For more than 40 years, a key aspect of infant formula marketing has been the distribution of diaper bags marked with a formula company's logo and holding containers of formula (also called "formula bags," "discharge kits," or "infant feeding support bags"). These bags were provided by formula companies as freebies, given to new mothers by hospitals at discharge from childbirth. In exchange for providing formula companies with access to new mothers (who they saw as potential customers), hospitals received free formula to use with babies in their care.
This arrangement incentivizes hospitals to make sure every mother leaves with a bag of infant formula samples in hand, even though many leading health authorities—including the World Health Organization (WHO) and the U.S. Surgeon General—have urged providers “not [to] serve as advertisers for infant formula … [or] implicitly promote [it].”
Since the 1991 launch of the Baby-Friendly Hospital Initiative (BFHI), a global program designed by WHO and UNICEF to protect, promote, and support breastfeeding, a growing number of birthing facilities worldwide have stopped distributing discharge kits. But it was the launch of one campaign in particular that really propelled the movement forward.
In January 2007, the Massachusetts Breastfeeding Coalition (MBC) launched an effort requesting that Massachusetts hospitals stop distributing formula marketing bags from their maternity wards. Coalition chair Melissa Bartick, MD, noted that such distribution is a “conflict of interest,” since “[t]he only way to sell more formula is to sell less breastfeeding.” Obstetrician Lauren Hanley observed that “[t]he bags undermine the advice we are giving to our patients,” since medical authorities agree that babies should receive only breast milk for the first six months of life.
The coalition’s “Ban the Bags” campaign drew support from the Massachusetts chapters of the American Academy of Pediatrics (AAP), the American College of Obstetrics and Gynecology (ACOG), the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), and the Massachusetts Breastfeeding Coalition (MBC). A letter signed by authorities from all of these organizations was delivered to directors of clinical services, CEOs, and marketing divisions for the 39 maternity hospitals that distributed discharge bags at that time.
The campaign came after a contentious year for formula marketing in the state, in which the Public Health Council (which sets regulations for health care providers in the state) voted to ban the marketing of bags from maternity hospitals, Governor Romney fired three members of the Council, and the Council re-voted and reversed its decision.
Since the Public Health Council decided to allow formula marketing bags to remain in maternity wards, the Massachusetts Breastfeeding Coalition launched “Ban the Bags” to raise awareness and generate support for their effort.
Under the slogan, “Hospitals should market health, and nothing else,” “Ban the Bags” has worked to get formula marketing out of maternity-infant care. Marsha Walker, a nurse and board-certified lactation consultant who co-chairs the campaign, says that the effort “has gathered tremendous momentum in removing this unethical marketing practice from U.S. hospitals.” In fact, a study published in the June 2015 issue of Pediatrics reported that the distribution of such “bags” to mothers decreased dramatically from 2007 to 2013. In 2007, nearly 73 percent of hospitals distributed such bags; in 2013, only about 32 percent distributed them. In 2007, Rhode Island was the only state where less than one-quarter of hospitals distributed bags; by 2013, 24 states and territories met this mark. Currently, six states are bag-free (West Virginia, Maryland, New Hampshire, Rhode Island, Massachusetts, and Delaware), as are Philadelphia, Washington DC, and all of the hospitals of the Indian Health Services.
“Breastfeeding is a public health challenge,” says Dr. Susan Browne, one of the pediatricians who signed the letter for the state AAP chapter. “Marketing campaigns for baby formula have no place in our state’s hospitals.”
The absence of breastfeeding and breast milk in infants is linked to increased rates of ear infections, diarrhea, and hospitalization, as well as chronic illnesses, including such costly diseases such as obesity and type 1 diabetes. Moreover, mothers who don’t breastfeed or breastfeed for only a short time face higher risks of ovarian cancer, breast cancer, and type 2 diabetes. “Ban the Bag” continues its efforts to remove bags from maternity wards across the U.S.
