Wednesday
Mar172010
New study on impact of free formula on breastfeeding rates
Wednesday, March 17, 2010 
A Canadian report was released looking at the impact of free formula on breastfeeding rates. At parentcentral.ca, Laurie Monsebraaten and Noor Javed wrote about the study in Free formula spoils breastfeeding:Almost 40 per cent of new mothers leave the hospital with free infant formula, a recipe for spoiled breastfeeding according to a new Toronto Public Health report.
Women who didn’t receive the free samples were 3.5 times more likely to be breastfeeding exclusively after 2 weeks, said Breastfeeding in Toronto, Promoting Supportive Environments, released Tuesday.
The study, conducted in 2007 and 2008, found that of 1,500 first-time mothers surveyed, 39 per cent were given formula at hospital discharge. As a result, many of these women stopped breastfeeding sooner than those women who weren’t given formula.
These numbers are astounding, considering that 90% of Canadian women who give birth initiate breastfeeding. If we assume that the 10% that went straight to formula got a handout, then that means that almost 1/3 of women who do initiate breastfeeding are leaving the hospital with formula samples.
Overall, by 3 months:
- 32% are exclusively formula feeding
- 16% are combination feeding (some breast, some formula)
- 52% are exclusively breastfeeding
I am willing to concede that some of the mothers that leave the hospital with formula samples may not have overcome their breastfeeding difficulties even if no sample had been offered. That said, the combination of the high number of women receiving free formula when discharged and the likelihood that they will break into that sample by the two week mark is likely a strong contributor to the significant drop between breastfeeding initiation and continued exclusive breastfeeding.
According to the parentcentral.ca article:
“They give it to the women ‘just in case’,” she said. “But the real message is that you will probably fail... and one bottle leads to another.”
The Toronto East General Hospital is the only baby friendly hospital in Toronto, canceled its contract for free formula in 2005 to comply with the baby friendly requirements and the WHO International Code of Marketing of Breast-Milk Substitutes. Since they do not get the formula for free from formula companies, they need to actually assess whether a mom needs the formula, instead of handing it out 'just in case.'
Other countries with a larger percentage of baby friendly hospitals than we have in Canada and the United States also have higher breastfeeding rates. I think one of the many things that needs to be done to give moms the best chance possible of being successful at breastfeeding is to ensure that they aren't being sabotaged from Day 1. Don't you?
Note: source for all statistics on Canadian breastfeeding rates is the Maternity Experiences Survey from 2006/2007.
Image credit: D-Arb on flickr
Reader Comments (67)
I probably don't belong on this board, but there is a value in helping new mothers know what the options are. The LC at our hospital did not believe in nipple shields, pumping or formula. For us, this became a big problem. After a C-section because my daughter was breach, my milk didn't come in for 5 days. Because my daughter was very small (5%ile), she was the size of the average 34 week old fetus. This size issue became a real problem in terms of achieving a successful latch. Because my milk didn't come in promptly and the problems with the latch, her weight keep dropping. No one cared as her weight dropped to 4lbs 13oz because she had only lost 11-12% of her birth weight. At that point, I felt that it had gone too far, and I gave her formula. I think that this was a wonderful choice for us.
If the LC had a more moderate position, we might have started to pump earlier in the hospital. We could have tried the smaller nipple shields that I brought. Instead, I wound up with large 1/4 inch or bigger scabs on each breast and a child who was still loosing weight on day 5.
We ulitimately got it under control and my daughter has had pumped BM for the last 7 months. If the LC had been more flexible (pumping to stimulate milk, nipple shields), she might have been a more successful breast feeder.
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I agree. There is MAYBE one Lactation Consultant trained nurse in our entire Hospital here. I was luckier b/c I chose midwives for all three of my births and they are well trained! I think that it should be part of the curriculum for nurses, esp. if they are training for OB Nursing. I mean, what else are they supposed to be there for other than to support the new Mom, however she needs it!! Friends of mine who delivered in the hospital here (with OB/GYN's) were ALL offered formula if the newborn didn't immediately latch successfully! That's terrible!! Besides the fact that most newborns will sleep for the first 24 hours after the birth if they have a drink upon arrival (a fact I learned from the midwives), probably 99% of new Moms are NOT going to have immediate BF success! It's a learned ability and they aren't going to learn if there is no one to teach them!
