Congratulations: It's a consumer! Successful strategies for eliminating formula company marketing to new mothers in the hospital

Background: Hospital-based distribution of formula sample packs is an established marketing technique which undermines exclusive breastfeeding. Currently, 92% of US hospitals distribute formula sample packs to new mothers at discharge, but this unethical practice is rapidly being discontinued in certain regions. In 5 states, fewer than 75% of hospitals distribute sample packs.

Goals: To determine strategies that lead to successful elimination of formula sample packs.

Methods: We identified sites where large numbers of hospitals had discontinued formula sample pack distribution in a short timeframe. We worked with city and state Departments of Health, health care providers, and regional Breastfeeding Coalitions to determine techniques that had successfully changed hospital practice.

Results: Activism by grass-roots community advocates, in combination with support from regional or local health departments, led to elimination of the practice. Despite endemic and long-standing resistance, successful strategies often had a regional, domino-like effect once employed. Effective approaches included setting goals to become the first "bag-free" US city or state; ethics-based campaigns, pursuing WHO Baby-Friendly(TM) status, and incentive-based strategies including distribution of awards to hospitals by the regional health department. In New York City, the Health and Hospitals Corporation removed sample packs from all the city's 11 public hospitals within a relatively short timeframe. In Portland, Oregon, 15 hospitals eliminated sample packs within 1 year, in anticipation of receiving DPH awards for improved public health practice.

Conclusion: Community-based advocacy, education, and pressure from health policy makers can successfully change an ingrained practice to enhance public health outcomes.