Director Fine, the Lt. Governor as well as the First Lady spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding. State health officials noted that studies link giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.

For more information, see coverage in USA Today.

Mothers continue to receive uninvited coupons and samples mailed to their homes — according to a recent CDC study, nearly 2/3 of first-time mothers received a free sample of infant formula in the mail .  

Industry marketers continue to reach mothers through mailing lists sold by baby product manufacturers or maternity retailers. In the hospitals, some mothers have reported that baby photo companies are providing addresses to the formula industry to pitch their products to moms.

The industry seems to be extending that strategy to small businesses: we’ve had reports that businesses catering to young families, such as baby photo studios, are handing out formula samples and coupons to clients. In one case, the owner of a photo studio confirmed that a formula representative had approached her about distributing their marketing materials. In another case, a photo company that takes newborn photos in the hospital was connecting with at least one formula manufacturer to share contact information of new parents.

Where have you seen formula handouts in your community? And what can we do to educate businesses about the financial costs and health risks of marketing branded formula to new mothers?  

Mead Johnson hit new lows this past week, calling Lipil “The Breast Milk Formula” on its web site. The title to the web page was changed to “Enfamil – Lipil” following a concerted campaign by breastfeeding activists to contact the Federal Trade Commission.

Mead Johnson’s advertising is already under review by the FTC for overstating the health benefits from added fatty acids DHA/ARA. With the recent “breast milk formula” ploy, Mead Johnson sank to new lows, essentially claiming that infant formula is the same thing as human milk.

Breastfeeding listservs sent out alerts starting June 12, urging advocates to write to the Federal Trade Commission and file a complaint about this deceptive advertising. The web site still listed “The Breastmilk Formula” on June 13, but within days, Enfamil had replaced the title.

Nevertheless, the rest of the web page continues to mislead families with spurious claims that their formula is equivalent to human milk. The page combines colorful graphics with claims that babies fed with DHA/ARA supplemented formula are smarter and have better vision than those fed other types of formula.

In fact, a study by the widely-respected Cochrane Review found that adding artificial long chain polyunsaturated fatty acids (LCPUFA’s) such as DHA and ARA to infant formula had no beneficial effect for healthy infants. In their summary, they write:

This review found that feeding term infants with milk formula enriched with LCPUFA had no proven benefit regarding vision, cognition or physical growth.

In fact, supplementation with LCPUFA’s may cause dangerous side-effects. A recent report by the National Alliance for Breastfeeding Advocacy (NABA) and the Cornucopia Institute found that some infants fed formula with DHA and ARA supplements developed diarrhea, vomiting and dehydration. In an alert to parents, they write:

DHA and ARA in infant formula have been linked to severe diarrhea, vomiting, dehydration, and gastrointestinal pain in some infants. Since these additives are relatively new in infant formula, not all pediatricians are aware of their possible side effects.

It’s time to let the FTC know that continued misleading advertising of “breast milk formula” is unacceptable. Act now to file a complaint on the FTC web site. A sample letter of complaint follows below.

Sample Letter
I wish to register a complaint regarding text contained at the following Mead Johnson website:

http://www.enfamil.com/app/iwp/enfamil/productDetail.do?dm=enf&id=-10733&iwpst=B2C&ls=0&csred=1&r

Mead Johnson manufactures infant formula and markets it in a manner that is false and misleading to consumers. This deceptive text could lead consumers to believe that Enfamil formula is the same as breastmilk and cause them to purchase this product thinking that it will produce the same health outcomes breastfeeding. Enfamil formula contains fungal and algal sources of DHA and ARA. These sources of DHA and ARA are metabolized differently from the long chain fatty acids naturally present in breast milk. Mead Johnson has been cautioned by the FTC to refrain from overstating the health benefits from these fatty acids, yet the company has escalated its claims to the point that it represents its product as “the breast milk formula,” suggesting it is equivalent to human milk.

