Fewer U.S. hospitals are giving away free infant formula, a new study finds, a shift that may help encourage more new mothers to breastfeed.
Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes. Formula provides nutrients needed for growth and development, but doesn’t offer added protection against illness or infection.
“Hospitals and health care systems are places we look to for guidance on health,” lead study author Dr. Jennifer Nelson, a researcher at the U.S. Centers for Disease Control and Prevention, said by email. “When hospitals distribute formula to breastfeeding mothers, it signals that formula feeding is as good as breastfeeding.”
In large part to stop sending that signal, hospitals have gradually moved away from giving new mothers gift bags stuffed with free formula samples and coupons, often supplied by companies as a way to establish brand loyalty and bolster sales.
Only about a third of hospitals distributed free formula in 2013, down from 73% six years earlier, according to the study published May 25 in the journal Pediatrics.
Nelson and colleagues reviewed data from surveys sent to all U.S. hospitals and birth centers every two years to see whether they sent women home with free formula samples. In each of the survey years – 2007, 2009, 2011 and 2013 – more than 98% of the hospitals responded to this question.
At the start of the study period, Rhode Island was the only state where fewer than one in four hospitals had formula handouts. Massachusetts and New York brought the total to three states in 2009, and were followed in 2011 by Oregon, Vermont and the District of Columbia.
By 2013, only two states – Iowa and South Dakota – still had more than three in four hospitals giving away free formula.
Only 5.5% of teaching hospitals gave out free formula that year, down from about 63% in 2007. About 365 of non-teaching hospitals handed out formula at the end of the study, down from 77% in 2007.
The hospitals that delivered the most babies had some of the most dramatic decreases in free formula handouts, the study found. Less than 12% of hospitals delivering at least 5,000 babies a year gave away formula in 2013.
One drawback of the study is that it only collected information on formula distribution to breastfeeding mothers, not on practices related to formula-feeding mothers, the authors note.
Formula handouts discourage breastfeeding because mothers assume if hospitals give it to them, that they should use it, said Dr. Lori Feldman-Winter, a professor of pediatrics at Cooper University Hospital in New Jersey. The giveaways may also make mothers think they are unlikely to be successful at breastfeeding, she said.
“The first few months of breastfeeding are highly dependent on the delivery hospital experience and the connection to community support,” said Feldman-Winter, who wasn’t involved in the study. “Evidence shows that providing new mothers with free formula in hospitals or as part of discharge packs (free gifts) decreases overall and exclusive breastfeeding.”
Formula handouts can lead women to abandon exclusive breastfeeding, but may not affect how long women decide to feed babies a combination of breast milk and formula, Nelson said.
Other factors besides free formula handouts in the hospital can also impact whether women attempt breastfeeding and how long they stick with it, she noted. Women may be embarrassed, have lactation difficulties they don’t know how to fix, limited maternity leave, or challenges pumping milk when they return to work.
In the U.S., nearly four in five mothers start breastfeeding, but one week after birth only 60% breastfeed exclusively, Nelson said. “This suggests that many women are not getting the early support that they need.”
— Lisa Rapaport0