Hospitals should market health, and nothing else.

Hospitals’ distribution of free products from formula companies is a gross violation of the World Health Organization’s (WHO) International Code on Marketing of Breastmilk Substitutes. As a result of efforts out of Massachusetts, the ‘Ban the Bags’ campaign has been successful in stopping aggressive formula marketing tactics in hospitals. In December 2005, Massachusetts became the first state to stop hospitals from distributing formula company gift bags to new mothers. The national Ban the Bags campaign continues to educate the public about the issue and encourage families and health care professionals to move marketing tactics out of maternity hospitals.
What’s wrong with those cute formula “gift” bags?

For decades, formula companies have given out attractive diaper bags to maternity patients at discharge, and parents often appreciate receiving a free gift. But these free gifts are a marketing technique used to just boost sales of formula. These free gifts hurt breastfeeding by reducing the number of women exclusively breastfeeding at all times measured between zero and six months of age. There is ample evidence that when breastfeeding mothers get corporate-sponsored bags, they are more likely to start using formula, even when the bags do not contain formula.

The bags are not really free. They cost the companies less than $7 each, but a year of brand-name baby formula costs parents more than $2,000. Additionally, increased costs to families who receive these bags come from adverse health outcomes related to not breastfeeding; examples include the cost of medications and time lost from work to care for a sick child. Hospital-based marketing pays off for pharmaceutical companies because most parents choose to buy the same brand they got in the hospital.
The bags are specifically harmful to populations with the poorest health outcomes. Low income women are at the highest risk of poor health outcomes that can be prevented by breastfeeding. Additionally, low income women often see these ‘gift bags’ as a way to save money. However, since the formula in a gift bag represents less than a week’s worth of feedings, and decreases a mother’s chance at establishing sufficient milk supply, it will hardly help stretch the budget of low income families. Families will have to go purchase additional cans of formula, likely for the rest of a baby’s first year of life. In fact, Boston Medical Center, which cares for a high proportion of low income women, stopped distributing these bags in the 1990’s, because it considers the practice unethical.
Exclusive breastfeeding for the first six months of life is the current recommendation from the American Academy of Pediatrics. There is abundant scientific evidence that early introduction of formula is linked with adverse health outcomes even for babies who are also breastfeeding. These outcomes are best summarized in the AAP’s recent position statement on breastfeeding, and on the AAFP’s position statement on breastfeeding.

MBC Ban the Bags Fact Sheet

 80% of baby formula sold in the United States comes from major pharmaceutical companies.

 Pharmaceutical companies use hospitals to market formula because the practice implies that doctors and hospitals endorse not only formula-feeding in general, but their brand in particular. They use hospital-distributed commercial discharge bags to advertise their product directly to new mothers as they leave the hospital.

 Research shows that mothers who receive commercial discharge bags are more likely to start using formula. The effect is so dramatic that it is seen even when the bags do not contain formula samples.

 The commercial discharge bags market the most expensive brands of formula, which hurts formula-feeding families as well. There is evidence that the marketing fosters brand loyalty: families continue to use the brand they were given in the hospital. Each of these bags costs the companies less than $7, but a year of name-brand formula costs parents mare than $2,000, a significant portion of which pays for marketing. As a result, families pay at least an extra $700 per year for name-brand formula as compared to store brands.

 The American Academy of Pediatrics (AAP), the American College of Obstetrics and Gynecology (ACOG), the American Academy of Family Physicians (AAFP), and the World Health Organization (WHO), along with many other public health organizations, recommend that mothers breastfeed their babies exclusively for six months and continue to breastfeed with the addition of complementary foods for at least the first year.

 Mothers who use formula instead of breastfeeding face increased risks of breast cancer, ovarian cancer, and type 2 diabetes. Children who are formula-fed have higher rates of many infant infections, as well as chronic diseases such as type 1 diabetes, leukemia and lymphoma, and obesity. The benefits of breastfeeding are dose-related; the more breastmilk a baby receives, the greater the protection for both mother and baby.

 Studies suggest that infants who are not breastfed have significantly higher health care costs, something the Commonwealth cannot afford in this era of health care reform. Formula feeding costs tax payers by increasing expenses for MassHealth and WIC food benefits. A 2001 report from the US Department of Agriculture estimates that the US could save at least $3.6 billion in annual health care costs if breastfeeding rates rose to the levels recommended by the Surgeon General.

 Research shows that mothers who formula-feed have three times as many one-day absences from work to care for sick children as do breastfeeding mothers. Other research estimates that one year of sick time could be saved for every thousand babies breastfed instead of formula-fed.

 Many organizations oppose hospital distribution of commercial discharge bags, including the AAP; the AAFP; District I of ACOG; the Centers for Disease Control; the WHO; the Massachusetts Medical Society; and the Massachusetts Public Health Association. The federal Government Accountability Office (GAO) recently spoke out against this specific practice, defining it as marketing, and the 2000 Surgeon General’s report also condemned it.