Hospitals Provide Formula Sample Packs While Medical Organizations Encourage Breastfeeding

"Packaged as smart diaper bags, the commercial sample packs contain formula, coupons, advertisements and baby products," the authors write as background information in the article. "Typically, they are given free to the hospital by the relevant infant formula manufacturer and are distributed to patients by clinicians when mother and newborn are discharged from the hospital."

Institutions that have voiced opposition to this practice include the Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and World Health Organization.

Anne Merewood, M.P.H., I.B.C.L.C., of the Boston University School of Medicine, and colleagues contacted 1,295 hospitals in 21 Eastern states and the District of Columbia by telephone between October 2006 and March 2007. Of those, 1,215 (93.8 percent) distributed formula sample packs to at least some new mothers. Patterns were evident by state and by region. In New Hampshire, 70.4 percent of hospitals distributed the packs, while 100 percent of those in New Jersey, Maryland, Mississippi, West Virginia and the District of Columbia did so.

Among 80 hospitals that were free of sample packs, 20 had eliminated the practice before 2000 and 60 since 2000. "The proportion of bag-free hospitals has risen significantly between 1979 and 2006," the authors write. "Elimination of sample packs was ongoing, with clusters of activity in certain regions such as New York City and Massachusetts." The reductions in these areas were likely associated with focused public health efforts to eliminate the packs, the authors note.

"Exclusive breastfeeding rates among young infants are discouragingly low," with only 11 percent of U.S. infants exclusively breast-fed at 6 months, they conclude. "Formula sample packs have been shown to undermine breastfeeding, and their elimination from U.S. hospitals may help to increase exclusive breastfeeding rates nationally. The prevalence of sample pack distribution is disturbing and incongruous given extensive opposition, but encouraging trends suggest that the practice may be curtailed in the future."