Free Formula Samples Hamper Breast-Feeding Efforts

Nancy A. Melville

December 01, 2011

December 1, 2011 (Washington, DC) — New mothers who are not offered free infant formula samples by hospitals after giving birth tend to breast-feed longer; however, efforts to convince hospitals not to provide the samples are facing some tough challenges, according to research presented here at the American Public Health Association 139th Annual Meeting.

The World Health Organization (WHO) recommends that hospitals refrain from the common practice of providing the sample formula packets to new mothers, largely because it has the potential to undermine breast-feeding efforts.

A 2009 report from the Institute of Medicine on conflict-of-interest issues involved in the dissemination of industry-sponsored formula placed added pressure on hospitals to end the practice.

Despite the recommendation, however, the majority of hospitals in the United States continue to distribute the formula sample packets, according to the authors.

"Ninety-one percent of US hospitals distribute industry-sponsored formula sample packs to new mothers in violation of WHO recommendations," they write.

To investigate the effect of formula sample distribution on breast-feeding practices, the researchers prospectively enrolled 527 breast-feeding women at Cooper Hospital in Camden, New Jersey — 284 before the policy to discontinue this practice was implemented (control group) and 243 after the policy was implemented (intervention group). Researchers called subjects weekly for 10 weeks after discharge to check on infant status and infant feeding practices.

Those in the intervention group had significantly lower rates of stopping breast-feeding than those in the formula group (= .048).

Before the policy was implemented, mothers received discharge bags that often contained 6 months' worth of industry-sponsored formula sample packs. The policy was designed to discontinue this practice.

The actual rates of women who were provided formula in both groups, however, were discouraging — and somewhat disconcerting, said lead author Anne Merewood, PhD, MPH, director of the breast-feeding center at Boston Medical Center and associate professor of pediatrics at Boston University School of Medicine, Massachusetts. In the control group, 61% of women reported receiving formula in their discharge bag; in the intervention group, 28% reported receiving formula.

Overall, 51% of women received bottles of formula to take home before the policy was implemented, as did 56% after the policy was implemented.

"Despite a policy change, women continued to receive formula samples in discharge bags, presumably placed there by hospital staff. Women also continued to receive bottles of formula to take home," the authors write.

"The effect of the [policy] may have been stronger had it not been contaminated by such practices," Dr. Merewood said.

Although hospitals need formula to provide to mothers who are unable to breast-feed, better training of staff could make a difference in encouraging breast-feeding, she noted.

Melissa C. Bartick, MD, from the Cambridge Health Alliance in Massachusetts, agrees that the findings underscore the need for more education of staff and mothers.

"We see this over and over again. The staff means well and they think they are helping the mother by giving them these samples, but they really are not," she said.

"For one thing, it undermines breast-feeding; women who are provided with formula in the hospital are less likely to reach their breast-feeding goals."

"For another, since gastrointestinal intolerance to some formulas is common, mothers tend to develop a strong allegiance to a brand that their baby tolerates. If they are sent home with an expensive brand, that formula can wind up costing them as much as $700 more a year than a generic brand, so really, the staff is not doing the mother any favors."

The finding that breast-feeding cessation rates declined, despite only partial compliance with the policy not to disseminate formula samples, offers one encouraging sign of the potential benefits of full compliance of the policy, Dr. Bartick added.

"We know that mothers who receive formula when they don't need it can have breast-feeding difficulty, so one can assume that the results would likely have been even better if the staff hadn't been giving the mothers the formula samples," she said.

Dr. Merewood and Dr. Bartick have disclosed no relevant financial relationships.

American Public Health Association (APHA) 139th Annual Meeting: Abstract 247095. Presented November 1, 2011.

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