Hospital gift of formula fading away.

Byline: Tim Christie The Register-Guard

It seems like a small kindness bestowed upon new mothers as they leave the hospital - a gift bag with coupons, magazines, parenting pamphlets and a sample of infant formula, courtesy of the formula makers.

But an increasing number of hospitals, spurred by breast-feeding advocates and public health groups, have quit giving mothers the handouts, fearing that it undermines the medical consensus that breast milk, not formula, is best for babies and mothers.

Formula companies, which provide the bags for free to hospitals, are fighting back, saying mothers want the bags and that no one should deny their right to feed their babies formula if they choose.

There's even disagreement about what to call the freebies: Formula companies prefer the clinical-sounding "discharge bags"; critics call them "marketing bags."

New York City's 11 public hospitals made headlines in January when they decided to phase out the gift bags. A group opposed to the gift bags, banthebags.org, lists 152 hospitals in 37 states that have stopped providing bags. That represents less than 3 percent of the country's 5,756 hospitals.

In Oregon, which could be categorized as the Breast-feeding Capital of the United States, many of the state's biggest hospitals have decided to stop giving out the gift bags, or are moving in that direction.

Oregon has the highest breast-feeding rates in the country based on a number of measures - women who ever breast-feed, those who breast-feed at six months and at 12 months, and those who breast-feed exclusively at three months and six months.

Oregon is the only state with an exclusive breast-feeding rate of more than 25 percent at 6 months.

The American Academy of Pediatrics - which recommends that infants be breast-fed exclusively for six months, and that breast-feeding should continue for at least one year as long as both mother and child want to - has come down against the gift bags.

The lactation specialists at Sacred Heart Medical Center were ahead of the curve. They decided nearly a decade ago to stop giving the bags to new mothers.

The decision was based partly on research that shows breast-feeding provides benefits that formula doesn't, and partly because the hospital didn't want to become a promotional arm of formula companies, said Debbie Jensen, coordinator of Sacred Heart's breast-feeding program.

"It's an incredible marketing tool that in a sense the hospital provides free to formula companies," she said.

McKenzie-Willamette Medical Center in Springfield still provides the gift bags to new mothers who say they would like one, hospital officials said, but nurses remove the formula from bags for mothers who have chosen to breast-feed.

Other Oregon hospitals have decided to stop providing the gift bags or are heading in that direction.

Providence Health Systems stopped giving out the gift bags at its seven Oregon hospitals on May 31, 2006, including at Providence St. Vincent Medical Center in Portland, which delivers one of every eight babies born in Oregon, spokesman Gary Walker said.

"We support breast-feeding, so when you're sending formula home that's sending a different message," he said.

Legacy Health System, which operates six hospitals in Portland and Vancouver, Wash., stopped giving out gift bags several years ago, although it does keep a small supply of the bags on hand to give to new mothers who say they prefer formula feeding, spokeswoman Lise Harwin said.

Oregon Health & Science University provides free samples of formulas to new mothers, but has begun a process to end the practice, spokeswoman Tamara Hargens said.

Proponents of breast-feeding cite research showing that infants who are breast-fed are less likely to get, or be severely sickened by, diarrhea, ear infections and bacterial meningitis.

Other studies suggest that breast-feeding can help protect against sudden infant death syndrome, diabetes, asthma and obesity, according to the American Academy of Pediatrics.

Research also has found that breast-feeding benefits mothers, reducing the risk of ovarian and breast cancer, and possibly reducing the risk of hip fractures and osteoporosis.

Gail Wood, a spokeswoman for Mead Johnson Nutritionals, maker of the best-selling Enfamil formula, said hospitals that elect not to provide the formula bags are taking away mothers' rights, cutting off "a vital source of information on infant formula" and eroding the relationship between the mother and her doctor.

"We're here for babies," she said. "It would be unethical for us to interfere with a mother's decision to breast-feed or formula-feed. We would never discourage a mother to breast-feed."

Wood said: "The choice should be made between family members and the mother and her doctor. ... What right is it of someone else to decide how I feed my child?"

She also disputed suggestions that breast-feeding is a public health issue.

"This should not be a public debate," she said.

According to the American Academy of Pediatrics, increased breast-feeding has the potential to decrease annual health costs by $3.6 billion in the United States.

When the American Academy of Pediatrics revised its policy statement on breast-feeding in 2005, it cited "commercial promotion of infant formula through distribution of hospital discharge packs" as one of the obstacles to breast-feeding. It urged pediatricians to "work actively" to eliminate such programs.

The U.S. Government Accountability Office, in a 2006 report to Congress, found in seven of the 11 studies it reviewed, breast-feeding rates were lower for women who received the formula gift packs.

A systematic review of nine breast-feeding studies, conducted by the Cochrane Collaboration, found that formula promotional materials such as gift bags reduced the prevalence of exclusive breast-feeding.

"There is very good evidence that these marketing bags are extremely effective at doing two things: Reducing the rate of exclusive breast-feeding and making sure, if a mother choose to switch to formula, that she chooses the brand the hospital gave her," said Dr. Nancy Wight, a neonatologist at Sharp Mary Birch Hospital for Women in San Diego and a past president of the Academy for Breastfeeding Medicine.

Formula companies would never spend millions distributing the gift bags to hospitals if they didn't bring them market share, she said. Because the bags are handed out by nurses, they carry the implied endorsement of formula by hospitals, she said.

"Hospitals should be in the business of marketing health, not an inferior product," Wight said.