CDC reports 79% of hospitals aren’t giving out formula samples

May 2015- The 2015 CDC mPINC survey shows that 78.7% of hospitals report that they do not give out “discharge packs” with formula samples to breastfeeding mothers. Data from older mPINC surveys shows the number of hospitals distributing formula companies discharge packs to breastfeeding mothers has markedly declined between 2007 and 2013, according to a study published May 2015 in Pediatrics. The percentage of hospitals distributing infant formula discharge packs to breastfeeding mothers was 72.6% in 2007 and 31.6% in 2013, a decrease of 41 percentage points. In 2007, there was only 1 state (Rhode Island) in which <25% of hospitals distributed infant formula discharge packs to breastfeeding mothers, whereas in 2013 there were 24 such states and territories.  Note that the CDC data is different from BantheBags’ data in two important aspects: CDC data is based on self report only, whereas BantheBags verifies the self report of every hospital we list. CDC data also does not specify whether the discharge bags are from formula companies or not, and only specifies whether they are given to breastfeeding mothers. At BantheBags, we will only list hospitals who have banned all industry-sponsored discharge bags to all mothers.

Top-ranked hospitals have abandoned infant formula promotion

A new study from Public Citizen and the Ban the Bags campaign shows that the majority of the top ranked hospitals in the U.S. News and World Report’s “Best Hospitals” no longer distribute gift bags from infant formula manufacturers. See the press release at http://www.citizen.org/pressroom/pressroomredirect.cfm?ID=4001. The abandonment of this marketing practice at top hospitals can serve as an example of how ending this marketing tactic shows a dedication to the health and safety of a hospital’s littlest patients. Sixty-seven percent of top hospitals in gynecology (30 out of 45) reported not distributing formula company sponsored discharge bags, formula samples or other formula company promotional materials to mothers in their maternity units.  Eleven percent of hospitals in gynecology (5 of 45) still distribute formula company-sponsored materials, and a handful of hospitals did not respond to the survey. If your hospital is still engaged in this detrimental practice it’s time to ask why a health institution persists in endorsing and marketing potentially hazardous brand name products to its vulnerable patients. The entire study can be found at http://www.citizen.org/documents/Best-Hospitals-End-Infant-Formula-Marketing-to-Support-Breastfeeding-Report.pdf.

Latch On NYC Levels the Playing Field from Formula Marketing

Sept 23, 2012—This month, New York City hospitals starts implementing their voluntary breastfeeding initiative, Latch On NYC.  Earlier this summer, Latch On NYC hit news and blogs all over the country, with many Americans objecting to the requirement of participating hospitals to track their inventories of infant formula, as they do with medications. Some commentators thought this move unnecessarily “punished” formula feeding mothers, and likened the move to locking up narcotics.

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Massachusetts Celebrates Banning the Bags

July 22nd, 2012
BOSTON— Massachusetts celebrated being the nation’s second and largest bag-free state today in a celebration at the State House. “We are so proud of our 49 hospitals. This wasn’t easy, and it wasn’t a cost-neutral decision for a lot of the hospitals,” said Dr. Bobbi Philipp, a pediatrician at Boston Medical Center and head of the Mother-Baby Summit Initiative. At the celebration, Marsha Walker, head of Ban the Bags, issued an ambitious challenge: the next celebration will be when all our hospitals become Baby-Friendly. Dr. Lauren Smith, a pediatrician and the medical director of the Massachusetts Department of Public Health, was effusive in her praise for this accomplishment. DPH has been a strong supporter of breastfeeding and a close partner of the Massachusetts Breastfeeding Coalition for many years.

The event’s host, State Senator Susan Fargo, who sponsored the legislation that gave mothers the right to nurse in public, spoke of the importance of selecting politicians with a strong record on public health. She noted that Mitt Romney, who forced DPH to rescind a DPH regulation banning marketing of infant formula by hospitals when he was governor, had a poor record in this regard, including hiring public health officials with no public health background.

Dr. Melissa Bartick, an internist and chair of the Massachusetts Breastfeeding Coalition, noted “this is a grass-roots, David vs. Goliath victory for public health, and we deserve to be very very proud.” She detailed the events that occurred under Governor Romney in 2006, including the story of the banner that hung behind all the speakers, which reads “Why are hospitals marketing baby formula? Hospitals should market health, and nothing else.” The same banner was used at MBC’s State House demonstration in 2006 in an unsuccessful attempt to convince Romney to reverse his decision. Those efforts, she noted, had the support of the Massachusetts Public Health Association, the Massachusetts Chapter of the American Academy of Pediatrics, the Massachusetts section of the American College of OB-GYN, and the Massachusetts Medical Society (publishers of the New England Journal of Medicine). Bartick urged the nation to move forward in eliminating conflicts of interest. As long as our health institutions take money from formula companies, fast food, and soft-drink manufacturers, she stated, “they cannot truly practice evidence-based medicine.” She noted that the national office of the American Academy of Pediatrics accepts financial support from all these companies. “Taking such money will ultimately cost these institutions their credibility, something that no amount of money can buy.”