The National Alliance for Breastfeeding Advocacy (NABA) and the Cornucopia Institute jointly filed a petition with the FTC on January 24, 2008 requesting the investigation into false and misleading claims by formula manufacturers regarding these fatty acids as possible violations of the law (15 USC 45). This particular ad is misleading, because a Cochrane review of randomized trials has shown that there is no evidence for a beneficial effect of LCPUFAs in infant formula. Such misleading information may lead consumers to make ill-informed decisions about infant feeding.

Of note, The US Department of Health and Human Services targets exclusive breastfeeding in the Health People 2010 goals. Public health groups on the state and federal level invest millions of dollars to support breastfeeding. Advertisements such as this one directly undermine those efforts by misleading parents into thinking that infant formula is equivalent to breastmilk.

The FTC is legally obligated to end misleading advertisements under Section 5 of the Federal Trade Commission Act, 15 USC 45. The FTC has described a misleading advertisement as a representation, omission, or practice that is likely to mislead the consumer. In the case of DHA/ARA as advertised on this website, there is a high likelihood that consumers will be mislead into believing that this formula offers benefits to their infant’s development and is equivalent to breastfeeding. This deception can cause harm to both mother and infant leading to premature formula supplementation or cessation of breastfeeding.

I urge the FTC to thoroughly investigate this matter pursuant to your authority, including but not limited to the issuance of a civil investigative demand. We must ensure that consumers have accurate information regarding the health consequences of artificial breast milk substitutes.

Sampling gets the product into the hands of the consumer, provides for its easy use at the first sign of breastfeeding roadblocks, and starts the process of early weaning – the perfect setup for creating a market where none existed before.

CHICAGO—A majority of U.S. hospitals on the East coast distribute formula sample packs to new mothers, contrary to recommendations from most major medical organizations concerned about the potential for distributing these packs to reduce breastfeeding rates, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. However, the practice is changing significantly.

“Packaged as smart diaper bags, the commercial sample packs contain formula, coupons, advertisements and baby products,” the authors write as background information in the article. “Typically, they are given free to the hospital by the relevant infant formula manufacturer and are distributed to patients by clinicians when mother and newborn are discharged from the hospital.” Institutions that have voiced opposition to this practice include the Centers for Disease Control and Prevention, Ame rican Academy of Pediatrics, American College of Obstetricians and Gynecologists and World Health Organization.

Anne Merewood, M.P.H., I.B.C.L.C., of the Boston University School of Medicine, and colleagues contacted 1,295 hospitals in 21 Eastern states and the District of Columbia by telephone between October 2006 and March 2007. Of those, 1,215 (93.8 percent) distributed formula sample packs to at least some new mothers. Patterns were evident by state and by region. In New Hampshire, 70.4 percent of hospitals distributed the packs, while 100 percent of those in New Jersey, Maryland, Mississippi, West Virginia and the District of Columbia did so.

Among 80 hospitals that were free of sample packs, 20 had eliminated the practice before 2000 and 60 since 2000. “The proportion of bag-free hospitals has risen significantly between 1979 and 2006,” the authors write. “Elimination of sample packs was ongoing, with clusters of activity in certain regions such as New York City and Massachusetts.” The reductions in these areas were likely associated with focused public health efforts to eliminate the packs, the authors note.

“Exclusive breastfeeding rates among young infants are discouragingly low,” with only 11 percent of U.S. infants exclusively breast-fed at 6 months, they conclude. “Formula sample packs have been shown to undermine breastfeeding, and their elimination from U.S. hospitals may help to increase exclusive breastfeeding rates nationally. The prevalen ce of sample pack distribution is disturbing and incongruous given extensive opposition, but encouraging trends suggest that the practice may be curtailed in the future.”

(Arch Arch Pediatr Adolesc Med. 2008;162[9]:823-827 )

• Read coverage in the Chicago Tribune

Editor’s Note: This study was supported by a contract from the Department of Health and Human Services to the Breastfeeding Center, Boston Medical Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .