Breastfeeding and Mailed Samples of Formula

CQ #27 - January 23, 2017

by Anne Eglash MD, IBCLC, FABM

What happens to breastfeeding when new mothers receive formula samples in the mail? According to authors of a study published in 2016, formula companies have given free formula samples to new mothers for at least 40 years. Previous studies have evaluated the effect of formula samples in hospital gift bags at the time of discharge, and generally found a decreased rate of exclusive breastfeeding.

This study used data from a national US government survey called the Infant Feeding Practices Study II to evaluate the relationship between receiving infant formula samples in the mail, and the rates of ANY breastfeeding or Exclusive breastfeeding for the first 6 months postpartum.

What do you think the study found when evaluating the effect of receiving formula samples by mail on breastfeeding rates?

57.4% of mothers in the survey received mailed samples of infant formula
There was no difference in ‘any breastfeeding’ between the mothers who received infant formula by mail and those who did not.
The mothers who received formula by mail were more likely to be less educated and in a lower socioeconomic class.
Women who receive infant formula by mail have lower rates of exclusive breastfeeding by 6 months as compared to women who did not receive infant formula.
Women who received infant formula prenatally were less likely to initiate breastfeeding.

Click here to view the answer to this question.

Correct Answers: The answer is A, B, D. Abstract:

https://www.ncbi.nlm.nih.gov/pubmed/26701801

The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates

Waite WM1, Christakis D1.

INTRODUCTION:
Decades of research supports the health benefits of breastfeeding. Prior studies have shown that hospital discharge bags containing free samples of infant formula are associated with decreased breastfeeding exclusivity. This study aims to determine if receiving a free sample of infant formula in the mail has an impact on breastfeeding duration and exclusivity.

MATERIALS AND METHODS:
This was a cohort study analyzing data from the Infant Feeding Practices Study II. The main outcomes of interest were any breastfeeding through 12 months of age and exclusive breastfeeding through 6 months of age. The main predictor of interest was receipt of a free sample of infant formula in the mail around the time of the infant's birth. Logistic regression models were developed to evaluate the association between the outcomes and predictor of interest at each month.

RESULTS:
This study included 3,031 infants; mothers of 1,741 (57.4%) received a sample of infant formula in the mail. There was no difference in the likelihood of any breastfeeding at each month among those who received formula in the mail compared with those who did not. There was also no difference in exclusive breastfeeding through 5 months; however, by 6 months of age infants whose mothers received formula in the mail were less likely to be exclusively breastfed (odds ratio = 0.57; 95% confidence interval, 0.37, 0.89).

CONCLUSIONS:
Receiving infant formula in the mail decreases the likelihood of exclusive breastfeeding by 6 months of age while having no impact on the duration of any breastfeeding.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

The authors of this research found that women who were white, wealthier, and with a higher level of education were more likely to receive formula by mail. This is also a group with relatively high breastfeeding rates. This research demonstrates that this group of mothers with a strong intention to breastfeed had a shorter duration of exclusive breastfeeding if they received free formula samples by mail.

Formula companies are very keen marketers and are able to compile demographic information on pregnant women through a variety of means. Businesses, medical groups, and hospitals who provide services to pregnant mothers should consider the consequences of sharing demographic information with formula companies. This study demonstrates how sharing of such information undermines the health of mothers and babies, both short term and long term.

The International Code of Marketing of Breastmilk Substitutes is an universal code of marketing ethics for companies that make infant formula. This has never been adopted as national legislation in the USA.

Given that the United States federal government employs initiatives to increase breastfeeding rates as a means of improving the health of our nation, it would only make sense that the USA adopt and enforce the International Code of Marketing of Breastmilk Substitutes. By not legislating the harmful marketing practices of infant formula companies, the federal government’s efforts to steadily increase exclusive breastfeeding rates past 1 month will remain in jeopardy.

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Breastfeeding and Mailed Samples of Formula

What do you think the study found when evaluating the effect of receiving formula samples by mail on breastfeeding rates?

Correct Answers: The answer is A, B, D. Abstract:

The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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