Feb. 16, 2000 (Lake Tahoe, Calif.) -- Despite the World Health Organization's prohibition on the distribution of free formula samples and the promotion of formula in health care facilities, such materials are widely available in the U.S. and are often distributed directly through obstetricians' offices. This conveys a mixed message that formula feeding is as healthy as breastfeeding and significantly affects the number of women who stop nursing during the first two weeks after childbirth, according the author of a study in the February issue of the journal Obstetrics & Gynecology.
Previous studies have shown that distribution of materials and formula samples by hospitals in the period after birth decreases breastfeeding duration. But Cynthia R. Howard, MD, MPH, tells WebMD that this is the first study that looks at the effects of distribution of commercially produced breastfeeding promotional materials at prenatal visits to the doctor. Howard, who is associate professor of pediatrics at the University of Rochester School of Medicine in New York, points out that while the material clearly states that breastfeeding is preferable to formula, the packs do contain coupons and advertisements for formula and statements about its use in a variety of situations, such as when a mother returns to work.
Howard and her colleagues found that while the decision to breastfeed and the duration of nursing beyond two weeks was not significantly affected by receiving a commercial pack, there was a fivefold increase in the number of those women who quit breastfeeding while still in the hospital. There was nearly a twofold increase in quitting early -- that is during the first two weeks after birth -- in those who received the commercial packs.
"After two weeks, there were no long-term differences in breastfeeding. But we did see that among a subgroup of women who were undecided about how long they wanted to breastfeed or who had goals that were less than three months (about 43% of the study group), those who received commercial packs breastfed five weeks less [than those who didn't]." Howard tells WebMD. Those having their first child or breastfeeding for the first time and women who planned to return to work within six months were more likely to have uncertain goals. "It may be that women with short-term goals have less commitment," says Howard, adding that breastfeeding may require at least three to four weeks to be successfully established.
The study, which was supported by a grant from the Maternal and Child Health Bureau, involved 444 women at six obstetric offices. On the first prenatal visit, the participants were randomly assigned to one of two groups: 235 received a commercial pack consisting of a diaper bag, commercially produced educational material, a can of powdered formula, a business reply card to join a so-called baby club, a coupon redeemable for a case of infant formula, and formula discount coupons. Another group of 209 women received the research pack containing a diaper bag, noncommercial educational materials, a coupon for infant items from a local department store, and a package of electric outlet covers. Interviews were conducted after delivery, and the breastfeeding women were contacted by telephone at two, six, 12, and 24 weeks after birth.
"This is an interesting study because it shows that information given to a woman early in pregnancy will have an effect on her choices," says Anastasia Stekas, RN, MSN, a board-certified lactation consultant at Mount Sinai-NYU Health in New York City, who reviewed the study for WebMD. "Women trust their obstetricians ... and what is given by them is extremely influential."
Stekas agrees with the authors that one of the limitations of the study is the lack of socioeconomic and racial diversity. She also raises the question of the obstetrician's bias. "For the first few weeks, breastfeeding is very hard, and if for some reason the obstetrician encourages a woman to stop, she will."
- The World Health Organization prohibits the distribution of free formula samples and promotions in health care facilities, but this is widely practiced in the U.S.
- New research shows that distribution of these materials can influence more women to stop breastfeeding within the first two weeks after childbirth.
- In the long-term, there was no difference in breastfeeding habits among women who did or did not receive these promotional materials.