Booby Traps Series: When a gift from your OB is not a gift at all

This is the fourth in a series of posts on Booby Traps™ during pregnancy, made possible by the generous support of Motherlove Herbal Company.

Did you receive a formula gift bag at your obstetrician or midwife’s office?  That’s the topic of today’s post in this series on Booby Traps™ we may encounter during pregnancy.

There are at least eight studies showing that formula gift bags given at hospitals decrease breastfeeding rates (even when the formula itself is removed), and I’ll discuss those in a future post.  But until recently there was no research to answer the question: do formula gift bags given at the OB/midwife’s office undermine breastfeeding?

The answer is yes, and the proof comes from a randomized, controlled trial (the gold standard for research) from the University of Rochester School of Medicine.  This study randomly assigned over 500 mothers to either receive a formula gift bag which contained educational information, a formula sample, and coupons for more formula, or a bag with similar materials but with all formula advertising removed.  These bags were distributed at the mothers’ first prenatal visits.  The study found that, while the breastfeeding initiation and long term duration were not affected,

Exposure to formula promotion materials increased significantly breast-feeding cessation in the first 2 weeks. Additionally, among women with uncertain goals or breast-feeding goals of 12 weeks or less, exclusive, full, and overall breast-feeding duration were shortened.

How significant was the effect of the formula bags on the women who stopped before 2 weeks?  The authors say, “Relative risks for cessation before hospital discharge were approximately five-fold higher.”  This amounted to one in every 17 women exposed to the formula bags stopping breastfeeding before she left the hospital.  And those women who had uncertain goals or who intended to breastfeed for 12 weeks or less – the ones who breastfed less and less exclusively if they received the formula bags?  They accounted for over 40% of the randomly chosen women in the study.  The study found that 21% of the women who received the formula bags redeemed a coupon they received for a free case of formula – an outcome which almost certainly influenced their breastfeeding duration.  I think it’s also fascinating that such a strong effect was seen in this population of “largely white, married, middle-class, well-educated women,” a demographic group very likely to initiate breastfeeding, according to CDC data.

And remember, this was all a result of a gift bag given at the first prenatal visit.  Marsha Walker, of the National Alliance for Breastfeeding Advocacy, says that formula companies often have gifts designed to be given each trimester, so that a mom might receive up to 3 or 4 gifts during her pregnancy from her OB.  And Marsha confirmed that as hospitals have been curtailing their distribution of formula gift bags, the companies have been concentrating their efforts on physicians’ offices.

Not surprisingly, the authors conclude, “Formula promotion products should be eliminated from prenatal settings.”

So, what can you do if you’re given formula company material when you go to see your OB or midwife?

Ban the Bags (an organization dedicated to eliminating formula gift bags from hospital maternity wards) has a sample letter you can send to your hospital if you receive a formula bag there, and I’ve modified the letter to apply to your OB/midwife’s practice:

Practice Manager
Obstetrician/Midwifery Practice

Dear Practice Manager,

I recently had a prenatal visit at your office, and am writing this letter to express my concern about the infant formula bag I received from your practice. Even though I am planning to breastfeed, I was given a gift which included infant formula and related promotional materials.

Did you know that research has shown that women who receive formula gift bags in their obstetrician’s office are five times more likely to stop breastfeeding before they even leave the hospital (1)?  Because breastfeeding  is associated with lowered risk of numerous health risks for babies and also for mothers, including lowered risk of breast cancer, diabetes, and ovarian cancer (2), the Centers for Disease Control, the U.S. Surgeon General, the World Health Organization and many other health organizations oppose the distribution of free formula samples and promotional materials.

I have to question whether your practice is truly supportive of breastfeeding when you distribute materials proven to undermine breastfeeding.

I trust you will take into consideration my negative experience, and adjust your practice’s policy regarding free infant formula bags. Please acknowledge my letter and let me know what your plans are for stopping this practice.

Thank you for your time.


1 Office Prenatal Formula Advertising and its Effects on Breast-Feeding Patterns, Obstetrics & Gynecology: February 2000 – Volume 95 – Issue 2 – p 296-303

2  Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Structured Abstract. May 2009. Agency for Healthcare Research and Quality, Rockville, MD.

You can find Ban the Bags’ entire toolkit here.

So, did you receive a formula bag at your OB or midwife’s office?  Would you ever send a letter like the one above to complain?

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23 Comments | Last revised on 03/10/2011

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