Hospitals that discontinued distributing industry-sponsored infant formula sample packs to new mothers doubled from 2007 to 2010, but many continue the practice despite criticism that it discourages breastfeeding, study data indicate.

Anne Merewood, PhD, MPH, a certified lactation consultant at Boston Medical Center, and colleagues, performed a follow-up study to determine how the practice of handing out free formula sample packs had changed among 1,200 U.S. maternity hospitals first surveyed in 2007. The researchers analyzed data from the 20 best and 20 worst states.

The number that discontinued handing out formula packs increased from 14% in 2007 to 28% in 2010. Although this is an improvement, it still means that the majority of hospitals continue to hand out the samples, the researcher noted.

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This may be because formula companies offer hospitals incentives, including supplies for premature and other special needs infants that are unable to breastfeed, CDC director Thomas Friedan, MD, MPH, pointed out last month, after the agency released a report that said U.S. hospitals are not doing enough to promote breastfeeding.

Other health organizations have called for a halt to hospitals providing free infant formula samples, including WHO, the American Academy of Pediatrics and the American Academy of Obstetricians and Gynecologists.

In the current study the proportion of formula-free hospitals improved the most those in the top ranked states for breast-feeding, increasing from 25% in 2007 to 46% in 2010 (P<0.0001). Improvements were also noted among the bottom states but were not as substantial, increasing from less than 1% to 7% during the same time period.

“This implies that patterns in formula removal may be influenced by ‘peer pressure’ or changing cultures at surrounding institutions, as sample pack-free institutions become more normal,” the researchers wrote.

Rhode Island had the highest proportion of formula-free hospitals at 86%, data indicated, whereas Maryland, Mississippi, South Dakota and the District of Columbia faired the worst, with no formula-free hospitals.

These findings seem to correlate with actual breastfeeding prevalence rates, the researchers noted. Using data from a separate 2010 CDC study on breastfeeding, they determined that the 10 best states had an average breastfeeding initiation rate of 81.5% vs. 67% in the worst states.

Study limitations include lack of data on hospital formula pack distribution outside of maternity wards and the possibility that the selected states included in the study were not nationally representative.

“One industry response to widespread efforts to change this practice has been to increase distribution of samples in other health care settings, for example, via the obstetrician’s office, or direct to the home,” the researchers warned.

Merewood A et al. Pediatrics. 2011; doi:10.1542/peds.2011-0983.