal Program was able to order large wholesale quantities of Enfamil and hand out as many cans as parents requested after waiting in long lines during its weekly food distribution.
Now, the nonprofit can only order smaller amounts while Target and Costco allow customers to buy two two-packs at a time. The organization's Amazon order of new formula, meanwhile, has been delayed at least three weeks.
The shortage has placed enormous stress on clients, according to Homeless Prenatal Program's founder and outgoing executive director, Martha Ryan.
A stockpile of formula at its warehouse on 18th Street and Potrero Avenue has dwindled to just a few small shelves.
“It’s really affecting the moms,” she said. “Imagine being a mom and how worried you would be on top of all these things you’re dealing with.”
The shortage has, naturally, led to a suggestion to simply breastfeed. But not all mothers can produce the needed amount of milk for medical conditions like diabetes or past breast surgery. Pumping to bottle feed takes time and money for equipment that not every mother can access.
Meylin Hernandez was able to breastfeed her 4-month-old until undergoing pancreatic surgery earlier this month, which coincided with the height of the formula shortage.
She was previously able to buy cans through the federally-funded Women, Infants & Children (WIC) Supplemental Nutrition Program but that is no longer enough now that she can’t breastfeed at the same level. Cans last her about three or four days.
Preparing to pay more for formula, Hernandez plans to go back to cleaning houses in a month while her husband works as a day laborer to pay $2,500 rent on Third Street. The couple also has a 4-year-old.
“I can no longer breastfeed my baby,” Hernandez said in Spanish, through the same translator as Ninahuanca. “Some days I worry a lot because I don’t have work. My husband works really hard.”
Keeping an infant fed every three to four hours is considered a full-time job, said Sarah Quigley, a lactation consultant at University of California, San Francisco.
Breastfeeding takes about 30 minutes a session. There are also premature newborns, fostered or adopted babies who are not in the immediate care of their birth mothers.
“Although breastfeeding is natural, it doesn’t come naturally,” said Priti Rane, director of nutrition services who oversees programs like WIC at the San Francisco Department of Public Health. “Formula is designed to meet all of the nutritional needs of a rapidly growing infant. Any imbalances of forfeiture of these nutrients are going to have lifelong consequences.”
In light of the shortage, Bay Area public health officials on Friday urged parents not to dilute formula to stretch their supply or attempt to make it themselves. They also advised refraining from using expired formula, toddler formula for infants, or cow, goat or plant-based milk.
The supply isn’t impossible in San Francisco. But the uncertainty still permeates local mothers like Ninahuanca. She is not working so she can care for her newborn and 7-year-old while sharing a studio with three other people on Ellis Street. She’s trying not to stress, which could cause her body to produce even less milk.
For parents with the money to buy formula, it’s simply not as readily available as it typically is and may take more effort to track down.
Families that Quigley works with are finding that their usual places to pick up formula are out—so they try to order it online.
Government officials Rep. Josh Harder of Turlock and U.S. Transportation Secretary Pete Buttigieg say they’ve personally dealt with shortages for their infants.
Yet there seem to be glimmers of hope on the horizon.
Last week, Abbott reached a deal with federal authorities to reopen its plant in compliance with food safety regulations and President Joe Biden invoked the Defense Production Act to speed up manufacturing of baby formula and import supplies from abroad.
Parents short on milk can try Mother’s Milk Bank—which is based in San Jose and serves the Bay Area—while parents with a surplus of milk can donate their supply, Quigley said. The group will pay for equipment and shipment.
Low-income families can also apply for WIC and receive lactation support through hotlines like La Leche League International and other organizations compiled into a guide by UCSF.
“Every parent wants to make sure their child is getting enough to eat,” Quigley said. “If there’s anything compromising that, it’s going to be all consuming for parents. The uncertainty right now is, ‘Do we have more supply coming in? Is it going to get worse?’ That’s the thing that a lot of people don’t know.”