Are we undermining breastfeeding?
Dana Silver, MD, FAAP – Co-Chapter Breastfeeding Coordinator
Last week 2 boxes of Enfamil formula arrived at my office without a request. The previous week, we had received two boxes of Similac formula along with special “Welcome Packs” (nice bag, formula, coupons), again without consent or request. When I visit the Ob/Gyn office upstairs, formula literature, note pads, magazines sponsored by formula companies, and gift packs are not hard to find. Finally, there are always the special free discharge bags new mothers receive in the hospital complete with formula “just in case” there are problems.
So, what’s the big deal? Does it really affect breastfeeding rates? The answer, of course, is that it does. Numerous studies have demonstrated the impact that hospital discharge bags have on duration of breastfeeding. A 2000 Cochrane Review meta-analysis showed that giving breastfeeding women a commercial discharge pack decreased duration and exclusive breastfeeding rates1. A 2008 study in American Journal of Public Health found the same2. In addition, the data is clear that once a woman starts supplementing, she is far more likely to stop breastfeeding earlier.
Advertising through free samples, posters, pens, etc. in a doctor’s offices can have the same effect as the commercial discharge bags. They send the subtle, or not so subtle, message that breastfeeding is at risk of failing and that the healthcare provider feels commercial formula is just as good as breastfeeding. Whether or not you intend to send this message does not matter when the images are there. In addition, the formula discharge bags and other freebies often contain “breastfeeding support guides” which offer advice that undermine breastfeeding.
Johns Hopkins Hospital and Upper Chesapeake Hospital are the only two hospitals in Maryland who have “Banned the Bag.” They no longer provide the “free” hospital discharge bags from formula companies to postpartum mothers, and mothers have accepted this without much complaint. These two hospitals should be commended for taking this step. Throughout the country there are far more hospitals who have joined in, and hopefully more in Maryland will follow suit.
Pediatric healthcare providers are in a unique position to contribute to the initial and ongoing support of the breastfeeding dyad. In addition to providing medical knowledge and support for breastfeeding, take a look around at your office and in your hospitals and see what else you might be able to do. Some babies may need infant formula, but put the samples away in a closet. Just as many offices and hospitals have banned freebies (lunch, etc.) from pharmaceutical companies because of the ethical implications, the same should be said for infant formula companies.
Resources:
- AAP’s Section on Breastfeeding (
- Academy of Breastfeeding Medicine (
- Ban the Bags (
References:
- Donnelly et al., Commercial hospital discharge packs for breastfeeding women. Cochrane Database Syst Rev. 2000;(2):CD002075.
- Rosenberg et al., Marketing infant formula through hospitals: The impact of commercial hospital discharge packs on breastfeeding. AJPH, 2000;98(2):290-5.