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Infant Formula Marketing Letter to Hospitals

Letter to Hospitals: Stop Allowing Infant Formula Companies to Distribute Formula Samples to New Moms

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The following letter was sent to 2600 hospitals across the country. Over one hundred organizations – listed below – signed on to the letter calling on hospitals to stop allowing formula companies to market infant formula in their facilities.

March 30, 2012

Dear Chief Executive,

We strongly urge you to immediately discontinue the distribution of commercial infant formula manufacturer discharge bags in your facility. Many health care institutions are now scrutinizing the ethics and safety of commercial marketing and distribution of pharmaceutical products within their facilities; distribution of commercial discharge bags marketing infant formula is similarly unethical and contrary to good public health policy.

There is overwhelming consensus among all major health professional organizations regarding the health benefits of breastfeeding for mothers and babies and the importance of exclusive breastfeeding for the first six months of life.[1] Hospital promotion of infant formula through dissemination of these discharge bags contravenes this consensus, needlessly and inexcusably harming babies and families. Moreover, formula feeding imposes a significant burden on the nation’s economy. Breastfeeding saves families and the economy countless dollars.

When hospitals distribute formula samples, they participate in the marketing efforts of formula companies at the expense of patients. Moreover, by distributing samples, they imply that these products are medically approved and recommended. Yet, there is ample evidence that formula samples reduce breastfeeding duration and exclusivity. Multiple studies have shown that women who receive commercial hospital discharge packs stop breastfeeding sooner than those who do not.[2] Hospitals expend resources to support mothers to breastfeed, but reduce the impact of these efforts by distributing formula samples. Research shows that bag distribution sends a message more powerful than any verbal messages.[3] New mothers who at first experience difficulty breastfeeding are apt to choose to use free formula samples given to them in discharge bags instead of seeking out assistance with breastfeeding. Aware of these dangers, in 1981 the WHO established the International Code of Marketing of Breast-milk Substitutes.[4] The Code states that healthcare facilities are not to be used for the marketing of infant formula. Hospitals in the U.S. that continue to distribute formula samples are in violation of the WHO Code.

Your hospital aims to promote the health of infants and mothers, but the ongoing promotion of infant formula conflicts with this mission. In 2009, the Centers for Disease Control and Prevention’s mPINC study found that 34.2 percent of hospitals nation-wide had stopped distributing formula samples.[5] This was an increase from 2007, when only 27.4 percent of hospitals had discontinued the sample bags.[6] Recently, Rhode Island became the first state where all birthing hospitals have banned the distribution of formula samples.[7] This is important progress but far from sufficient. We urge your hospital to join those hospitals that refuse to act as marketing agents for formula companies. We look forward to your response, and would be pleased to discuss these matters with you further.


Robert Weissman
President, Public Citizen

On behalf of:

National Organizations

Academy of Breastfeeding Medicine
American Academy of Nursing
American College of Nurse-Midwives
American Medical Student Associatio
American Public Health Association
Association of State & Territorial Public Health Nutrition Directors
Ban the Bags
The Best for Babes Foundation, Inc.
Center for Science in the Public Interest
Coalition for Improving Maternity Services
Consumers Union
Every Mother, Inc.
Food and Water Watch
HealthConnect One
Healthy Children Project, Center for Breastfeeding
Human Milk Banking Association of North America

International Board of Lactation Consultant Examiners
La Leche League International
Lamaze International
National Alliance for Breastfeeding Advocacy
National Congress of Black Women, Inc.
National Physicians Alliance
National WIC Association
National Women’s Health Network
Our Bodies, Ourselves
Prevention Institute
Public Health Law & Policy
Shape Up America!
United States Breastfeeding Committee
United States Lactation Consultant Association
Wellstart International

State Organizations

Alabama Breastfeeding Committee
Arizona Breastfeeding Coalition
Breastfeeding Center of Pittsburgh
Breastfeeding Coalition of Oregon
Breastfeeding Coalition of the Uniformed Services
Breastfeeding Coalition of Washington
Breastfeeding Initiative
California Breastfeeding Coalition
California Center for Public Health Advocacy
Carolina Global Breastfeeding Institute
Central Louisiana Breastfeeding Coalition
Coalition of Oklahoma Breastfeeding Advocates
Colorado Breastfeeding Coalition
Connecticut Breastfeeding Coalition
District of Columbia Breastfeeding Coalition
Eastern Kentucky Breastfeeding Coalition
Florida Breastfeeding Coalition, Inc.
Georgia Breastfeeding Coalition
Guam Breastfeeding Coalition
Healthy Mothers, Healthy Babies Coalition of Georgia
Illinois State Breastfeeding Task Force
Indiana Black Breastfeeding Coalition
Indiana Perinatal Network / Indiana State Breastfeeding Coalition
Kansas Breastfeeding Coalition, Inc.
Lactation Improvement Network of Kentucky

Louisiana Breastfeeding Coalition
Maryland Breastfeeding Coalition
Massachusetts Breastfeeding Coalition Minnesota Breastfeeding Coalition
Missouri Breastfeeding Coalition
Mothers’ Milk Bank of Montana
Nebraska Breastfeeding Coalition
New York State Healthy Eating and Physical Activity Alliance
New York Statewide Breastfeeding Coalition
Ohio Breastfeeding Alliance
Ohio Lactation Consultant Association
Oregon Public Health Institute
Pennsylvania Breastfeeding Coalition
Pueblo of Isleta Breastfeeding Task Force
Puerto Rico Department of Health Breastfeeding Promotion Committee
South Carolina Breastfeeding Coalition
South Carolina Eat Smart, Move More Coalition
Tennessee Breastfeeding Coalition
Texas Breastfeeding Coalition
The US Territory of Guam WIC program
Vermont Breastfeeding Network
Vermont Lactation Consultant Association, Inc.
Virginia Breastfeeding Task Force
West Virginia Breastfeeding Alliance

