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This is part of our Latina Mom and Baby Health: A Research Review »
Exposure to formula marketing can impact breastfeeding
Given the benefits of breastfeeding on reducing childhood obesity in the Latino population, it follows that factors discouraging mothers from breastfeeding may be detrimental to childhood obesity rates in Latino youths.
Exposure to formula marketing can have a negative affect on a woman’s decision to initiate and/or continue breastfeeding.116–118
Mothers enrolled in WIC may be at particularly high risk, as WIC is the largest consumer of infant formula in the U.S. and provides free formula to low-income mothers.119 In addition, many states allow formula manufacturer’s to use statements such as “WIC approved” or “WIC eligible,” which may falsely imply that WIC endorses infant formula use over breastfeeding.116,117
A 2015 review of marketing claims demonstrated that many infant formula advertising campaigns make unwarranted claims regarding their products that are not supported by sufficient clinical evidence.120
Formula marketing persists in many places
Formula marketing comes in many forms, from free education packs in medical offices to hospital discharge packs for new mothers. These marketing materials commonly include formula samples, discount coupons or vouchers, pamphlets, posters, and other promotional materials.121
According to one survey in Rochester, New York, 65 percent of women reported that they had received free formula offers at some point during their pregnancy; 78 percent reported receiving materials published by a formula company.122 Another survey in Monroe, New York found that 61 percent of obstetrician offices offered free formula and 41 percent displayed some form of formula promotional material.123
Since 1989, formula companies have engaged in direct consumer marketing via television commercials, magazine advertisements, and more recently social media.121 In 2013, one study revealed that the prevalence of infant formula advertisements had steadily increased in two popular U.S. parenting magazines between 2009 and 2012; at its peak, about 15 percent of the advertisements in these parenting magazines were dedicated to infant formula.124
In addition, exposure to formula information in print media or on websites is associated with an increased likelihood of mothers intending to use formula or use formula earlier, and a decreased likelihood of breastfeeding initiation.125 Infant formula marketing via social media platforms such as Facebook, mobile apps, and YouTube videos also represents a growing area of concern.126
Evidence shows that women who encounter advertisements for infant formula in medical practices may be unintentionally discouraged from initiating breastfeeding or may be less likely to breastfeed for the recommended amount of time.118,127–129
In one randomized controlled trial, women exposed to formula company-produced marketing materials versus non-commercial materials at the first prenatal visit were more likely to stop breastfeeding before hospital discharge or before 2 weeks postpartum.118 Commercial materials also negatively impacted rates of exclusive breastfeeding and overall breastfeeding duration for women who were uncertain about their breastfeeding plans or who planned to breastfeed for ≤12 weeks.118 In a focus group setting, women reported that formula marketing decreased confidence in a mother’s ability to breastfeed, especially in cases where marketing material was supplied by healthcare practitioners or their practices.130
In addition to marketing in medical offices, distribution of hospital discharge packets containing free formula samples or coupons can also discourage breastfeeding exclusivity or duration.117,131–139
In a U.S. Government Accountability Office review, seven of 11 studies demonstrated lower breastfeeding rates among women who had received hospital discharge packs containing formula samples or coupons, compared with women who received non-commercial discharge packs or no packs at all.117
These findings were corroborated by more recent studies in 2012 and 2014.140,141 In the latter study, rates of exclusive breastfeeding at 10 weeks and 6 months were significantly lower among women who had received discharge bags containing formula samples and/or coupons, compared with women receiving breastfeeding supply bags or no discharge bags at all.141
Regulating formula marketing
In 1981, WHO and UNICEF jointly published the International Code of Marketing of Breast Milk Substitutes, outlining recommended standards for advertisers, health care institutions, and health care workers.142 According to a report in 2011, the United States is the only developed country that has not taken action to enforce this International Code.143
A 2014 study demonstrated that none of the pediatrician waiting rooms observed were completely Code compliant and the vast majority still had formula-promotional materials readily available.144
Support for the elimination of commercial discharge packs and the distribution of free formula, coupons, or commercially published handouts by pediatricians has also come from the AAP, the Academy of Breastfeeding Medicine, and the Surgeon General.145,146,39
To avoid inadvertent promotion of formula use over breastfeeding, several states are regulating marketing materials in hospitals and medical offices.
The New York State Department of Health requires that all hospitals utilize written policies to ensure that formula is only administered to breastfeeding infants when medically indicated.147
Rhode Island eliminated the distribution of free formula discharge packs to new mothers in 2011.
As part of the WHO’s Baby Friendly Hospital Initiative (BFHI), hospitals aiming to achieve “Baby-Friendly” status are required to implement the WHO/UNICEF Ten Steps to Successful Breastfeeding, which includes requirements for eliminating formula.55 Several reports in the literature have demonstrated that breastfeeding initiation and duration are improved for babies born in BFHI hospitals.57,148,149
In 2013, 32 percent of hospitals and birth centers in the U.S. distribute industry-sponsored discharge packs with formula samples to new mothers, but this is down from 73 percent in 2007.150–154
A 2011 study, found states with the highest concentration of hospitals removing formula sample distribution were also those with the greatest average breastfeeding initiation rates.155
The majority of the literature on formula marketing and breastfeeding rates does not focus on Latina women, however there is evidence that low-income, WIC-enrolled mothers may be targeted with more marketing.
