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Marketing in Hospitals

Fact Sheet: Infant Formula Marketing in Healthcare Facilities

A 2013 CDC study shows that the majority (68.6 percent) of U.S. hospitals no longer distribute industry-sponsored samples of infant formula to breastfeeding mothers.[1]Formula makers use this insidious marketing tactic to encourage mothers to feed their babies formula instead of breastfeeding. Mothers who receive formula samples are less likely to breastfeed exclusively and breastfeed for shorter periods of time. Yet, healthcare providers agree that breastfeeding for the first six months of life offers crucial, long-term benefits for children. It’s time to end this dangerous practice and protect children’s health.

Infant formula giveaways are bad for babies

  • Breastfeeding is best for babies. All major medical organizations recommend exclusive breastfeeding for the first six months, followed by continued breastfeeding for the first year and beyond, with the gradual introduction of appropriate complementary foods to the infant’s diet beginning around six months of age.[2] Despite these recommendations, in the U.S. only 16.3 percent of babies are exclusively breastfed for six months.[3]
  • Distributing infant formula samples to new mothers leads to a decrease in breastfeeding. Studies have shown that women who receive commercial discharge bags containing infant formula are more likely to stop breastfeeding sooner than those who don’t receive these samples. The link between formula samples and reduced breastfeeding is well-documented.[4]
  • Higher rates of breastfeeding exist in states that have better records of banning formula samples from hospitals. In states with the most hospitals that have banned distribution of formula samples, the average breastfeeding initiation rate was higher than those states with the worst records.[5]
  • Recognizing the dangers of formula marketing, the WHO established the International Code of Marketing of Breast-milk Substitutes in 1981. The Code states that manufacturers of infant formula should not provide samples of products to pregnant women and mothers. Healthcare facilities are not to be used for the marketing of infant formula brands.[6] Most hospitals in the United States are in violation of the WHO Code.

Breastfeeding saves lives and dollars

  • Health benefits for children: Children that are not breastfed have an increased risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma, obesity, type 1 and 2 diabetes, childhood leukemia, Sudden Infant Death Syndrome (SIDS), and necrotizing enterocolitis. One study found that breastfed children are 22 percent less likely than those who are not to be obese.[7]
  • Health benefits for mothers: Mothers who do not breastfeed experience increased morbidity and mortality over those who do, including increased risk of type 2 diabetes, breast cancer, obesity, ovarian cancer, post-partum depression, and bladder infections.[8]
  • Benefits to the U.S. economy: The cost savings to the U.S. economy if more parents were to breastfeed their babies would be significant. One study found that if 90 percent of families in the United States breastfed babies exclusively for six months, savings could amount to $13 billion. If 80 percent of families met the six month exclusive breastfeeding goal, $10.5 billion could be saved.[9]
  • Economic benefits for families: Formula feeding costs between $800 and $2800 per year.[10] Breastfeeding saves families the cost of formula, as well as potential healthcare fees for infants that do not reap the health benefits of breast milk.
  • Hospitals and other businesses win. Women who breastfeed need fewer days off for child care because their children are healthier.[11]

Infant formula samples are not really “free”

  • The brand name formulas that are distributed are up to 66 percent more expensive than store brands. But mothers who start using one brand of formula are likely to stick with it in the long run, making formula samples far from “free.”[12] If they continue using the brand name formulas given for “free” in discharge bags, it will cost at least $700 extra per year.[13]



[1] Personal correspondence with CDC staff, September 2012. Unreleased data.

[2] 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/breastfeedingpositionpaper.html; 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 Association105, 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/calltoactiontosupportbreastfeeding.pdf.

[3]Department of Health and Human Services, Centers for Disease Control and Prevention. “Breastfeeding Report Card–United States, 2012.” Retrieved 31 October, 2012, from http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf.

[4] Bartick, Melissa, and Arnold Reinhold. “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.” Pediatrics 125, no. 5 (2010): e1048-e56; 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.

[5] Sadacharan, R., X. Grossman, E. Sanchez, and A. Merewood. “Trends in US Hospital Distribution of Industry-Sponsored Infant Formula Sample Packs.” Pediatrics 128, no. 4 (2011): 702-05.

[6] 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.

[7] Ip, S., M. Chung, G. Raman, P. Chew, N. Magula, D. DeVine, T. Trikalinos, and J. Lau. “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.” Agency for Healthcare Research and Quality Publication, U.S. Department of Healthcare and Human Services. Retrieved 2 November, 2011, from http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf; Arenz, S., R. Rückerl, B. Koletzko, and R. Von Kries. “Breast-Feeding and Childhood Obesity—a Systematic Review.” International Journal of Obesity 28, no. 10 (2004): 1247-56.

[8] Ip et al., “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.”; Labbok, Miriam H. “Effects of Breastfeeding on the Mother.” Pediatric Clinics of North America 48, no. 1 (2001): 143-58.

[9] Bartick and Reinhold, “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.”

[10] Calculations based on prices of store brand and name brand formulas at Walgreens.com in November 2011 and average consumption of 30 oz. of formula per day.

[11] Cohen, R., M.B. Mrtek, and R.G. Mrtek. “Comparison of Maternal Absenteeism and Infant Illness Rates among Breast-Feeding and Formula-Feeding Women in Two Corporations.” American Journal of Health Promotion 10 (1995): 148-48.

[12] Reiff, Michael I., and Susan M. Essock-Vitale. “Hospital Influences on Early Infant-Feeding Practices.” Pediatrics76, no. 6 (1985): 872-79.

[13] Ban the Bags. “Ban the Bags Tool Kit.” Retrieved 6 February 2012, from http://www.banthebags.org/.