Regional and Local Organizations

Acadiana Breastfeeding Coalition, Inc.
Cambridge/Somerville WIC
Consortium to Lower Obesity in Chicago Children, Children’s Memorial Hospital
Greater Miami Valley Breastfeeding Coalition
Lactation Study Center, University Of Rochester
La Leche League of Charlottesville, VA
La Leche League of Northern Dutchess
La Leche League of Yonkers, New York
La Leche of Marine Park, Madison
Lorain County Breastfeeding Coalition
Luzerne County Breastfeeding Coalition
Maternity Care Coalition
Mid-Hudson Lactation Consortium
Missoula City-County Health Department

Missoula Montana WIC
Northeast Georgia Breastfeeding Coalition
Northern Ohio Lactation Association
Oswego County Breastfeeding Coalition
Pennsylvania Mid-state Lactation Coalition
Permian Basin Breastfeeding Coalition
San Antonio Breastfeeding Coalition
Shelby County Breastfeeding Coalition
South Eastern Lactation Consultants Association
South Sound Breastfeeding Network
The Greater Hudson Valley Family Health Center, Inc. WIC Program
Western Pennsylvania Lactation Consultants Association


[1] American Academy of Pediatrics Section on Breastfeeding. “Breastfeeding and the Use of Human Milk (Policy Statement).” Pediatrics 115, no. 2 (2005): 496-506; American Academy of Family Physicians. “Family Physicians Supporting Breastfeeding (Position Paper).” Retrieved 9 February, 2012, from http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositi… Academy of Breastfeeding Medicine. “Position on Breastfeeding.” Breastfeeding Medicine,no. 4 (2008), http://online.liebertpub.com/doi/pdfplus/10.1089/bfm.2008.9988; James, D. C., and B. Dobson. “Position of the American Dietetic Association: Promoting and Supporting Breastfeeding.” Journal of the American Dietetic Association 105, no. 5 (2005): 810-18; American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women and Committee on Obstetric Practices. “Special Report from ACOG. Breastfeeding: Maternal and Infant Aspects.” ACOG Clinical Review 12, no. 1 (suppl) (2007): 1S-16S; National Association of Pediatric Nurse Practitioners. “NAPNAP Position Statement on Breastfeeding.” Journal of Pediatric Health Care 21, no. 2 (2007): A39-A40; World Health Organization and United Nations Children’s Fund. “Global Strategy for Infant and Young Child Feeding.” World Health Organization. Retrieved 9 February, 2012, from http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf; U.S. Department of Health and Human Services. “The Surgeon General’s Call to Action to Support Breastfeeding.” U.S. Department of Health and Human Services, Office of the Surgeon General. Retrieved 14 February, 2012, from http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupport….

[2] Bergevin, Cynthia , Y. Dougherty, and M.S. Kramer. “Do Infant Formula Samples Shorten the Duration of Breast-Feeding?” The Lancet 321, no. 8334 (1983): 1148-51; Donnelly, A., HM Snowden, MJ Renfrew, and MW Woolridge. “Commercial Hospital Discharge Packs for Breastfeeding Women.” Cochrane database of systematic reviews (2000); Dungy, C.I., J. Christensen-Szalanski, M. Losch, and D. Russell. “Effect of Discharge Samples on Duration of Breast-Feeding.” Pediatrics 90, no. 2 (1992): 233; Rosenberg, Kenneth D., Carissa A. Eastham, Laurin J. Kasehagen, and Alfredo P. Sandoval. “Marketing Infant Formula through Hospitals: The Impact of Commercial Hospital Discharge Packs on Breastfeeding.” Am J Public Health 98, no. 2 (2008): 290-95; Snell, BJ, M. Krantz, R. Keeton, K. Delgado, and C. Peckham. “The Association of Formula Samples Given at Hospital Discharge with the Early Duration of Breastfeeding.” Journal of Human Lactation 8, no. 2 (1992): 67; Wright, Anne, Sydney Rice, and Susan Wells. “Changing Hospital Practices to Increase the Duration of Breastfeeding.” Pediatrics 97, no. 5 (1996): 669-75.

[3] Reiff, Michael I., and Susan M. Essock-Vitale. “Hospital Influences on Early Infant-Feeding Practices.” Pediatrics 76, no. 6 (1985): 872-79.

[4] World Health Organization. “International Code of Marketing of Breast-Milk Substitutes.” Retrieved 10 October, 2011, from http://www.who.int/nutrition/publications/code_english.pdf.

[5] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “CDC National Survey of Maternity Care Practices in Infant Nutrition and Care (mPINC), 2009.” Table 5.2a: Distribution of infant formula discharge packs by facility type, size, NICU level, and region. Retrieved 14 February, 2012, from http://www.cdc.gov/breastfeeding/data/mpinc/data/2009/tables5_1a-5_2a.htm.

[6] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “CDC National Survey of Maternity Care Practices in Infant Nutrition and Care (mPINC), 2007.” Retrieved 14 February, 2012, from http://www.cdc.gov/breastfeeding/data/mpinc/data/2007/tables5_1a-5_2a.htm.

[7] Associated Press. “No More Free Infant Formula at RI Hospitals.” USA Today. Retrieved 6 February, 2012, from http://yourlife.usatoday.com/parenting-family/story/2011-11-29/No-more-f….