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January's Research Article Discusses One Aspect Of The WHO Code On The Marketing Of Breastmilk Substitutes – Supply Of Free Formula To Mothers

January 2013

The formula-containing gift bag, given to mothers on discharge, has been ubiquitous in the USA and other places for as long as some of us can remember. Numerous randomized controlled trials over the years have demonstrated the detrimental effect these bags have on exclusive breastfeeding and duration of breastfeeding. With the signing of the WHO Code many countries worked to eradicate this free supply of formula to all mothers, while other places have waited until Baby Friendly Initiative impetus has set them on the path. This is a big change for many hospital staff, and its intention not always well understood.


A study (Feldman-Winter, 2012) conducted in a hospital in New Jersey, USA, attempted to look at breastfeeding rates before and after replacement of formula containing gift bags with a hospital-sponsored, formula-free bag. Staff were educated about the negative effects of these bags and how to handle requests from mothers for the formula-containing bag. Despite this education, more than 1/3 of mothers in the intervention group who received the hospital-sponsored bag reported receiving samples of infant formula from the hospital.

This highlights a barrier to implementation of Baby Friendly that you may face in your hospitals – staff resistance to change, or lack of buy-in to the principles of the Initiative. Semenic et al (2012) collated barriers and facilitators to Baby Friendly implementation from the research, noting among them:

  • Staff not held accountable for inappropriate use of formula supplements.

The facilitator to this barrier, identified in 4 research papers, was:

  • Restricting staff access to pacifiers or formula for supplementation.

Though the original intent of Feldman-Winter’s study provided limited results due to contamination, it highlighted an issue of concern to us all – staff accountability for their actions, particularly in regard to hospital policy. They too found that placing formula in a locked cupboard, to be accessed only by request and staff signature, was their solution.

In our ideal world staff knowledge about breastfeeding will be sufficient … working together we’ll get there one day in the not too distant future.

Feldman-Winter L, Grossman X, Palaniappan A, et al. Removal of industry-sponsored formula sample packs from the hospital: does it make a difference? J Hum Lact. 2012 Aug; 28(3):380-8

Semenic S, Childerhose JE, Lauzière J, Groleau D. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review. J Hum Lact. 2012 Aug; 28(3):317-34.

Denise Fisher, IBCLC
Director, Step2 Education
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