In a welcome bit of news for state health officials and breast-feeding advocates, the last few maternity hospitals that were still offering free infant formula gift bags to new mothers have decided to ban the practice. All 49 birth facilities in the state have voluntarily eliminated the formula giveaways as of the beginning of July, making Massachusetts the second state to do so. Rhode Island hospitals ended the practice last November.
“We applaud the effort of all of the hospitals to make this explicit statement of their support of breast-feeding here in the Commonwealth,” said Dr. Lauren Smith, the public health department’s medical director.
Back in 2005, Massachusetts tried to end the free formula practice with a statewide ban instituted by the Public Health Council, but that decision was overturned several months later when then-Governor Mitt Romney replaced council members who were in favor of the ban.
More than a dozen studies have shown that breast-feeding mothers who received free formula samples after they left the hospital were less likely to be breast-feeding by the time their infant was one month old. “Using formula without a medical reason is one of the biggest predictors of breast-feeding failure,” said Dr. Melissa Bartick, chair of the Massachusetts Breastfeeding Coalition.
But infant formula makers responded that formula giveaways have been inappropriately blamed for women opting out of nursing because it’s, for example, to difficult to maintain when they head back to work. “Some critics of formula samples claim research has ‘consistently shown’ that samples in discharge kits negatively affect duration of breastfeeding,” the International Formula Council, an industry group, said in a statement. “In fact, the research results have not been consistent. Some studies show an effect, while others do not.”
The group’s vice president Mardi Mountford added that parents of non-breastfed infants who are discouraged from using infant formula, “may resort to inferior methods of infant feeding which can cause serious nutritional deficiencies and put their infant’s health at risk.”
The American Academy of Pediatrics recommends that mothers exclusively breast-feed for the first six months to provide babies with protection against respiratory illnesses, ear infections, gastrointestinal diseases, and allergies. Breast-fed babies also have a lower risk of sudden infant death syndrome and a reduced likelihood of becoming obese teens and adults.
Whether or not free formula swayed some mothers to stop nursing, those free brand-name formula samples may have ultimately led to increased expenses for parents—to the tune of $700 a year—for those who stuck with the initial pricier brands, such as Enfamil and Similac, instead of switching to a cheaper generic formula, according to an analysis performed by the Coalition.
The move to voluntarily end free formula giveaways started gaining momentum among maternity hospitals soon after the state’s rejection of a legislative ban; in 2005, only seven hospitals in the state had banned the gift bags but by 2010, the number had risen to 27. At the beginning of this year, only 12 hospitals were still giving formula away.
Part of the trend away from giveaways may have had something to do with a state breast-feeding advocacy group’s posting of a list of birth centers that had banned the gift bags as well as a list of those that were still offering formula freebies. At the annual meeting of the group, MotherBaby Summit, “hospital administrators told us they wanted to get off the second list,” said Dr. Bobbi Philipp, a Boston Medical Center pediatrician who’s involved with the group. “Was there peer pressure? I would say a little bit.”
The UMass Memorial Medical Center in Worcester decided to stop handing out free formula bags last fall because of “pressure” within the institution to no longer have corporate marketing on any hospital materials, said Dr. Ellen Delpapa, medical director of the hospital’s labor and delivery unit, as well as to encourage breast-feeding.
“We now give women a free canvas bag with our hospital logo, but it doesn’t have anything in it,” said Delpapa. “So far, we’ve had no complaints; no one has missed the formula.”
Whether the voluntary bans will have a significant impact on long-term breast-feeding rates remains to be seen. Many women may still turn to formula during those first sleep-deprived weeks after they leave the hospital, pointed out Philipp, if they’re having trouble nursing.
Boston Medical Center is one of only four hospitals in the state that has received a “baby-friendly” designation by UNICEF and the World Health Organization, which means it maximizes chances of successful breast-feeding by having babies room in with their mothers, allowing no formula supplementation unless medically necessary, and having lactation consultants on hand to instruct new mothers.
Baby-friendly hospitals also can’t accept free formula from manufacturers, which most hospitals still do even if they don’t give away samples in gift bags. Cambridge Birth Center, Tobey Hospital in Wareham, and Melrose-Wakefield Hospital all became baby-friendly hospitals within the past two years.
“Becoming a baby-friendly hospital is a very energy intensive process for a hospital,” said Smith, of the Department of Public Health, requiring them to add more staff with expertise in lactation and shift their practices to enable babies to breast-feed within a half-hour after birth, when they have a strong instinct to find the breast and latch on.
Added Bartick, “Most hospitals aren’t practicing evidence-based medicine for infant feeding and care, which makes initiating breast-feeding that much harder for new mothers.”