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Formula Marketing: Why Free Samples Are Costly

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by Mary Jessica Hammes
November 04, 2011

Haley Johnson made it clear she intended to exclusively breastfeed her daughter, Sydney. So she was surprised that, after giving birth, the hospital sent her home with a gift bag containing a shelf organizer, a bottle cooler, a can of powdered formula, and literature about bottle-feeding.

“The nurse discharging me asked if I was breast or formula feeding, so she would know what sort of welcome gift to get for me,” says Johnson, who lives in Richmond, Virginia. “I was a little stunned when she presented me with a formula package for breastfeeding moms.”

When Johnson finally had a chance to read the literature,  “I was pretty disgusted,” she says. “Essentially, it said, ‘Hey, breastfeeding can be hard, and you may not want to do it all the time, so don’t forget about us!’”

Formula company–sponsored diaper bags have been ubiquitous throughout the U.S.—but a new study shows that is starting to change.

Stop marketing formula
A new article published in Pediatrics says that while the practice is still very common, fewer hospitals are giving away the discharge bags containing free formula samples.

“Trends in U.S. Hospital Distribution of Industry-Sponsored Infant Formula Sample Packs” is a follow-up to a 2007 study that surveyed every state to find the proportion of hospitals giving free formula to new moms. In 2007, the researchers picked the 10 best and 10 worst states. They called every hospital (1,239) in the 20 states, and asked if new mothers receive a “formula company-sponsored diaper discharge bag.”

In 2007, 14 percent of those hospitals were sample-pack-free, but in 2010, 28 percent of those same hospitals were sample-pack-free. Change was more significant in states where more hospitals had already stopped giving away formula in 2007.

“Most U.S. hospitals continue to distribute industry-sponsored formula sample packs, but trends indicate a significant change in practice; increasing proportions of hospitals eliminate these packs,” the study reads.

Relatively speaking, this trend is changing quickly, according to Anne Merewood, senior author of the Pediatrics study and director of The Breastfeeding Center at Boston Medical Center. She comments it is reflective of a new ethical look at the matter, one in which doctors and hospitals are taking less input and free samples from pharmaceutical companies. (Not that the free formula samples are going away—keep reading to find out where they’re going.)

Why such a fuss over giving away free formula in hospitals, or the fact that the trend is changing? For starters, eight different studies show that discharge bags negatively impact breastfeeding and that formula samples shorten the duration of breastfeeding and decrease exclusive breastfeeding rates. Another criticism is that hospitals do not give away any other kind of sample, and the discharge bags essentially make hospital staff unpaid sales reps, providing free formula marketing on behalf of the manufacturers.

The International Formula Council’s (IFC) background sheet on formula gift bags claims that criticizing the practice distracts from the real obstacles to long-term breastfeeding, identified in a 2009 survey conducted on behalf of the IFC as: “Demands of work or school; the inability to produce enough milk; the expense of a breast pump; the feeling that breastfeeding restricts freedom; no time to pump at work.”

Ban the Bags offers a counterpoint to common claims made by the IFC (and hospitals defending the practice of giving away free formula samples in gift packs), including:

  • Banning formula is not anti-business. Gift packs undermine public health, making them “costly, unethical, and ultimately, bad for business.”
  • Banning formula is not anti-choice. It’s not a question of personal decision-making, but an example of unethical marketing practices.
  • A government regulation would not be intrusive or unnecessary, as babies are “vulnerable populations,” making regulation a “sensible measure to protect the public health,” similar to regulations on secondhand cigarette smoke.
  • Banning formula doesn’t make women feel guilty, but does prevent the “deliberate undermining of breastfeeding by an industry that profits when breastfeeding fails;” a discussion of guilt distracts from the real issue of failing to inform women of the risks of formula -eeding.
  • Banning formula doesn’t deprive poor women of a free gift, but prevents “exploitive” marketing. Data show that formula-feeding increases health care costs, including among the uninsured.
  • Maternal employment among working class women is not the major barrier to breastfeeding, especially for working class women with few workplace accommodations. Early formula supplementation interferes with the establishment of a full milk supply, making it difficult to keep breastfeeding after returning to work.
  • Formula is not as safe and healthy as it’s alleged to be, especially when one considers the current obesity epidemic, and the fact that breastfeeding is one of the “pillars of the U.S. Public Health system’s anti-obesity campaign.”

The IFC cites a 2008 Pediatrics study, which examined how maternity care practices at UNICEF/WHO-designated Baby-Friendly Hospitals impact breastfeeding duration rates.

The study authors, “…did not find an association between not providing a formula sample or coupon in a hospital gift pack and increased breastfeeding duration…consistent with a Cochrane review in 2000 that suggested there was no evidence to support a significant effect of commercial hospital discharge packs (with formula or promotional materials) on early termination of nonexclusive breastfeeding.”

However, the 2008 study also found that “hospital discharge packs seem to reduce the number of women exclusively breastfeeding at six and 13 weeks postpartum when compared with no intervention or a noncommercial pack in which samples of infant formula had been removed.”

The study found that practices “consistently associated with longer breastfeeding duration included breastfeeding initiation within one hour of birth, giving only breast milk, and not giving any pacifiers.”