by Anne Eglash MD, IBCLC, FABM
Do mothers who receive free formula samples by mail have lower breastfeeding rates?
The International Code of Marketing of Breastmilk Substitutes, AKA ‘The Code’ was created in 1981 after an association was made between increased infant mortality and a decade of aggressive formula marketing in the 1970’s. The Code calls for governments to prohibit formula companies from advertising directly to or giving free formula to pregnant and nursing mothers. The United States has never enforced The Code, so new mothers in the USA have been receiving free formula for decades.
Studies have shown that receiving formula in hospital discharge gift bags is associated with a decrease in exclusive breastfeeding. Many hospitals, and even states, have done away with this practice. This has led to formula companies mailing formula directly to the homes of pregnant and nursing mothers.
A study published in 2016 evaluated the duration of breastfeeding among 1,741 women who received free formula by mail, and compared their rates with 1,290 women who did not receive free formula.
What do you think the authors found while evaluating the association between receiving mailed formula samples and breastfeeding rates? (choose one or more)
- Women were more likely to receive formula by mail if they were wealthier, white, married, older, and more highly educated.
- Women who had stronger intentions to breastfeed were more likely to receive formula.
- The women who received formula samples were less likely to breastfeed after 6 months as compared to those who did not receive formula samples (after adjusting for age, race, education, income and planned infant feeding method).
- Mothers who received free formula by mail were less likely to breastfeed exclusively at 6 months postpartum, although this difference was not statistically significant.
See the Answer
The answers are A, B, D (not C)
Breastfeed Med. 2016 Jan-Feb;11(1):21-5. doi: 10.1089/bfm.2015.0099. Epub 2015 Dec 24.
The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates
Waite WM1, Christakis D1.
INTRODUCTION:
Decades of research supports the health benefits of breastfeeding. Prior studies have shown that hospital discharge bags containing free samples of infant formula are associated with decreased breastfeeding exclusivity. This study aims to determine if receiving a free sample of infant formula in the mail has an impact on breastfeeding duration and exclusivity.
MATERIALS AND METHODS:
This was a cohort study analyzing data from the Infant Feeding Practices Study II. The main outcomes of interest were any breastfeeding through 12 months of age and exclusive breastfeeding through 6 months of age. The main predictor of interest was receipt of a free sample of infant formula in the mail around the time of the infant’s birth. Logistic regression models were developed to evaluate the association between the outcomes and predictor of interest at each month.
RESULTS:
This study included 3,031 infants; mothers of 1,741 (57.4%) received a sample of infant formula in the mail. There was no difference in the likelihood of any breastfeeding at each month among those who received formula in the mail compared with those who did not. There was also no difference in exclusive breastfeeding through 5 months; however, by 6 months of age infants whose mothers received formula in the mail were less likely to be exclusively breastfed (odds ratio = 0.57; 95% confidence interval, 0.37, 0.89).
CONCLUSIONS:
Receiving infant formula in the mail decreases the likelihood of exclusive breastfeeding by 6 months of age while having no impact on the duration of any breastfeeding.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Most of my patient receive free formula in the mail during pregnancy or early postpartum, and at this point, we have no legislation that prevents this practice. Given current stealth marketing techniques and our rampant social media use, formula companies will continue to easily find their target audience.
What I find most interesting about this study is that the formula companies identify women who have the highest likelihood of exclusive breastfeeding, and are more likely to send them free formula. Women who are wealthier, older, more educated, and white are more likely to breastfeed as compared to younger, poorer, less educated women of color. It is frightening to know that companies learn so much about us.
The good news here is that receiving formula by mail appears to have less impact on breastfeeding rates as compared to receiving formula from health care professionals. The bad news is that the practice continues without restraint. When physicians or nurses give out formula, they are endorsing its use. Even though hospital gift bags with formula are waning, many medical offices have shelves lined with formula samples that are handed out during outpatient visits. We need a campaign to convince medical offices that giving out free formula is ‘20th century’, and insults the intelligence of families who are working hard to breastfeeding successfully. In addition, these providers and office staff are duped into thinking that they are doing their patients a favor, not recognizing that they are pawns for the formula industry.
Peggy Stalheim
Yes, I think this practice influences new mothers. I have read that formula company marketers have studied weaning, and found 3 months postpartum to be a time when mothers might be considering offering ABM. Moms may be facing challenges around working and expressing milk at work, barriers around nursing in public , and messages from society saying they have done a great job and now it is OK to stop. A nursing friend showed me a postcard from a formula company that she received and it included these exact messages.