One early study of low-income Latina women was able to show that those who received gift packs containing formula samples had significantly lower breastfeeding rates during the first three weeks postpartum.134
More from our Latina Mom and Baby Health: A Research Review »
- Introduction & Methods
- Key Research Finding: Maternal obesity
- Key Research Finding: Breastfeeding
- Key Research Finding: Breastfeeding promotion
- Key Research Finding: Marketing of infant formula (this section)
- Key Research Finding: Latino infant habits
- Key Research Finding: Early childcare settings
- Policy Implications
- Future Research Needs
References for this section »
116. Kaplan DL, Graff KM. Marketing breastfeeding–reversing corporate influence on infant feeding practices. J Urban Heal Bull New York Acad Med. 2008;85(4):486-504. doi:10.1007/s11524-008-9279-6.
117. General Accounting Office. Breastfeeding: Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect against Misuse of WIC Name. Report to Congressional Addressees (GAO-06-282). 2006. http://www.gao.gov/new.items/d06282.pdf.
118. Howard C, Howard F, Lawrence R, Andresen E, DeBlieck E, Weitzman M. Office prenatal formula advertising and its effect on breast-feeding patterns. Obstet Gynecol. 2000;95(2):296-303.
119. Kent G. WIC’s promotion of infant formula in the United States. Int Breastfeed J. 2006;1(1):8. doi:10.1186/1746-4358-1-8.
120. Belamarich PF, Bochner RE, Racine AD. A Critical Review of the Marketing Claims of Infant Formula Products in the United States. Clin Pediatr (Phila). 2015. doi:10.1177/0009922815589913.
121. Greer FR, Apple RD. Physicians, formula companies, and advertising. A historical perspective. Am J Dis Child. 1991;145(3):282-286.
122. Howard CR, Howard FM, Weitzman ML. Infant formula distribution and advertising in pregnancy: a hospital survey. Birth. 1994;21(1):14-19.
123. Howard CR, Schaffer SJ, Lawrence RA. Attitudes, practices, and recommendations by obstetricians about infant feeding. Birth. 1997;24(4):240-246.
124. Basch CH, Shaffer EJ, Hammond R, Rajan S. Prevalence of infant formula advertisements in parenting magazines over a 5-year span. J Pediatr Nurs. 2013;28(6):e28-e32. doi:10.1016/j.pedn.2013.07.001.
125. Zhang Y, Carlton E, Fein SB. The association of prenatal media marketing exposure recall with breastfeeding intentions, initiation, and duration. J Hum Lact Off J Int Lact Consult Assoc. 2013;29(4):500-509. doi:10.1177/0890334413487256.
126. Abrahams SW. Milk and social media: online communities and the International Code of Marketing of Breast-milk Substitutes. J Hum Lact Off J Int Lact Consult Assoc. 2012;28(3):400-406. doi:10.1177/0890334412447080.
127. Howard FM, Howard CR, Weitzman M. The physician as advertiser: the unintentional discouragement of breast-feeding. Obstet Gynecol. 1993;81(6):1048-1051.
128. Dusdieker LB, Dungy CI, Losch ME. Prenatal office practices regarding infant feeding choices. Clin Pediatr (Phila). 2006;45(9):841-845. doi:10.1177/0009922806294220.
129. Valaitis RK, Sheeshka JD, O’Brien MF. Do consumer infant feeding publications and products available in physicians’ offices protect, promote, and support breastfeeding? J Hum Lact Off J Int Lact Consult Assoc. 1997;13(3):203-208.
130. Parry K, Taylor E, Hall-Dardess P, Walker M, Labbok M. Understanding women’s interpretations of infant formula advertising. Birth. 2013;40(2):115-124. doi:10.1111/birt.12044.
131. Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital discharge packs for breastfeeding women. Cochrane Database Syst Rev. 2000;(2):CD002075. doi:10.1002/14651858.CD002075.
132. Dungy CI, Christensen-Szalanski J, Losch M, Russell D. Effect of discharge samples on duration of breast-feeding. Pediatrics. 1992;90(2 Pt 1):233-237.
133. Rosenberg KD, Eastham CA, Kasehagen LJ, Sandoval AP. Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Am J Public Health. 2008;98(2):290-295. doi:10.2105/AJPH.2006.103218.
134. Snell BJ, Krantz M, Keeton R, Delgado K, Peckham C. The association of formula samples given at hospital discharge with the early duration of breastfeeding. J Hum Lact Off J Int Lact Consult Assoc. 1992;8(2):67-72.