U.S. exclusive breastfeeding rates among newborns fall far short of national goals. Studies 1-5 show that distribution of formula company “diaper discharge bags” (infant formula sample packs) to new mothers at discharge undermines exclusive breastfeeding: the latest study, which found a negative effect of formula packs on exclusive breastfeeding at every week for 10 weeks postpartum, appears in the February 2008 issue of the American Journal of Public Health. 1
The formula sample packs, which contain formula, coupons and other products, are given free of charge to the hospital, and distributed to new mothers. Such hospital-based distribution is widely criticized by medical and policy-making bodies, including the Government Accountability Office,6 the Centers for Disease Control and Prevention,7 the American Academy of Pediatrics,8 the American College of Obstetricians and Gynecologists,9 the U.S. Office on Women’s Health10 and the World Health Organization.11
Ban the Bags as a national movement began in 2006, after the Massachusetts Breastfeeding Coalition, working with the Massachusetts Department of Public Health, attempted to remove formula sample packs from Massachusetts hospitals through statewide perinatal regulations. Then-Gov. Mitt Romney quashed the attempt,12,13 but the energy from the Massachusetts effort was directed towards national advocacy.
Ban the Bags functions on many levels to publicize the cause and support advocates and clinicians who want to eliminate sample packs in their hospitals or regions. Information, resources, and progress reports are provided on the Web site. A broad survey, presented at the APHA Annual Meeting in 2007, documented that most U.S. hospitals distribute formula sample packs, but that in recent years, many have discontinued the practice. According to data collected between late 2006 and early 2007, Vermont, Massachusetts, Oregon, and New Mexico had the lowest numbers of hospitals distributing sample packs (58-68 percent). In many states, including Arizona, Arkansas, Mississippi, New Jersey, and the District of Columbia, 100 percent of hospitals distribute the sample packs.
Some public health advocates have made outstanding progress towards elimination of the sample packs. The New York City Department of Health and Mental Hygiene launched a major breastfeeding initiative in 2006, which included efforts to reduce the influence of the formula industry, and led to the elimination of sample packs from all 11 public hospitals operated by the NYC Health and Hospitals Corporation.14 In 2007, work from the Breastfeeding Coalition of Oregon led to Portland, Oregon, becoming the first U.S. city where formula sample discharge packs were banned in every hospital.15
For more information, visit www.banthebags.org.
Anne Merewood, MPH, IBCLC; Director, The Breastfeeding Center, Boston Medical Center; Assistant Professor of Pediatrics, Boston University School of Medicine
References
1. Rosenberg KD, Eastham CA, Kasenhagen LJ, Sandoval AP. Infant formula marketing through hospitals: Impact of commercial hospital discharge packs on breastfeeding. American Journal of Public Health In press.
2. Bergevin Y, Dougherty C, Kramer MS. Do infant formula samples shorten the duration of breast-feeding? Lancet 1983;1(8334):1148-51.
3. Frank DA, Wirtz SJ, Sorenson JR, Heeren T. Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial. Pediatrics 1987;80(6):845-54.
4. Dungy CI, Losch ME, Russell D, Romitti P, Dusdieker LB. Hospital infant formula discharge packages. Do they affect the duration of breast-feeding? Arch Pediatr Adolesc Med 1997;151(7):724-9.
5. Dungy CI, Christensen-Szalanski J, Losch M, Russell D. Effect of discharge samples on duration of breast-feeding. Pediatrics 1992;90(2 Pt 1):233-7.
6. Government Accountability Office. Some strategies used to market infant formula may discourage breastfeeding; State contracts should better protect against misuse of WIC name, 2006.
7. Shealy KR, Li R, Benton-Davis S, Grummer-Strawn L. The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services, 2005.
8. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506.
9. American College of Obstetricians and Gynecologists. ACOG Educational Bulletin,
Breastfeeding: maternal and infant aspects. Washington DC, 2000.
10. Office on Women's Health, US Department of Health and Human Services. Health and Human Services Blueprint for Action on Breastfeeding. Washington DC, 2000.
11. World Health Organization. International Code of Marketing of Breast-milk Substitutes. 1981, Geneva.
12. Smith S. Romney keeps tight rein on Health Dept. The Boston Globe 2006 Sept 10.
13. Associated Press. Romney overhauls panel that backed ban on baby formula giveaways. The Boston Globe 2006 May 20.
14. Zimmerman R. Wall Street Journal 2007.
15. Colburn D. Hospitals heed call to hold the formula. The Oregonian 2008 January 2.