AAP Resolution On Freebies Not Among Top 10

by Heidi Green
July 28, 2012

July, 2012, Massachusetts became the second state to ensure that families in its hospitals and birthing centers would not be inundated with formula marketing bags. But Massachusetts is not alone in its efforts to restrict formula marketing. November, 2011, Laura Sinai, MD filed a resolution—Divesting from Formula Marketing in Pediatric Practice—calling upon the American Academy of Pediatrics (AAP) to “advise pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.” During the March, 2012 AAP Annual Leadership Forum, the resolution was “adopted as amended,” but because the non-binding resolution was not among the AAP’s “top 10″ resolutions at that meeting, no further action will be taken. It’s now up to the resolution’s author and sponsors (AAP Section on Breastfeeding and 13 AAP Chapters) to decide how to best achieve their objective.

What is an AAP resolution
Each spring, the leaders of AAP’s chapters, councils, committees, and sections come together to advise the AAP Board of Directors about issues of concern to its members at a meeting known as the Annual Leadership Forum. While any AAP member, chapter, council, committee, or section may submit a resolution for consideration at this meeting (and, for the first time in 2012, through online discussion in advance), only the directors vote on which 10 resolutions warrant their concerted effort in the year ahead.

The “top 10″ are selected from any number of resolutions, and can address a wide variety of topics, including clinical practice, administration, advocacy, and sponsorship. The list of this year’s “top 10″ can be found elsewhere online.

While the text of AAP resolutions is typically found within the “Members Only” section of the organization’s website, Dr. Sinai’s resolutions was added to the organization’s “Breastfeeding Initiatives” web page. As a note there explains, “Resolutions submitted at the Annual Leadership Forum are considered by the AAP Board of Directors, but are advisory and not binding.”

What does this resolution say?
In a brief, but strongly worded statement, the resolution recognizes that “free distribution of commercial materials such as formula samples, diaper bags, formula coupons, and other gifts via commercial infant formula marketing” is an implicit endorsement of formula, and “advise[s] pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.”

The resolution also acknowledges the actions of other national organizations—“the Centers for Disease Control and Prevention and the U.S. Surgeon General have stated strongly and clearly that patients must be protected from commercial infant formula marketing,” the physician’s group writes, [and] the “Federal Government Accountability Office (GAO) … American College of Obstetricians and Gynecologists (ACOG), American Public Health Association (APHA), and the AAP all identify distribution of formula company packs as ‘inappropriate in medical environments and recommend against it.’”

The resolution notes research showing that formula samples not only endorse formula feeding but may also lead some parents to believe that pediatricians favor formula feeding over breastfeeding, causing mothers to add formula to their babies’ diets sooner and stop breastfeeding earlier.

Why does it matter?
Public health advocates have been calling for a ban of formula marketing for years, an effort that picked up steam with the launch of the “ban the bags” campaign in 2005. Rhode Island became the first state to enact a ban when its seven hospitals eliminated formula bag distribution in 2011 and Massachusetts’ 49 hospitals followed suit in July 2012.

While the failure of the resolution to make the “top 10″ list is disappointing, it’s submission lends support to the  “no free lunch” movement, which aims to remove pharmaceutical company giveaways and freebies of all kinds from health care. With endorsement from several professional organizations, the no free lunch movement aims to “sever [the] bonds [between] the American medical community [and] pharmaceutical companies,” due to “the negative impact pharmaceutical advertising has on human behavior.”

What next?
Whether the resolution’s author and sponsors will choose to resubmit the resolution in the hope of making AAP’s 2013 “top 10″ list remains to be seen. Regardless, this is still an important step toward improving the health of mothers, infants, and children nationwide. As noted in the resolution, “not breastfeeding increases the risk of adverse health outcomes in mothers and their infants,” so any action that decreases breastfeeding rates deserves to be scrutinized.

It appears that the American Medical Association (AMA) agrees. With encouragement from the AAP Section on Breastfeeding, the AMA recently amended its Support for Breastfeeding policy by recommending:

• implementation of the WHO-UNICEF 10 Steps to Successful Breastfeeding
• implementation of the Joint Commission Perinatal Care Core Measures Set for Exclusive Breast-Milk Feeding
• exclusive breastfeeding for six months, followed by continued breastfeeding as complementary foods are introduced
• employer programs that support breastfeeding mothers
• employers in all fields of health care to serve as role models by supporting breastfeeding mothers

This certainly isn’t the last word on the issue of formula marketing. Formula bag distribution still takes place in maternity wards, with nurses giving bags (totes, backpacks etc.) to parents at the time of discharge. While resolutions (when acted upon) can be helpful, real change requires commitment on the part of all concerned including hospitals, birthing centers, nurses and other health care providers, and parents.