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Organizations that have made statements opposing hospital-based distribution of
free commercial formula discharge bags
The American Academy of Pediatrics (AAP)
The AAP states that pediatricians should "Promote hospital policies and procedures that facilitate
breastfeeding. Work actively toward eliminating hospital policies and practices that discourage
breastfeeding (eg, promotion of infant formula in hospitals including infant formula discharge packs
and formula discount coupons...)."
American Academy of Pediatrics Policy Statement. Breastfeeding and the use of human milk.
Pediatrics. Feb 2005;115(2):496-506
The American College of Obstetricians and Gynecologists (ACOG)
"Formula companies try to attract the interest of pregnant women with gift packs. Care providers
should be aware that the giving of gift packs with formula to breastfeeding women is commonly a
deterrent to continuation of breastfeeding. A professional recommendation of the care and feeding
products in the gift pack is implied. Physicians may conclude that noncommercial educational
alternatives or gift packs without healthrelated items are preferrable."
Educational Bulletin No. 258 July 2000.
The American Public Health Association (APHA)
"The science to support breastfeeding is clear, as is the science to support the negative impact of
marketing to new mothers. A scientific analysis in 2000 of previously published studies found that
women who got gift bags were less likely to exclusively breast-feed. Since the early 1970’s APHA
has been on record, consistently supporting international promotion of breastfeeding and the
WHO/UNICEF Code of Marketing of Breastmilk Substitutes . . . Formula marketing in hospitals targets
young consumers and aims to establish brand and product loyalty at the expense of public
health. . . . We join with our colleagues in urging you to protect the public health and reverse
your position on formula marketing in hospitals."
Letter to Gov. Mitt Romney, May 16, 2006.
The Centers for Disease Control and Prevention (CDC)
According to the CDC, "The effect of the marketing practices of commercial competitors on breastfeeding
is of particular concern because of its disproportionately negative impact on mothers in the United
States who are known to other¬wise be at high risk for early termination of breastfeeding, including
those who are primiparous (first-time mothers), have less formal education, are nonwhite, or are ill
postpartum"
Shealy KR, Li R, Benton-Davis S, Grummer-Strawn L. The CDC Guide to Breastfeeding Interventions.
Atlanta: U.S. Department of Health and Human Services, 2005
The United States Government Accountability Office (GAO)
"Studies have shown that some infant formula marketing, particularly hospital discharge packs, may
discourage breastfeeding."
Breastfeeding: Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State
Contracts Should Better Protect against Misuse of WIC Name GAO-06-282 February 8, 2006
Massachusetts Medical Society (MMS)
The Massachusetts Medical Society "Supports inclusion of strong language that discourages hospitals
from marketing the use of formula and thereby undermining the efforts of physicians, nurses and other
health care providers to make breastfeeding the preferred method of feeding newborns."
Summary of Public Testimony 105 CMR 130.000 et seq: Hospital Licensure Regulations
Massachusetts Public Health Association (MPHA)
"Formula feeding is linked to myriad health problems, from breast cancer in mothers to childhood
obesity. Obesity rates in Massachusetts have increased 80 percent in the last 15 years - our state’s
hospitals should not promote a product that may make it worse. Research shows that children who are not
breastfed have higher health care costs, resulting in increased Medicaid expenditures. Research also
shows their parents miss more time from work to care for sick children, resulting in decreased economic
productivity. . . Formula companies can, and will, continue to market their product in commercial
settings. They should stay out of our state’s maternity wards."
-Letter to Gov. Mitt Romney, April 10, 2006
The Office on Women’s Health, US Department of Health and Human Services (DHHS)
DHHS concludes that "The marketing of infant formula negatively affects breastfeeding"; and that
being "given [an] infant formula kit [is] strongly discouraging" to breastfeeding initiation.
HHS Blueprint for Action on Breastfeeding, Washington, D.C. U.S. Department of Health and Human
Services, Office on Women’s Health, 2000.
The World Health Organization (WHO)
The WHO states that "No facility of a health care system should be used for the purpose of promoting
infant formula", and "Facilities of health care systems should not be used for the distribution of
material provided by a manufacturer or distributor [of infant formula]"
The International Code of Marketing of Breastmilk Substitutes
For a comprehensive list of formula marketing Code violations, please see the
following text:
Selling Out Mothers and Babies; Marketing of Breast Milk Substitutes in the USA (2002) by
Marsha Walker, RN, IBCLC
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