Should Doctors and Hospitals Give out Free Infant Formula?

Should Doctors and Hospitals Give out Free Infant Formula? Should hospitals give out free infant formula? No, say public health advocates who are now petitioning hospitals in the United States to end the practice, saying it undermines breastfeeding.

There’s really no going around it, they say. Breast milk is the ideal food for newborns and babies up to two years old, and no manufactured formula can confer the many unique benefits of breast milk.

“These benefits, very well chronicled in the scientific literature, are stunningly comprehensive,” says Dr. David L. Katz, founding director of Yale University’s Prevention Research Center, in an April 9 blog piece syndicated by the Huffington Post’s Healthy Living.

He then goes on to tick off the benefits: “They range from the psychological effects of such close bonding between mother and baby, to enhancements to both skeletal and cognitive development, to the transmission of protective maternal antibodies as the newborn immune system and GI tract slowly mature, to an apparently lifelong defense against obesity we don’t even fully understand.”

Dr. Katz is also the founder and president of the non-profit Turn the Tide Foundation, who is known globally as an expert in nutrition, weight management and chronic disease prevention, as well as integrative care and patient-centered care models.

The World Health Organization has long been promoting breastfeeding. It recommends colostrums — the yellowish, sticky breast milk produced at the end of pregnancy — as the perfect food for the newborn, and advises mothers to feed this to their babies within the first hour after birth.

All health experts agree that exclusive breastfeeding is recommended up to six months of age and continued breastfeeding along with appropriate complementary foods recommended for babies up to two years old or beyond.

Are companies using hospitals, doctors to promote baby formula?
But roughly two-thirds of all U.S. hospitals allow drug companies access to their maternity wards, laments Dr. Elizabeth Ben-Ishai, the campaign coordinator for Public Citizen’s Commercial Alert Project, where they are allowed to hand out “discharge bags” of free infant formula to new moms. The bags are accompanied by discount coupons for subsequent purchases of the same formula, samples of their product along with diapers, pamphlets and other items. Samples are often also mailed to people’s homes along with coupons for more.

Led by Public Citizen, dozens of consumer and public health organizations are lobbying hospitals to disallow the giveaways, which they say undermine breastfeeding.

In a letter sent to more than 2,600 hospitals on April 9 the organizations called on hospital administrators to stop distributing free samples of formula. The practice, they say:
• Can be taken by patients as an endorsement by healthcare providers.
• Entangles doctors and hospitals in the marketing schemes of pharmaceutical and food manufacturers.
• Discourages some new mothers from breastfeeding.
• Works against efforts of hospitals and healthcare providers to promote breastfeeding.
• Encourage women to give up nursing their infants instead of seeking help and support.
• Encourage them to spend between US$800 and US$2,800 a year on formula when the free samples are gone.

The group was sent on their behalf by the advocacy group Public Citizen.

In another letter to hospital chief executives, Public Citizen President Robert Weissman points out that while hospitals aim “to promote the health of infants and mothers… the ongoing promotion of infant formula conflicts with this mission.”

The health advocates are also petitioning the US$4 billion infant formula industry’s leaders — Abbott Laboratories, Mead Johnson Nutrition Co and Nestle SA — to halt the practice.

Some hospitals have already stopped formula giveaways, and a few states and cities have banned the practice, as well.

Are they really meeting women’s needs?

Formula makers and hospitals defend the free samples, saying they are meeting women’s needs and respecting women’s choices.

In a statement, the American Hospital Association says its members drafted policies based on mothers’ preferences. While breastfeeding was best, “having information and resources available for mothers who choose not to breastfeed is a responsible and supportive approach for the hospital.”

Such samples have been given away for more than 40 years, says the industry trade group, and most women wanted the bags. Besides, “We can’t forget that some moms even though they plan to breastfeed, they either can’t or they decide not to,” says International Formula Council Executive Vice President Mardi Mountford. “We believe they want more information, not less.”

But “this is not about setting any limits on mothers’ choices,” Dr. Ben-Ishai counters. “It’s about opportunistic marketing by the formula companies, and the ethics of the hospitals that allow this marketing to take place on their turf.”

“By distributing their goodies on maternity wards, the formula companies are getting a ‘halo effect’ — making it seem as if the hospitals and health professionals are recommending formula,” she says.

“Although the formula companies all give lip service to ‘breast is best,’ their aggressive advertising and marketing do everything to undermine it, points out Karla Shepard Rubinger, executive director of the Academy of Breastfeeding Medicine, and Dr. Katz cites this on his blog.

According to Dr. Rubinger, “There is a significant amount of research to show that where formula is provided at no cost, breastfeeding rates are lowest.”

“Our goal is to better educate physicians, hospitals, and other healthcare providers to understand why breastfeeding is so very important: It’s universally available, free, evidence-based, supported in all cultures throughout time, shows documented benefits for mother and baby, and is ‘green’ into the bargain,” she says.

Right now, just 14 percent of 6-month-old infants are exclusively breastfed — U.S. health officials want to increase that to about 26 percent by 2020. According government data, breastfeeding also lags among lower-income women.

WHO says, however, that breastfeeding in the U.S. is increasing — and attributes this to the fact that hospitals now offer breastfeeding support and allow babies to stay in their mothers’ hospital rooms.

The number of hospitals that give away formula has also dropped, the Centers for Disease Control and Preventions says in a report released in 2011 — from 73 percent in 2007 to 66 percent in 2009.

The day after the letter was published in newspapers, a number of hospitals in many states announced that they will stop the practice.

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