US hospital infant formula sample giveaways 'not violation of WHO Code'


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Abbott's Similac brand hospital discharge bags for breastfeeding (left) and bottle feeding (right) mothers (Image: Public Citizen)
Abbott's Similac brand hospital discharge bags for breastfeeding (left) and bottle feeding (right) mothers (Image: Public Citizen)

Related tags Infant formula Breastfeeding

The International Formula Council (IFC) has dismissed claims that the US practice of providing free hospital discharge bags containing samples of infant formula is in violation of the International Code of Marketing of Breastmilk Substitutes.

Last month, US consumer group Public Citizen delivered an 18,000 signature-strong petition to Mead Johnson Nutrition (Enfamil), Abbott Laboratories (Similac), and Nestlé USA (Gerber), in which it urged them to “stop distributing samples of infant formula in healthcare facilities.”

Public Citizen claims that by supplying US healthcare providers with product samples to distribute to parents, the firms have failed to adhere to the principles of the World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes - notably Articles 5.2 (“Manufacturers and distributors should not provide, directly or indirectly, to pregnant women, mothers or members of their families, samples of products”) ​and 6.2 (“No facility of a health care system should be used for the purpose of promoting infant formula”).​ approached Abbott Laboratories, Mead Johnson Nutrition, and Nestlé USA regarding the petition but was referred to IFC, which counts all three as members.

In a statement, IFC argued simply that no violations of the Code could have taken place because its principles were never incorporated into US law.

“All IFC members support the aims and principles of the WHO International Code of Marketing of Breastmilk Substitutes (Code),”​ said Mardi Mountford, executive vice president, IFC.

“However, the voluntary Code is inconsistent with US law and policy, and was therefore not adopted in the US. Thus, US hospitals who distribute formula samples are not in violation of the WHO Code.”

“Healthcare provider endorsement”

Quoting Centers for Disease Control and Prevention (CDC) data, Public Citizen claims that more than half of all US hospitals distribute infant formula firm-sponsored discharge bags that include product samples.

“This is most controversial because many studies show that women who receive the formula discharge bags with samples breastfeed less exclusively and for shorter durations,” ​Eva Seidelman, researcher, Public Citizen told

“Experts believe women view the formula discharge bags with samples as a healthcare provider endorsement of formula feeding even where breastfeeding is promoted and healthcare providers do not intend to make sure an endorsement," ​she said.

IFC has, however, disputed such suggestions, citing a 2012 survey in which 94% of new mothers said that restricting the use of infant formula in the hospital would not have influenced their decision on whether or not to breastfeed.

“Focusing on infant feeding support kits detracts from the real barriers to breastfeeding such as access to healthcare after leaving the hospital, breastfeeding support in the workplace and paid or longer maternity leave,”​ said Mountford.

“Further, suggesting moms can be swayed from breastfeeding by receiving information on infant formula or a small sample does a great disservice to them.”

“The IFC and its members believe mothers are best positioned to make feeding decisions that meet the unique needs of their baby and family. Moms deserve to be supported in those decisions to ensure optimal nutrition and wellbeing. At the end of the day, the real objective for any campaign intended to increase breastfeeding rates should be to provide sound advice and support to new mothers.”

Future dialogue?

Public Citizen kicked off its Keep Infant Formula Marketing Out of Health Care Facilities​ campaign in 2012 by sending a letter signed by more than 150 public health, consumer and medical organizations to the 2,600 largest hospitals in the US. Around the same time, it launched a consumer petition urging Abbott, Mead Johnson and Nestlé “to stop co-opting healthcare facilities for marketing purposes.”

On May 21 2014 - to mark 33 years since WHO’s adoption of the Code - Public Citizen, flanked by scores mothers and ally organizations​, hand delivered the petition to a Mead Johnson executive outside the company’s headquarters near Chicago, Illinois.

Copies of the petition were also delivered to Abbott Laboratories and Nestlé.

“Mead Johnson accepted our petition but they did not ask to meet with us to further discuss the issue or make any commitments,”​ she said.

“We sent the petition to other companies and have not heard back about dialogue.”

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