Breastfeeding rates are back on the rise after decades of decline, despite formula manufacturers’ best efforts to get new mothers hooked on their products early.
WASHINGTON — Nearly two dozen organizations and almost 18,000 mothers are calling on three of the United States’ largest manufacturers of infant formula to halt the longstanding practice of promoting their products in hospitals, particularly by giving out “discharge bags” full of free samples to new moms.
Critics say women who receive such samples are markedly less likely to exclusively breastfeed for six months, as widely recommended by medical practitioners. In addition, the practice directly contravenes a three-decade-old code of ethics developed by the World Health Organization and repeatedly encouraged by the U.S. government.
However, the financial motivation to continue this practice — and to provide free products or other incentives to hospital maternity wards — remains powerful for many companies.
“If I were to feed my newborn formula, I would likely use the formula provided by the hospital,” Julie Carson, who gave birth in the Washington area in early May, told MintPress News. “I trusted the hospital to care for us, and I would trust their choice in formula.”
Yet for some consumer rights advocates, this perception of medical approval can be problematic, particularly when it comes to the sample-filled bags that many hospitals continue to provide to new mothers. When she checked out of the hospital, for instance, Carson was given a discharge bag that included samples of Similac, a widely used product from Abbott Labs in Maryland.
“Discharge bags remain very controversial because they suggest an endorsement by the hospital of formula feeding or supplementation,” Eva Seidelman, a researcher and coordinator of the formula marketing campaign at Public Citizen, a consumer advocacy group, told MintPress.
“The inclusion of formula in these bags sends the message that breastfeeding is very difficult and that mothers will probably need to use formula at some point. Studies on the use of formula have found that women who receive formula in these packs tend to breastfeed for shorter durations.”
Of course, many women need to or choose to use formula for a variety of reasons, often for medical purposes, and for these families a few free bottles of any product would clearly be welcomed. Breastfeeding proponents warn, however, that because a mother’s milk supply is directly related to demand, even minor supplementation can lead to a decreasing supply — and hence, the need for more formula.
Yet that fact, advocates say, often isn’t made clear enough to new mothers interested in exclusive breastfeeding, and the situation is further muddied by any automatic inclusion of formula samples in a discharge pack. In 2006, a national campaign called Ban the Bags grew out of the Massachusetts Breastfeeding Coalition, and since that time the group says that more than 800 hospitals have reported banning discharge bags.
Today, advocates estimate that at least half of all U.S. hospitals have eliminated or limited the distribution of formula company-sponsored sample bags, though underreporting makes it difficult to determine the exact number. Last week, Public Citizen delivered a related petition to three of the largest formula manufacturers, Mead Johnson, Abbott and Nestle.
“In the United States, the vast majority of birthing hospitals give away industry-provided samples of infant formula to new mothers after they give birth,” thepetition states.
“Infant formula companies are directly harming babies’ health and undermining the healthcare mission of hospitals by engaging in this destructive marketing practice,” it states, calling on the three manufacturers to “stop distributing samples of infant formula in healthcare facilities, including hospitals and other medical clinics.”
While hospitals have been under pressure to move away from formula samples for several years, the new campaign is the first concerted effort to target formula manufacturers. But these companies are pushing back on such a characterization, emphasizing that promotions provide an important educational service for new mothers.
“Focusing on infant feeding support kits detracts from the real barriers to breastfeeding such as access to healthcare after leaving the hospital, breastfeeding support in the workplace, and paid or longer maternity leave,” Mardi Mountford, executive vice president of the International Formula Council, a trade association, told MintPress in a statement.
“Further, suggesting moms can be swayed from breastfeeding by receiving information on infant formula or a small sample does a great disservice to them.”
Mead Johnson, a major manufacturer, says that it recognizes different perspectives on the issue. A company spokesperson told MintPress: “We believe that healthcare professionals are in a good position to provide appropriate counsel to support a mother in making an informed choice regarding the feeding practice that best meets the needs of her baby, her family and herself.”
In addition to its nutritional value and free supply, breast milk is credited with a unique spectrum of antibodies that provide protection against infections during the first several months of a newborn’s life. The United Nations is unequivocal on the benefits of immediate and exclusive breastfeeding of infants for the first six months.
UNICEF, the U.N. fund for children,suggests that “optimal” breastfeeding practices could save an additional 1.4 million children under five years old from death each year.
“Yet early cessation of breastfeeding in favour of commercial breastmilk substitutes and the needless supplementation and poorly timed introduction of other foods, often of poor quality, are far too common,” the agency states.
Indeed, by the early 1970s experts had seen a precipitous decline in breastfeeding rates around the world. For instance, whileresearchers reported strong breastfeeding patterns in the United States during the early 20th century, those figures had dipped to just 50 percent by the 1950s. And by 1972, just 22 percent of American mothers were said to be breastfeeding.
The release of the new Public Citizen petition was timed to coincide with the 33rd anniversary of the international response to this situation: landmark guidance from the WHO known as theInternational Code of Marketing of Breast-milk Substitutes. In the code’s introductory materials, the WHO states that by 1974 a “general decline” had been noted in breastfeeding in many parts of the world, which it attributed at least in part to “the promotion of manufactured breast-milk substitutes.”
Adopted in 1981, the code’s voluntary rules explicitly state that “[m]anufacturers and distributors should not provide, directly or indirectly, to pregnant women, mothers or members of their families, samples of products.” Medical centers, in particular, are singled out by the code. “Health workers should not give samples of infant formula to pregnant women, mothers of infants and young children, or members of their families,” it states. “No facility of a health care system should be used for the purpose of promoting infant formula.”
UNICEFsays that, to date, 84 countries have created legislation in line with the code, while similar bills are pending in another 14 countries. In the U.S., these guidelines have received backing from the Centers for Disease Control, the surgeon general and the American Academy of Pediatrics, among others.
The code and related efforts have been credited with facilitating a broad rise in breastfeeding rates in recent decades around the world. According to the most recentfigures from the CDC, for 2013, some 77 percent of U.S. infant at least begin their lives breastfeeding.
Yet the CDC notes that there is still “concern” over the fact that many infants are not breastfeeding for as long as recommended. For infants born in 2010, for instance, around 49 percent were breastfeeding at six months of age, though that is up from 35 percent a decade earlier.
While there are no federal laws and relatively few state regulations on the issue, hospitals in the U.S. have increasingly responded to consumer pressure. In 2006, for instance, the Ban the Bags initiative grew out of a strong push to end formula promotions at medical centers in Massachusetts. Similar successes have been seen in North Carolina, Oklahoma and elsewhere. (Public Citizen has a forthcoming report tracking strategies that have worked in this regard at the local level.)
In part, this pressure has been formalized under a certification program called theBaby-Friendly Hospital Initiative. Created in 1991 by UNICEF and the WHO, the initiative states that infants should receive only breast milk unless supplementation is medically needed. So far, around 160 U.S. hospitals have joined the undertaking, and Public Citizen’s Seidelman says that advocates are increasingly able to push medical centers to compete with one another on related criteria.
“It’s really developing momentum here in the U.S. A lot of hospitals want this designation, which appears to greatly increase rates of breastfeeding,” she said. “We now think that the majority of hospitals will also stop distributing formula samples in the near future.”
Perhaps in response, however, breastfeeding advocacy groups are seeing formula manufacturers move more aggressively into non-hospital medical centers.
“That’s definitely an increasing trend in pediatric offices, and gynecological and prenatal clinics,” Seidelman said. “While we’re getting better and better response with hospitals, we want a complete ban on this type of marketing in all healthcare offices.”