The baby-formula shortage has been something of a nightmare for Aleisha Velez, a 25-year-old mother of two who lives in Philadelphia. Velez relies on the federal government’s Woman, Infants, and Children (WIC) program to get free formula, which means she can’t just get the product shipped to her home. So over the past two months, she has called store after store to find in-stock formula before traveling up to an hour one-way on a train or a bus (or both) to get it. And then she does it all over again: Because many stores are limiting how much formula parents can buy, she now makes the trek about once a week, compared with once a month before the shortages. “I’m sitting here struggling to make sure my son has what he needs,” she told me while on the way back from a formula run. “I don’t see how it’s fair.”
With more than 40 percent of the country’s infant formula currently out of stock, millions of parents are scrambling to get ahold of supplies. But other parents with the means and know-how are relying on a controversial workaround—they’re tapping into a black market that lets them get formula from around the world shipped right to their home. Across social media, parents have been swapping advice and resources for how to get hold of various kinds of European formula, which is illegal to import to the United States.
Access to what is the primary form of nutrition for many babies has long been unequal. The parents of about 1.5 million infants have to wade through the aggravating bureaucracy of the welfare state simply to get a necessity. In contrast, a sizable number of parents evade the law to import European formula in order to access ingredients and nutrition standards that differ from what the FDA allows. American formula already is quite expensive, but smuggling in the European stuff is on another price tier altogether, running about four times more than the cheapest U.S. formula, and that’s before factoring in shipping costs. But now, as more wealthy parents opt for European-made formula in light of the crisis at home, the inequality is compounding. While some parents struggle to get formula at all, others are bypassing the American market to get what they view as superior formula delivered straight to their doorstep.
The formula sold in the U.S. is highly regulated and provides adequate nutrition for growth, but skirting the law to buy products from Europe opens up a whole new world of options. Though no U.S. manufacturers make formula with goat milk, for example, which some parents say their babies tolerate better, several brands in Europe do. Because of all the different choices, the black market started gaining steam in about 2015 among parents who are hyper-focused on the ingredients their kids consume, Anthony Porto, a pediatric gastroenterologist at Yale who studies infant-feeding trends, told me.
Indeed, on a prominent Facebook group with more than 30,000 members, parents write that they are looking for “the closest formula to breastmilk” and that they want to avoid “GMO ingredients” and “added corn syrup.” (The GMOs and corn syrup in American formulas haven’t been proven to be detrimental to babies.) They share notes and spreadsheets about the ingredients in formulas they consider “best,” including the Swiss brand Holle, the German brand HiPP, and the U.K. brand Kendamil.
Because European brands aren’t out of stock, the latest bump in interest among Americans may have less to do with their ingredients than their availability. Though the Facebook group was created in 2016, the current shortages seem to have pulled even more people into this world. In recent days, the group seems to be full of posts from new members seeking guidance on switching to European formula. A representative of Happy Tots Organic, a website that sells European formula, said in an email that since news of the shortages began, “sales have increased by at least 25 to 30%,” and Organic’s Best, another website, noted that “we are receiving an exponential amount of orders.”
But even for people with means, buying from the infant-formula black market is not necessarily straightforward. Parents can’t order directly from the European formula companies, or an online retailer like Amazon; they have to go through eBay, Facebook buying/selling groups, or third-party websites that sometimes get shut down. (In some cases, depending on where parents are purchasing European formula, they might not even know that it’s illegal.) And whereas U.S. formulas range from $0.50 to more than $1.90 per ounce, Holle’s goat-milk formula costs about $2.20 per ounce on the black market, not including shipping. The total cost can run close to $300 a month, if a baby is exclusively formula-fed. In Europe, these same formulas cost about a third of what they’re marked up to in the U.S.
The potential problems go beyond just finding somewhere to buy European formula. In the past, the FDA has cracked down on the import of European formula by targeting the third-party websites that import and sell it online, and U.S. Customs seizes formula that it discovers at the border. (The FDA is now planning a process to temporarily allow in some formulas from abroad to alleviate the current shortage, provided they meet certain requirements.) Some safety concerns, too, make using European formula a bad idea, Porto said. The instructions typically aren’t in English, the preparation requires metric units, the ratio of water to powdered formula is different from the U.S. standard, and parents might not be alerted to recalls. There have been reports of parents mixing European formula wrong and giving their babies too little or too many calories as a result.
Though Porto doesn’t recommend imported black-market European formula, he does appreciate that the European Union periodically updates their formula nutrition requirements based on current evidence, whereas the FDA has only made one change since 1985. For instance, in 2016, the EU added a requirement for DHA, which studies have indicated “improved kids’ outcome for verbal and nonverbal cognition,” he said, noting that many U.S. formulas contain less than half of the DHA amount required in Europe. (When I reached out to the FDA for comment on its infant-formula standards, a spokesperson declined, citing all the media inquiries that the agency is dealing with.)
The black market couldn’t be more different from how families on WIC get baby formula. Each state runs its own WIC system, each with its own formula offerings. Even normally, WIC parents can access only a handful of options within a single brand, and, depending on the state, the formula they purchase must come from a brick-and-mortar store. Without a medical exemption, parents in South Carolina can select from three Gerber formulas; in Georgia, three from Enfamil. Even for states that are allowing WIC participants more choices than they normally do because of the shortage, that choice is unfortunately drastically limited by the current low availability.
Parents want what’s best for their babies, and it of course makes sense that during a crisis they’re going to reach for whatever formula they can get, whatever the cost. Rich parents will always more easily access products for their babies—whether it’s self-rocking bassinets, chemical-free car seats, expensive baby food—but none is as essential to a baby’s first year of life as human milk or formula. The fundamental tragedy of this worsening inequality is that while rich parents can access European formula with higher levels of cognitive-enhancing DHA, for example, the parents who stand to gain the most from formula largely can’t. Lower-income parents are more likely to use formula than wealthier ones, because there are numerous barriers to breastfeeding for these families—such as no paid family leave and fewer lactation accommodations, says Ifeyinwa Asiodu, a professor at UC San Francisco whose research focuses on infant disparities.
Now that formula has the nation’s attention, Porto hopes for changes that could ensure that formula access isn’t so skewed. Perhaps some of the changes that the FDA is now pursuing will become permanent, opening the door for European formulas that are legally transported and appropriately packaged for American consumers, which would also make them significantly cheaper and increase competition in our limited American-formula market. Or maybe states will ease up on their WIC restrictions, helping parents more easily purchase the formula they need or want. And changes to FDA regulations could ensure that every formula has the same minimum standards for helpful ingredients and harmful ones.
For now, how American parents approach formula will continue to move in opposite directions. When I reached Velez on the bus, she lamented that at various points since the shortage began, she’s had to withhold bottles of formula and try to get her 9-month-old to eat more food now that he’s old enough for solids. And she was coming home without formula—the store she had visited was all out. The same week, a mom posted in the European-formula Facebook group with an update: “Just wanted to share that I ordered Kendamil on FormulaLand Inc and it got here in 4 days!”