by Anne Eglash MD, IBCLC, FABM
Does receiving free formula by mail reduce breastfeeding rates? The likelihood is yes, since I don’t suspect that formula companies are doing this out of the goodness of their hearts. They have shareholders to serve!
So the question is, to what extent does receiving free formula by mail effect breastfeeding rates? The authors of a study published in early 2016 used data from the Infant Feeding Practices Study II, a national survey by the US Center for Disease Control on infant feeding, to answer this question.
According to these authors, research has shown that aggressive formula marketing in the 1970’s was associated with an increase in infant mortality due to lack of breastfeeding. This led the World Health Organization to encourage governments to adopt the International Code of Marketing of Breast Milk Substitutes (AKA ‘The Code’). The Code is a set of principles that prevents formula companies from marketing directly to families or indirectly through healthcare providers. Unfortunately, the USA never formally approved The Code, so we continue to observe free formula samples being given to healthcare workers, to be passed to families, and families continue to receive free formula either in the hospital, medical office, or by mail.
According to the Infant Practices Study II data, what do you think is the impact of receiving free formula samples by mail on breastfeeding rates? (choose 1 or more)
- Free formula samples reduced exclusive breastfeeding rates after 5 months postpartum
- Free formula samples reduced exclusive breastfeeding rates at 1 month postpartum and beyond
- Free formula samples reduced exclusive breastfeeding rates after 3 months postpartum
- Free formula samples reduced ‘any’ breastfeeding
See the Answer
The answer is A
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 WM, Christakis D
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
This survey demonstrates that women who have the intention to breastfeed will do so despite formula samples being sent to them, which is great news. Unfortunately, having free formula samples disrupts exclusive breastfeeding by 5 months postpartum. The survey results also show that women in higher socioeconomic groups who are older, highly educated, white, and have a stronger intention to breastfeed are more likely to receive formula samples by mail. We know, of course, that these are characteristics of women who have the strongest intention to breastfeed during the first year postpartum.
How do formula companies obtain the names and addresses of pregnant mothers? According to the authors, mother-baby stores are likely sharing information about their customers, and many hospitals and health care offices are still giving free formula to their patients. Many American families used to consider free gift-packs of formula ‘normal’. However, in more recent years, ~80% of mothers in the USA are initiating breastfeeding, causing more and more families to scrutinize this practice of pushing free formula.
Here is my advice to baby stores and healthcare facilities:
Handing out free formula is so passe, so 20th-century. Families are smarter than they used to be. They have seen the rapid rise of research showing that breastfeeding is the smartest, surest way to optimize their children’s health in body and mind. Why be a free marketing agent for a multinational company that profits from increasing infant morbidity and mortality, especially when your patients/clients are snickering behind your back because you don’t see how obviously ignorant this practice is? Get a life! If you want to hand out a free gift to a pregnant or nursing mother, in fewer than 10 seconds you will come up with some great ideas such as diapers, wipes, clothes, safety locks, and groceries. What did that formula company do for you anyway??!!