by Mary Jessica Hammes
September 08, 2008

You know how the American Academy of Pediatrics is always going on about how mothers should breastfeed exclusively for six months, and then continue for at least a year?

Apparently, not all health care professionals are dedicated to promoting that ideal.

A new research study, published this month in the Archives of Pediatrics and Adolescent Medicine, investigated the distribution of free formula samples by U.S. hospitals. For the study, Boston University School of Medicine researchers contacted 1,295 hospitals (located in 21 eastern states and the District of Columbia) between 2006 and 2007. They found that 94 percent of the hospitals distributed the free formula to new parents. The study notes that there were regional trends: 70.4 percent of hospitals in New Hampshire distributed the formula, while in four other states—New Jersey, Maryland, Mississippi, and West Virginia—distribution was at 100 percent.

The researchers also noted that only 11 percent of U.S. babies are exclusively breastfed at the age of 6 months.

The researchers’ conclusion? “Formula sample packs have been shown to undermine breastfeeding, and their elimination from U.S. hospitals may help to increase exclusive breastfeeding rates nationally.”

There is hope for breastfeeding advocates: the researchers also noted that 80 hospitals were free of sample packs, and that “the proportion of bag-fee hospitals has risen significantly between 1979 and 2006.”

Still—there are an awful lot of hospitals still continuing the practice of distributing free formula. They don’t work for the formula companies, so why do they do it? Pat Nielsen—who worked for 10 years as a childbirth educator at Athens Regional Medical Center in Georgia, and as a director of an obstetrics unit in an Ohio hospital before that—has a few ideas:

“Hospitals receive free formula, and lots of other goodies from the formula and pharmaceutical companies in exchange for giving out the bags, and nurses are expected to do so,” says Nielsen, who now operates Full Bloom, a parenting resource center and store in Athens. (Indeed, this approach is used all over the world; for more information on the tactics of formula companies in developing countries, including the history behind a still-standing boycott against Nestlé, read this report from the UK’s The Guardian, published last year.)

In the U.S., says Nielsen, if an individual nurse objects to giving out the formula, that could create a socially awkward situation for her at work—and the mother would still get the bag in the end, anyway.

“Many nurses see the bags as a gift,” she adds. “When it’s suggested that breastfeeding mothers not be given a bag, some nurses actually say they believe it would be discriminating against breastfeeding mothers if they didn’t receive this gift, when formula-feeding moms get one.”

Then there are the personal experiences of the nurses themselves to take into account.

“Many nurses who work on postpartum units with new mothers trying to learn to breastfeed did not breastfeed their own babies—either by choice or because they, too, had difficulty—and they transfer their personal feelings to the mamas they work with,” she says.

Personally, I have long benefited from my hospital’s lactation department, which offers free programming and support groups for breastfeeding mothers. But I did end up with several free samples—from the hospital, in the mail, and from the pediatrician’s office. When I was given the samples in person, I was too timid to refuse; sleep deprivation must have altered my personality. I donated all of it, not wanting the temptation of formula in the house, when I felt so strongly about exclusively breastfeeding (mercifully, we encountered no major breastfeeding hurdles).

I spoke with several Athens-area moms who either breastfed or are still breastfeeding their children, and who received free formula in the hospital. It turns out that not all of them minded.

“It’s just formula,” says Erica Kooymans. “It’s not a big deal. My daughter is 13 months now, and still breastfeeds and hasn’t received a drop of formula, despite me having three free cases in the house. I don’t think it undermines a woman’s desire to breastfeed. Sometimes if you’re not familiar with pumping, it’s good to have formula on hand if you need to be gone for a feeding.”

“I actually welcomed free samples and sent in those Enfamil and Similac coupons to receive some in the mail,” says Lisa Myers, who exclusively breastfed her daughter for six months, but did give her some formula after that. She saw the samples as insurance against an emergency. “I wanted some on hand in case something went wrong with breastfeeding and I couldn’t do it and needed to supplement, or if I was sick and had to have some extended hospital stay—we would have it on hand rather than having to run out to the store in a frenzy,” she says.

Other mothers were less thrilled with their samples.

“I do remember feeling like it was sort of a sellout or something on the part of the hospital, or that I was basically being subjected to a ‘formula commercial’ and had to wonder what the motive behind showing it to patients could be,” says Amanda Camp. She did end up keeping the formula and used it once or twice to supplement bottles of pumped breast milk.

“I strongly believe hospitals and pediatricians should not give out anything that contains formula samples, coupons for formula, or formula-branded carry bags,” says Suzanne Richardson-White, who was “a little irritated” to receive formula in the hospital; she ended up donating it to charity. A better giveaway would feature contact information for breastfeeding support groups,” she says.

She adds, “If hospitals and pediatricians were really interested solely in the infants’ welfare, they would do this…but, of course, though they are dedicated to the health of babies, they are also out to make money.”

Julie Moon donated the formula that was mailed to her doorstep. “I thought it was a waste of money and time to send it to me,” she says.

“With all the talk of the importance of evidence-based practice in hospitals these days, it is amazing to me that this practice is allowed to continue,” says Nielsen. “There is no evidence that it is best for babies or mothers. It is only best for the bottom line—of hospitals and formula companies.”

What could hospitals do differently?
“Maybe we should encourage breastfeeding mothers, if they want the bag, to leave the contents of the bag in the room when they leave the hospital,” suggests Nielsen. “No one could argue that the formula is going to waste since they aren’t throwing it away— indeed, if the hospital is worried about this, they could set up a recycling program and donate the formula left behind to mothers and agencies who need it.”

Ban the Bags, a nationwide campaign to end free formula distribution in hospitals, suggests that hospitals pay for the formula, as they do for all other food for patients, passing the costs along through the room and board charge.

Until hospitals end the practice of distributing free formula, parents must be responsible and educated about their choices, says Camp.

“It’s up to every individual to be a critical consumer,” she says. “If you have questions about the type of formula they’re giving out, ask. Research it if you must. If you don’t want to use it, don’t. They certainly can’t force you and aren’t interested in forcing anyone.”