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I left the OB's office with an entire CASE of canned baby formula. I didn't want to take it, but they insisted and said I could always use it to make pancake batter and use it like condensed milk in recipes. Nice alternative! I tried it and it tasted like crap though. I support more implementation of human milk banks. Come on, it makes damn sense. Women get paid for their milk by many human milk organizations. Insurance can (and does) pay for the milk. I for one was overproducing milk with AA cup sized breasts. That would have been great to pump and sell to a milk bank for side income. Some babies born cannot accept even human milk, but a severely small percentage. We can help all the rest of the parents with HUMAN milk, not formula. Of course proper breastfeeding education is KING. That prevent many from even not breastfeeding at all.
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I agree parents who use formula should not expect the hospital to supply it once their child is discharged. Of course parents are responsible for their children's needs, making purchases when necessary. (I also think there should be programs for low-income families.) However, I believe formula sample bags are generally given to hospitals by formula companies to distribute to new parents. Formula companies foot the bill for those "goody bags" ... not the hospital. I'm concerned about the attitude behind not distributing formula samples (--that 'breast is best/ normal' and formula is bad)-- not the freebies themselves.
Suppose for a moment that pharmaceutical and feminine hygiene companies gave samples to hospitals to send home with new moms. Your reaction would probably something along the lines of, "Oh, that's nice. Then new parents have a little less to buy." It may occur to you those samples are a marketing tactic. But I doubt you'd object. If the products of which you have samples were not for you, you just wouldn't use them. You could always switch to other pads and probably other drugs later if you wanted. (Note: Check with your doctor before changing your medication.) If you knew up front you were not interested in the pads or medication, perhaps you would decline the samples in the first place.
Thousands of products are marketed to people. But it is assumed adults are capable of recognizing an attempt to sell them something and making their own assessment of whether or not to purchase them. I don't see why parents would not be capable of deciding what feeding products, (bottles, formula, breast pumps, nursing bras, nursing covers, etc.) if any, to use or buy.
True, distributing formula samples might look like an endorsement of formula feeding and/or a particular brand. However, I would blame that on poor/ lacking feeding advice, not the samples themselves... just as I would fault the hospital for not discussing different pain management options with new moms if they mistakenly thought only the pills the hospital sent home with them would do.
Personally, I would prefer that there be no marketing happening at the hospital. That said, I do think there is a difference between feminine hygiene products and infant formula. If I use feminine hygiene samples for a week and then decide they are not for me, it is not too late to change my mind. If I use formula for a week instead of breastfeeding, my milk will dry up. Sure, relactation is possible, but that isn't a route many moms go down at that point.
Well, we may have to agree to disagree on some things. Here is my opinion:
True. However, I would hope a mom who wants to breastfeed would know that she needs to nurse and/ or express regularly (at least 8 times a day, according to most sources, and preferably by feeding directly from the breast... especially in the beginning) to establish and maintain her supply. If a new mom does not realize using formula for a week instead of breastfeeding would cause her milk to dry up, I think the hospital needs to improve their infant feeding education.
Perhaps I should be more specific about the advice I think hospitals should give. I think new parents should be informed about the pros and cons of each feeding method. This includes breastfeeding, formula feeding, combo feeding, pumping and donor milk. Good information and support should given regardless of the feeding method the parents choose. I realize many hospitals have a ways to go in this respect.
Hospitals would make it very clear that the "goody bags" are sponsored by formula companies; the hospital receives free or discounted formula in exchange for distributing the sample bags. The bags should not be interpreted as an endorsement of formula in general or any brand in particular. The hospital staff should explain that most babies will do fine on any commercial formula, including generics, (with the caveat that infants should not be given follow-up or toddler formulas until they are old enough) and can switch brands without problems.
When moms are breastfeeding, the hospital should let them know about the possibility of supply problems and nipple confusion if they introduce bottles, formula or pacifiers before breastfeeding is established. However, I would also say that relief bottles and supplementing can sometimes be helpful. Parents have to make a judgement call about whether or not to have bottles and formula in the house. Bottles and/ or formula can be removed from the bags if they prefer. If the parents are not interested in the "goody bags" at all, that's fine too. Letting them know about alternatives to bottles, such as cups, spoons, syringes, droppers and SNSs would also be a good idea.
In short, I'm advocating making parents very savvy about formula marketing. That way, they can take advantage of the system instead of the other way around.
[...] Sure. Just like if you’re on a very strict diet, you don’t HAVE to eat the huge dessert buffet I’ve set up on your kitchen table right in front of your face, while I quietly whisper in your ear, “You’re going to fail this diet. It’s okay to be fat, so many other people are. You really can’t resist this chocolate. No one will fault you if you eat it. You can just eat a piece… or two… or three… and it’s okay…” Establishing breastfeeding can be incredibly difficult. Even if you’re still rolling your eyes, muttering point #4, consider these study results: [...]
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