After the State House celebration, Drs. Philipp and Bartick and Marsha Walker took some of the formula companies bags to the site of the original Boston Tea Party to ceremonially “throw them overboard” for the cameras. (Not to worry– MBC would not litter the Boston Harbor).

Massachusetts’ accomplishment and Romney’s role in it were featured in an explosive article in Time which came out yesterday. Dr. Philipp was interviewed today about the on WBUR, an NPR station, where she faced off with “Skeptical OB” blogger Dr. Amy Tuteur. The Boston Globe featured a story on the ban on July 13. WLBZ TV in Bangor, ME ran a story today featuring Anne Merewood, PhD of Boston Medical Center who researches the bags.

From the comments in some of the media, it is clear that not everyone understands why this ban matters. To this, Dr. Bartick asks, “In what universe is it ever OK for your hospitals, doctors, and nurses to be marketing a pricey brand-name product to you that you do not need?” Even if you never plan to breastfeed, she pointed out today, this pricey brand will cost you $700 more per year than store brand, and you are likely to stick to the brand that was marketed to you in the hospital.

Massachusetts hospitals eliminate formula marketing, becoming the nation’s second “bag-free state”

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Boston — As of July 1, 2012, all 49 Massachusetts maternity facilities have voluntarily eliminated the formula company diaper bags, traditionally given to new moms at hospital discharge. Massachusetts became the nation’s second “bag-free” state after Rhode Island’s seven hospitals eliminated the bags in 2011. The achievement will be celebrated on July 18, at 10:30 am at Nurse’s Hall at the State House, in an event that includes Dr. Lauren Smith, medical director of the Massachusetts Department of Public Health.

In 2005, nearly all maternity facilities in the state were giving out discharge bags from formula companies. The marketing technique is particularly effective in lowering breastfeeding rates in part because of the implied endorsement of the hospital and health professionals. The bags often come with a requirement that hospitals get their formula for free, which contributes greatly to unnecessary use of formula by breastfeeding mothers. Research has consistently shown that such use is one of the strongest predictors of early breastfeeding failure— with a resultant increase in formula sales.
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Rhode Island Birthing Hospitals End Baby Formula Giveaways

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Providence, Rhode Island — As part of efforts to support breastfeeding mothers, women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital. Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign joined the Rhode Island Health Department Monday November 28, 2011 in celebrating the state’s becoming the first in the nation to eliminate the distribution of infant formula marketing bags in all of Rhode Island’s birthing hospitals.

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.

Pediatrics study reports slow progress banning bags

A new study published in the medical journal Pediatrics finds slow progress in efforts to remove formula marketing from hospitals. The study followed-up formula pack distribution at 1239 maternity hospitals in 20 states, including the 10 states with the best and worst record for formula marketing in a 2007 study. Among the best-performing states, the proportion of bag-free hospitals increased by 18%. In the worst-performing states, the proportion increased by 6%. The study generated widespread coverage in the press, including stories from CNN, Time Magazine, the Associated Press, and the Huffington Post, as well as multiple other web sites.

Corporate Voices Toolkit Illustrates Perils of Conflicts of Interest

Last month, the non-profit group Corporate Voices for Working Families released an updated version of its worksite lactation toolkit, initially released in 2009. Again working with Working Mother Media, the toolkit “is made possible by the generous support of Abbott Nutrition,” makers of Similac infant formula. Corporate Voices also thanks Abbott for serving as a critical reviewer of the content of the toolkit.

The toolkit provides an excellent illustration of what happens when well-meaning organizations partner with the formula industry, potentially tarnishing their own credibility and hard-earned reputation. Research has already shown that when formula companies provide information on breastfeeding, mothers who use that material are more likely to use formula.

Yet, in its most egregious flaw, the toolkit repeatedly refers users to Abbott’s materials on breastfeeding, including a pamphlet they produced, their hotline and their website. There is also plenty of inaccurate information in their other materials in the toolkit.

The influence of the formula industry may be too subtle to be readily apparent to the average user, including editorial staff at Corporate Voices.

