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NYC breastfeeding: a new-old plan to wean the world off formula

Remember the Nestlé formula boycott? The long-term global effort to encourage breastfeeding as a healthier choice for newborns than formula – once focused on developing nations – is now a trend among US hospitals. But a new program to decrease the use of formula in hospitals, backed by NYC Mayor Michael Bloomberg, is being criticized as meddling in the decisions of mothers.

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Campaigns aimed at increasing breastfeeding rates, Mountford said, should include advice and support for new mothers, including education on proper formula preparation and bottle-feeding techniques so that mothers will be fully prepared for whichever option they choose.
 
Ms. Walker says the criticism of Bloomberg’s plan has misconstrued the purpose of the program, which is designed to put best practices into place for health-care providers who give counseling and evidenced-based advice on breastfeeding, and not to tell mothers what to do. 
 
“It has nothing to do with how choices are made or whether or not a woman chooses to breastfeed,” says Walker. “The initiative assures that if a breastfed baby needs to be supplemented with formula, it is not because the nurses don’t have time or because mothers don’t know how to breastfeed.”
 
There may be medical reasons that mothers would need to use formula for newborns, says Walker, but those are rare. 
 
Walker, who is also a certified lactation consultant, says that one of the main reasons women ask for formula from hospitals is because they are having trouble breastfeeding. The role of the hospital and health-care providers, says Walker, is to find out why a new mother is having trouble and how they can support her and the baby.
 
“The decision to breastfeed or not is made while moms are pregnant and well before they get to the hospital,” says Walker.
 
That decision may be influenced by formula marketing such as "discharge bags," suggests a recent study in the Journal of Human Lactation, titled “Removal of Industry-Sponsored Formula Sample Packs from the Hospital: Does It Make a Difference?” 
 
The study found that women who receive industry-sponsored formula when they are discharged from the hospital are less likely to breastfeed exclusively for the first six months, as recommended by the American Academy of Pediatrics. And data from the Centers for Disease Control and Prevention (CDC) show that only 13 percent of infants nationwide meet that goal.
 
Seventy-two percent of US hospitals gave mothers formula samples when they were discharged in 2010, a decrease from 91 percent in 2007, according to the study, conducted by staff at the Cooper University Hospital in Camden, N.J., and Boston Medical Center.
 
The IFC refutes research that links formula samples to decreased breastfeeding. 
 
“Results of research into any relationship between infant formula hospital sample distribution and breastfeeding have been inconsistent; some studies show an association while others do not,” says the IFC on their website.
 
Breastfeeding rates are on the rise nationwide, according to CDC data tracking breastfeeding from 2000 to 2009. The initiation rate increased from 71 percent in 2000 to 77 percent in 2009. Also breastfeeding at six months increased from 34.2 percent to 47.2 percent. The US Department of Health and Human Services’s goal is 60 percent by 2020, according to its Healthy People 2020 objectives.
 
Giving mothers free samples of formula is a marketing strategy that violates the World Health Organization’s International Code for Marketing Breast-Milk Substitutes, which was first published in 1981 to emphasize the influence of manufactured substitutes on breastfeeding practices. 
 
“It’s a very effective marketing strategy,” says Walker. “It’s not a gift, it’s not charity, and it's not because the hospital feels it is good for mothers.”
 
Formula companies know that 95 percent of mothers will use the formula brand that they receive from the hospital, says Walker, because mothers think that if the hospital hands it to them, doctors endorse it.
 
The American Association of Family Physician’s (AAFP) website, recommends that hospital staff not give formula or pacifiers to babies whose mothers choose to breastfeed exclusively. The organization also “discourages distribution of formula or coupons for free or discounted formula in hospital discharge or physician office packets given to mothers who choose to breastfeed exclusively.”
 
The American Academy of Pediatrics board of directors also passed a resolution in July to “advise pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings,” also stating that infant formula marketing has “direct negative effects on the continuation and exclusivity of breastfeeding.”
 
US Surgeon General Regina Benjamin supports a mother’s right to choose, but also says that mothers need access to accurate information about breastfeeding.
 
“The decision to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot or chooses not to breastfeed,” Dr. Benjamin said in a statement last year for World Breastfeeding Week, which runs Aug. 1 to 7. “But given the importance of breastfeeding for the health and well-being of mothers and children, we need to do what we can to help mothers who want to breastfeed to do so successfully.”

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