Hospital infant formula

My hospital used a certain brand of infant formula. Does that mean it’s the best brand?

Many hospitals that are not Baby-friendly, have a contract with an infant formula manufacturer. Under the contract, the manufacturer usually provides free or low-cost infant formula and other items and benefits to the hospital and the hospital agrees to use only that manufacturer’s infant formula and related products. It is a marketing method designed to increase sales and by extension, will reduce the rate of breastfeeding. Hospitals that have free infant formula are more likely to use it and mothers who use infant formula in hospital are less likely to breastfeed exclusively. They often continue using the same brand as they assume the hospital chose it because it was the “best.” In fact, hospitals usually choose brands based on the best deal they can get. Their infant formula is no better than any other infant formula and is likely more expensive than store-brand infant formulas. Hospitals designated “baby-friendly” by the Baby-Friendly Hospital Initiative must purchase infant formula at a fair market price and do not promote these products.

A) Advertising contracts between infant formula manufacturers and hospitals

1) Hospitals that are not baby-friendly

Many hospitals have a financial contract with an infant formula (formula) manufacturer. The contracts are usually exclusive to one manufacturer, so the only formulas available in the hospital are from that manufacturer. The formula is often provided free or at a low cost.

Contracts allow hospitals to reduce costs, since formula manufacturer often provide:

  • Items labelled with the formula brand or promotional advertising:
    • Free or low-cost formula, sterile water
    • Free or low-cost bottles, bottle nipples, and pacifiers
    • Crib (cot) cards, measuring tapes, and change pads
  • Hospital equipment such as incubators (baby isolettes)
  • Meals and marketing events often described as educational sessions for staff
  • Grants of money
  • Funding to members of committees or boards that create guidelines and policies (van Tulleken 2018)

All these are a form of marketing and are designed to increase sales for the manufacturer.  The hospital becomes in effect an agent of the formula manufacturer. 

These activities undermine breastfeeding. Seventy-nine countries, recognizing this issue,  have an overall prohibition on the use of health facilities for promotion of breast-milk substitutes (WHO 2020). In contrast, one study (Nelson 2019) estimated that 70% of American hospitals continued to accept free infant formula. 

2) Hospitals that are baby-friendly

Hospitals designated “baby-friendly” by the Baby-friendly Hospital Initiative must pay fair market value for formula and do not promote formula or related products.

B) Risks of hospitals marketing infant formula

1) Lower breastfeeding rates

Research shows that if formula is free to hospitals, they are more likely to use it (Tarrant 2015). Mothers who use formula in hospital are less likely to breastfeed exclusively and will breastfeed for shorter amounts of time (Sadacharan 2014; Tarrant 2015; Vehling 2018). T

2) Higher costs for families

Formula manufacturers know that families often stay loyal to whichever formula brand was used at the hospital (Moran-Lev 2021). They may be reluctant to change or may believe the hospital chose the formula brand because it was the “best”.

Families may even leave hospital with gift bags containing formula, coupons, and baby-care products and toys labelled with the formula manufacturer’s name and logo. These are all provided to maximize brand loyalty (Rosenberg 2008).

This is called a spillover effect, and it is highly effective at increasing sales (Choi 2020).

In reality, hospitals usually choose brands based on the best financial deal for themselves, not for the family. The hospital brand of formula is no better or worse than any other formula. The brand-name formulas used by hospitals are, however, generally more expensive than store-brand formulas. 

References

Choi YY, Ludwig A, Andreyeva T, et al. Effects of United States WIC infant formula contracts on brand sales of infant formula and toddler milks. J Public Health Policy. 2020 Apr 30.

Moran-Lev H, Farhi A, Bauer S, et al. Association of Socioeconomic Factors and Infant Nutrition Decisions: Breastfeeding and Type of Formula. Breastfeed Med. 2021 Apr 9

Nelson JM, Grossniklaus DA. Trends in Hospital Breastfeeding Policies in the United States from 2009-2015: Results from the Maternity Practices in Infant Nutrition and Care Survey. Breastfeed Med. 2019;14(3):165‐171

Rosenberg KD, Eastham CA, Kasehagen LJ, et al. Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Am J Public Health. 2008 Feb;98(2):290-5
 
Sadacharan R, Grossman X, Matlak S, et al. Hospital discharge bags and breastfeeding at 6 months: data from the infant feeding practices study II. J Hum Lact. 2014 Feb;30(1):73-9
 
Tarrant M, Lok KY, Fong DY, et al. Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration. Public Health Nutr. 2015 Oct;18(14):2689-99

van Tulleken C. Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers. BMJ. 2018 Dec 5;363:k5056

Vehling L, Chan D, McGavock J, et al. Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity. Birth. 2018 Mar 2

World Health Organization (WHO). Marketing of breast-milk substitutes: national implementation of the international code; Status Report 2020. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO