Supporting Studies on Infant Formula Marketing

Reference these studies when you talk to the media, healthcare providers, or hospital administrators.

Studies on the prevalence of formula sample distribution in the U.S.

1. Sadacharan, R., Grossman, X., Sanchez, E., & Merewood, A. (2011). Trends in US Hospital Distribution of Industry-Sponsored Infant Formula Sample Packs. Pediatrics, 128(4), 702-705.

Study of 1239 hospitals in 20 states found that most US hospitals continue to distribute industry-sponsored formula sample packs, but trends indicate a significant change in practice; increasing proportions of hospitals eliminate these packs. Change was more significant in states where higher proportions of hospitals had already eliminated packs in 2007. Based on the CDC’s breastfeeding report care for 2010, average breastfeeding initiation rates were significantly higher in the states with the best-record of banning samples when compare to those with the worst records (81.5 percent vs. 67 percent). Similarly, the rate of breastfeeding at six months was higher in states with the best record of banning sample bags (52.7 percent to 37 percent).

2. Merewood, A., Grossman, X., Cook, J., Sadacharan, R., Singleton, M., Peters, K., et al. (2010). US hospitals violate WHO policy on the distribution of formula sample packs: results of a national survey. Journal of Human Lactation, 26(4), 363.

Cross-sectional telephone survey of 3209 US maternity sites, conducted from 2006 to 2007. Found that 91% of hospitals distributed formula sample packs, and a trend toward discontinuation of the practice was statistically significant. Most US hospitals distribute infant formula samples, in violation of the WHO Code and the recommendations of public health and healthcare provider organizations.

3. Merewood, A., Fonrose, R., Singleton, M., Grossman, X., Navidi, T., Cook, J. T., et al. (2008). From Maine to Mississippi: hospital distribution of formula sample packs along the Eastern Seaboard. Archives of Pediatrics and Adolescent Medicine, 162(9), 823.

Studied 21 eastern states and the District of Columbia. Rates varied by region. Found that 94 percent of hospitals distributed formula sample packs. Regional trends were evident. The proportion of distributing hospitals ranged from 70.4 percent (New Hampshire) to 100.0 percent (4 states-New Jersey, Maryland, Mississippi, and West Virginia-and Washington, DC). The proportion of hospitals that do not distribute sample packs has risen significantly between 1979 and 2006.

Studies on the effects of industry-sponsored formula samples on breastfeeding

1. Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008). Marketing Infant Formula Through Hospitals: the Impact of Commercial Hospital Discharge Packs on Breastfeeding. Am J Public Health, 98(2), 290-295.

Among women who had initiated breastfeeding, 66.8 percent reported having received commercial hospital discharge packs. Women who received these packs were more likelyto exclusively breastfeed for fewer than 10 weeks than were women who had not received the packs

2. Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital discharge packs for breastfeeding women. Cochrane Database Syst Rev. 2000

Nine randomized controlled trials involving a total of 3730 women from North America were analyzed. Commercial discharge packs reduced exclusive breastfeeding.

3. Wright, A., Rice, S., & Wells, S. (1996). Changing Hospital Practices to Increase the Duration of Breastfeeding. Pediatrics, 97(5), 669-675.

Duration of breastfeeding was longer in women who did not receive commercial discharge packs with formula samples or coupons for formula samples.

4. Perez-Escamilla, R., Pollitt, E., Lonnerdal, B., & Dewey, K. (1994). Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.American journal of public health, 84(1), 89.

A meta-analysis of 18 studies showed that commercial discharge packs have a detrimental effect on exclusive breastfeeding at one month and any breastfeeding at four months.

5. Dungy, C. I., Christensen-Szalanski, J., Losch, M., & Russell, D. (1992). Effect of discharge samples on duration of breast-feeding. Pediatrics, 90(2), 233.

Women who received a manual breast pump in their discharge bags instead of formula samples were more likely to exclusively breastfeed their babies for a longer number of weeks (4.18 weeks compared to 2.78 weeks).

6. Snell, B., Krantz, M., Keeton, R., Delgado, K., & Peckham, C. (1992). The association of formula samples given at hospital discharge with the early duration of breastfeeding.Journal of Human Lactation, 8(2), 67.

At 21 days, there was a significant relationship between receipt of a gift pack and the decline of exclusive breastfeeding among a group of low-income Hispanic women. A larger proportion of breastfeeding women who received a gift pack either began by supplementing with formula or changed to bottle-feeding by three weeks.

7. Bergevin, C., Dougherty, Y., & Kramer, M. S. (1983). Do infant formula samples shorten the duration of breast-feeding? The Lancet, 321(8334), 1148-1151.

New mothers receiving formula giveaways were less likely to still be breastfeeding at one month and more likely to have introduced solid foods by 2 months These trends became more significant in three vulnerable subgroups: less educated mothers, primiparas, and mothers who had been ill post-partum. Results suggest that infant formula samples may shorten the duration of breast-feeding and hasten the age at which solids are introduced.

Selected studies on health benefits of breastfeeding

1. Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007).Breastfeeding and maternal and infant health outcomes in developed countries. Agency for Healthcare Research and Quality Publication, U.S. Department of Healthcare and Human Services. Retrieved 2 November, 2011, from

Found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.

2. Harder, T., Bergmann, R., Kallischnigg, G., & Plagemann, A. (2005). Duration of Breastfeeding and Risk of Overweight: A Meta-Analysis. American Journal of Epidemiology, 162(5), 397-403.

Meta-analysis of 17 studies shows that a longer duration of breastfeeding is associated with a larger decrease in risk of overweight.

3. Arenz S., Ruckerl R., Koletzko B., Von Kries R.(2004).Breast-feeding and childhood obesity: a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28, 1247-

Children who are breastfed are 22 percent less likely to be obese.

4. Labbok, M. H. (2001). Effects of Breastfeeding on the Mother. Pediatric Clinics of North America, 48(1), 143-158.

Breastfeeding reduces the risk for postpartum blood loss by increasing the rate of uterine contraction, premenopausal breast cancer, and ovarian cancer. In addition to reducing the severity of anemia, breastfeeding may cause changes that help to protect mothers against bladder and other infections. Epidemiologic studies seem to indicate that women who breastfeed may be at reduced risk for spinal and hip fracture after menopause. In addition to the direct health effects, breastfeeding seems to provide a sense of bonding, a sense of well-being, and an improved sense of self-esteem for many women.

Studies on the economic benefits of breastfeeding

1. Bartick, M., & Reinhold, A. (2010). The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics, 125(5), e1048-e1056.

Finding that if 90 percent of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80 percent compliance).

2. Oliveira, V., Prell, M., Smallwood, D., & Frazao, E. (2001). Infant Formula Prices and Availability: Final Report to Congress.  Retrieved 2 November, 2011, from

Finds that the average price of brand name infant formula is close to two thirds more than store brand formula. Parents who use brand name formula may spend $700 per year more than those who use store brand formula.

3. Weimer, J. (2001). The Economic Benefits of Breastfeeding: A Review and Analysis.Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture. Food Assistance and Nutrition Research Report No. 13. Retrieved 2 November 2011, from

A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent). This figure is likely an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis.

4. Cohen, R., Mrtek, M. B., & Mrtek, R. G. (1995). Comparison of maternal absenteeism and infant illness rates among breast-feeding and formula-feeding women in two corporations. American Journal of Health Promotion, 10, 148-148.

Finds that one-day absences from work to care for sick infants occurred more than twice as often among formula-feeding mothers than breast-feeding mothers.