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The Womanly Art of Breastfeeding Amy Spangler's Breastfeeding: A Parents Guide
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Massachusetts Bans Formula Freebies
By Gina Gerboth

In a groundbreaking step for mothers and babies, Massachusetts became the first state to prohibit hospitals from giving out free formula company diaper bags to new parents. Giving out these bags reduces the duration and exclusivity of breastfeeding and is considered unethical by many national and international groups, including the World Health Organization. Multiple studies, even from prestigious medical journals such as the Lancet, have shown that the bags interfere with breastfeeding, causing moms to switch to formula sooner or quit nursing altogether — even when the bags do not contain formula samples.

For decades, formula companies used hospitals to hand out diaper bags stocked with coupons and free samples. Most parents see these as a "free gift," but the bags are a marketing technique that implies that the hospital endorses the product, successfully boosting sales of formula at the expense of breastfeeding. "One day, formula marketing in hospitals will go the way of cigarette ads on TV," said Melissa Bartick, M.D., chairman of the Massachusetts Breastfeeding Coalition.

Morgan Henderson, a mother and breastfeeding advocate, says that not sending mothers home with formula or formula advertising is good. “It would have been tempting to use if things are tough,” Henderson explains. “If it had been an option and I’d had some in the house, it might have been an issue.”

New regulations with teeth
The new rules on formula marketing are part of a much larger update of existing perinatal regulations written by the Department of Public Health that were approved by the Public Health Council on Dec. 20, 2005. Hospitals must follow DPH regulations in order to be allowed to operate in the state. The regulations contain many other mandates that help promote and support breastfeeding and otherwise limit formula marketing. While regulations don’t necessarily have the force of legislation, Henderson says that “in theory a hospital can lose its accreditation if they don’t follow the MDPH protocols.” That gives the regulation some teeth to ensure enforcement.

In banning the distribution of these items, the DPH acknowledges that there is no medical justification for the institutional marketing of formula products to new parents. The vast majority of hospitals in Massachusetts and the United States give out free diaper bags containing formula to new moms and also accept free formula for in-hospital use.

This marketing practice deviates from the standards followed by health care providers and hospitals in every other respect. For example, hospitals do not give out coupons for name-brand clothing or name-brand foods outside of maternity. "We’d never tolerate the thought of hospitals giving out coupons for Big Macs on the cardiac unit," said Dr. Bartick, an internist. Since lack of breastfeeding is clearly associated with multiple adverse health outcomes in children and mothers, distribution of formula marketing materials by hospitals and health care providers has been recognized as unethical since at least 1981, when the World Health Organization approved the International Code of Marketing of Breastmilk Substitutes.

Henderson agrees: “There is the implication that if formula is either directly or indirectly offered to you by a care provider, then formula must be okay.”

Members of MBC on the taskforce that drafted the new regulations helped make the case for eliminating the diaper bags. The formula bags may actually cost families money: "Not only is there the expense of formula, but parents and society end up paying for medications and time lost from work to care for a sick child," says Dr. Kimberly Lee, a neonatologist at Beth Israel Deaconess Medical Center in Boston.

As proof of the companies’ influence, Dr. Lee notes that parents almost always continue to use the brand of formula their baby got in the hospital — and those formulas are typically the most expensive. These new regulations will go far in improving the quality of care to mothers and their newborns.

To read the regulations, you can visit the Massachusetts Breastfeeding Coalition’s web site.

© Gina Gerboth

NFO Pregnancy & Birth and Breastfeeding Editor Gina Gerboth is a freelance editor, indexer and writer, as well as a breastfeeding peer counselor and birth enthusiast. She lives in Pueblo, Colorado, with her husband, Jason, and three sons. Her business site can be found at, and you can read her personal blog at


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