Elimination of formula sample pack distribution in Indian hospitals: Setting a course for the rest of the nation

Background: Infant formula sample packs are frequently distributed to US new mothers at hospital discharge, in violation of the World Health Organization Code for the Marketing of Breast Milk Substitutes. Native Americans have rates of diabetes and obesity far above the US average. Formula feeding increases the risk of diabetes. Thus, hospital distribution of formula sample packs represents a public health threat to a Native American population.

Goal: To document the extent of formula sample pack distribution at I.H.S. and tribally operated hospitals throughout the US.

Methods: We obtained hospital contact information from the I.H.S. website. In November 2008, a research assistant called each hospital and asked if a formula company diaper discharge bag was distributed to any new mothers.

Results: Of 24 Indian Health Services/tribally operated hospitals in 7 states serving 22 tribes, 33% (8/24) did not distribute formula sample packs. By contrast, nationally, only 8% of US hospitals do not distribute sample packs. Navajo Nation, a 27,000 square mile reservation with 3,500 births a year had the best rate of sample-pack free hospitals: 71% (5/7) of their hospitals did not distribute formula sample packs.

Conclusion: I.H.S hospitals are more likely to be compliant with the WHO Code than other US hospitals. Navajo Nation has a far higher proportion of sample pack free hospitals than any state in the Union. This is in keeping with other breastfeeding-friendly practices on Navajo Nation such as passage of a breastfeeding workplace law in October 2008.