Infant formula is food for controversy
By Jessica Zigmond
Recent news about a campaign to stop the distribution of infant formula samples at hospitals could present a good opportunity to improve patient-centered care, a favorite phrase that clinicians and provider groups use almost daily.
Late last month, the consumer watchdog group Public Citizen sent a letter (PDF) to more than 2,600 hospitals urging those facilities to stop including free samples of infant formula in their patient discharge bags. “When hospitals distribute formula samples, they participate in the marketing efforts of formula companies at the expense of patients,” the letter said. The organization intensified its efforts yesterday when it launched an online petition urging Abbott, Mead Johnson and Nestle—the makers of Similac, Enfamil and Gerber, respectively—to stop marketing their products in hospitals. The petition asserts that marketing of infant formula violates the World Health Organization's international code of marketing of breast-milk substitutes.
“That's not accurate,” says Mardi Mountford, executive vice president of the Atlanta-based International Formula Council, which represents U.S. infant formula manufacturers, including the three highlighted in the petition. “The code is voluntary and the code is inconsistent with U.S. law and policy, and for that reason, not adopted in the U.S.,” she says, adding that the council's companies support the aims and principles of the code, but that this particular provision is not relevant in the U.S.
Mountford says the International Formula Council recognizes the health benefits of breastfeeding, and that most mothers know it's the ideal choice—but that the reality of the situation is not always what mothers might expect. That's why Mountford contends the focus on infant formula is the wrong focus. And that's where the patient-centered care argument comes in: What could hospitals do to help their patients learn and choose what is right for them?
“One of the most helpful things is having the support in the hospital and in the home—having that lactation consultant helping you learn about this,” Mountford says. “Not all hospitals have those, or many times there is a fee so a parent may be reluctant.”
Dr. Richard Schanler is the director of neonatology at North Shore Long Island Jewish Health System and chairman of the American Academy of Pediatrics' section on breastfeeding. The New York-based system—which delivers nearly 12,000 babies each year—does not include infant samples in patient discharge bags, according to Schanler. He says the practice of advertising such samples implies that breastfeeding will not go well, and could also cause patients to second-guess their decision to breastfeed.
“You have to be taught how to breastfeed,” Schanler says. “We have staff in the hospitals to teach mothers to get started. Some women have difficulty,” he adds. “Partial breastfeeding is better than no breastfeeding. Whatever you can do, is better than none. And that's where the formula comes in—where it isn't going well, and donated pasteurized breast milk is not available.”
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