Encouraging trends in US hospital distribution of infant formula sample packs

Background: Hospital-based distribution of formula company-sponsored sample packs, packaged as diaper discharge bags, to new mothers violates the World Health Organization's International Code of the Marketing of Breast-milk Substitutes, and interferes with breastfeeding exclusivity and duration. Nonetheless, according to our national survey in 2007, only 9% of US hospitals are sample-pack free. Objective: To determine whether changes occurred in the proportion of US hospitals distributing industry-sponsored formula sample packs between 2007 and 2010. Design: In 2010, we called all hospitals in 20 US states and asked whether their hospital distributed a “formula company-sponsored diaper discharge bag” to any new mothers. We selected states based on their 2007 record, choosing the 10 states with the best, and the 10 states with the worst record for sample pack distribution in 2007. Of these hospitals, 14% did not distribute sample packs in 2007. Respondent position at the hospital was noted. Results: We contacted 1239 hospitals in 20 states. 28% (349/1239) of hospitals contacted in 2010 were bag-free, compared to 14% (181/1323) in the same states in 2007. In 2010, the proportion of bag-free hospitals per state ranged from 0% (5 states) to 86% (Rhode Island). In the 10 best states, the proportion of sample-pack free hospitals increased by a mean difference in weighted proportion of 19% between 2007 and 2010 (p<0.0001). In the 10 worst states, the weighted proportion of sample-pack free hospitals increased by a mean difference of 6% (p<0.01). Conclusion: The majority of hospitals still distributed formula sample packs, but trends indicate a significant change in practice, with increasing proportions of hospitals eliminating formula sample packs. Such activity was greater in states where higher proportions of hospitals were already free of formula sample packs.