Free Formula Spoils Breastfeeding

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Free formula spoils breastfeeding
March 16, 2010

Laurie Monsebraaten

Noor Javed

New mothers given formula upon discharge ranged from 22 per cent to 78.5 per cent, depending on the hospital where she delivered: Toronto public health report

Almost 40 per cent of new mothers leave the hospital with free infant formula, a recipe for spoiled breastfeeding according to a new Toronto Public Health report.

Women who didn’t receive the free samples were 3.5 times more likely to be breastfeeding exclusively after 2 weeks, said Breastfeeding in Toronto, Promoting Supportive Environments, released Tuesday.

The study, conducted in 2007 and 2008, found that of 1,500 first-time mothers surveyed, 39 per cent were given formula at hospital discharge. As a result, many of these women stopped breastfeeding sooner than those women who weren’t given formula.

“A substantial proportion of hospitals are still doing this,” said Dr. David McKeown, Toronto’s Medical Officer of Health. “There are some incentives for hospitals to do this (promote formula)...and that is really not in the interest of infants and mothers.”

McKeown said hospitals should have a “comprehensive breastfeeding policy, help for mothers to initiate breastfeeding within a half-hour of birth, and ensure newborns are not given food or drink other than breast milk unless medically indicated.”

The World Health Organization (WHO), Health Canada, the Ontario Ministry of Health and Long-Term Care, and Toronto Public Health support exclusive breastfeeding to six months of age as the best nutritional choice for babies. At six months, they recommend solid food and continued breastfeeding until age two and beyond.

The Breastfeeding Committee for Canada, which promotes breastfeeding, notes that aggressive formula marketing has plagued hospitals since the 1940s.

“The provision of free formula in hospital, free educational materials for new parents and educational donations for staff has been taken for granted as a convenient way to provide patient and staff education,” the committee says on its website. “Strains on health care budgets have led health care facilities to depend on formula company donations as though there are no alternatives.”

There has always been controversy about hospitals receiving free formula. It is why Toronto East General Hospital – the only Baby Friendly hospital in the city and among about two dozen in the country – cancelled its contract in 2005, said Linda Young, director of maternal newborn and child health.

To become Baby-Friendly, hospitals and other facilities have to comply with the WHO’s International Code of Marketing Breastmilk Substitutes. This code stipulates that there should be no free or low cost supplies of breast-milk substitutes to maternity wards and hospitals.

“When the formula companies put together a contract, they list all the things that they give – the formula, the nipples, and the bottles, and it comes up to a big number,” Young said, adding there is sometimes a signing bonus of anywhere between $130,000 and $150,000 which hospitals can use for other programs and services.

The only other GTA hospital that Young knows of that is buying formula instead of getting it free is Lakeridge in Oshawa. “Any kind of money is hard to give up for a hospital,” she said.

The impact of promoting formula as they leave the hospital gives off mixed messages to new mothers, adds Young.

“They give it to the women ‘just in case’,” she said. “But the real message is that you will probably fail... and one bottle leads to another.”

The International Formula Council, representing infant formula makers and marketers, has long argued that free samples have no bearing on a women’s decision whether to breastfeed or formula-feed their baby and that mothers want to be informed of their choices.

Ann Holden, patient care manager for the family birthing centre at St. Joseph’s Health Centre, said the hospital receives free formula from manufacturers and is currently renegotiating its contract with Abbott Canada, makers of Similac.

But the hospital has never given out infant formula in the five years she has held the post, she said. “We have never given formula samples or any infant-feeding supplies.”

However, the hospital will provide free samples when mothers request formula for feeding, she said in an interview.


Dr. Jack Newman of the Newman Breastfeeding Clinic, said no birthing hospital in Southern Ontario hands out formula in gift packages anymore. Instead, most new mothers get infant formula from nurses when they leave the hospital.

“The nurses will say ‘I’m not supposed to hand this stuff out, but here are a couple of bottles if you are having trouble,’ ” he said in an interview Tuesday night.

“The nurses think they are helping,” Newman said. “But in fact they are not.”