What is most notable about the toolkit are the many things that it doesn’t say. For example, the toolkit contains long lists of resources, many of which are well respected, but nowhere does it mention the federal government’s Business Case For Breastfeeding, a competing worksite toolkit that is evidence-based and has no commercial bias. It also does not highlight the National Business Group on Health’s worksite material, which is also well respected.

In its main brochure, the Corporate Voices toolkit describes the health benefits to infants such as reduced ear infections, diarrhea and colic. But it fails to mention any more scary or serious conditions such as hospitalization for lower respiratory tract infection, Sudden Infant Death Syndrome, obesity, and diabetes. There is little risk to the formula industry to concede milder diseases of infancy that most of the public knows about anyway.

When the toolkit’s main brochure discusses the “benefits” of maternal health, it mentions only breast cancer, cervical cancer, and weight loss. These latter two conditions are without a strong evidence base, and are not included the 2007 Agency for Health Care Research and Quality analysis of breastfeeding data. Other serious maternal diseases that are in the AHRQ report go unmentioned: ovarian cancer and type 2 diabetes, for example.

The toolkit features many common but subtle problems often seen when the formula industry produces materials on breastfeeding such as:

  • Repeatedly describing only the “benefits” of breastfeeding, and never referring to the risks of not breastfeeding. Breastfeeding is the biologically normal way babies are fed; to describe the “benefits” of breastfeeding implies that formula is the normal way babies are fed.
  • Using superlative language to describe breastfeeding or breastmilk such as “best” or “optimal,” knowing that most people will settle for “good enough” or “average” and the ideal or optimal products are often beyond the reach or desire of the average person.
  • Overemphasizing how difficult breastfeeding can be—focusing on mothers’ struggles, pain, guilt, leaky breasts, etc. Included in this category are materials that emphasize the different kinds of equipment a mother “needs” in order to breastfeed: creams, pads, cover-ups, pumps, special clothing, etc.
  • Using language above the reading level recommended for health literacy when producing educational materials for the general public. Health literacy experts recommend that materials be written at a sixth grade level. Materials written at sixth grade reading level have short simple sentences, without the need for commas.
  • Using subtle language to ensure formula feeding mothers are included in all breastfeeding initiatives, as was illustrated in a letter from an Ohio representative to the Surgeon General included in the toolkit, predating the Surgeon General’s release of her Call to Action to Support Breastfeeding. The representative asks that the Call to Action be “balanced and supportive of all mothers,” and “improve the nutritional well being of all infants in this nation.”
  • Failure to mention more serious diseases associated with early cessation of breastfeeding, and only mentioning more minor risks that are already commonly known.

Aside from referring mothers and providers to Abbott materials, the toolkit includes many videos purporting to give tips on breastfeeding. Again, what is important is what is not included. Many of the videos are amateur productions by ordinary mothers with no particular expertise in breastfeeding, and they have little practical information about how to pump at work, or how to breastfeed and some even have overt misinformation. It is concerning that an organization with such resources as Corporate Voices would ignore any number of well-made professional resources in favor of amateur videos that provide little actual support.

Finally, there is almost no mention of the effect of introduction of formula on mother’s milk supply or her ability to breastfeed. Readers may be especially confused because well-respected material is included with obvious formula marketing material, making the entire package appear more credible than it really is.

Conflicts of interest are rife in the health care field, and that is why a growing number of academic medical centers are minimizing their faculties’ relationships with pharmaceutical and device makers. Increasingly, well-meaning doctors and administrators are learning that there is “No Free Lunch”. It is time that well-meaning non-profits learn the same lesson.

Non-profit organizations must be careful not to enter into agreements with any corporation whose activities compromise their own mission and policies. A non-profit interested in children’s health should not be entering into financial relationships with tobacco companies or makers of sugar-sweetened beverages, for example.

These corporations cannot be expected to compromise their bottom line for a good cause—their own shareholders would not stand for it. Thus, true promotion of breastfeeding will only hurt Abbott’s sales. However, a skillful manipulation of a worksite lactation program may actually help its sales, or at least ensure the sales are not negatively impacted. Abbott is well aware that the only way to sell more formula is to sell less breastfeeding. Corporate Voices has partnered with them at its own peril.

Abbott’s support of the Corporate Voices toolkit is not “generosity,” but a sensible marketing investment for its formula products. The result: Corporate Voices appears to be no more than a foolish pawn in Abbott’s greater marketing scheme, and not a good citizen legitimately trying to help working mothers and their employers.