Breastfeeding vs gift bags: a public health issue, not a “lifestyle” choice, says AAP

The American Academy of Pediatricians has this month adopted a resolution at its Annual Leadership Forum saying it recommends members should no longer distribute coupons, free samples or any other promotional items supplied by formula companies to new mothers. It’s a move accompanied by a statement that breastfeeding is not a lifestyle choice. It is a public health issue, and promotional materials of all kinds demonstrably reduce the rate of breastfeeding.

Here’s some of the actual text of the resolution, to show you how directly worded it is:

“research has demonstrated that the free distribution of commercial materials such as formula samples, diaper bags, formula coupons, or other gifts via commercial infant formula marketing implicitly endorses formula feeding and creates the impression that clinicians favor formula feeding over breastfeeding, and research demonstrates that this activity decreases exclusivity and duration of breastfeeding, therefore be it RESOLVED, that the Academy advise pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.”

You can read the entire resolution here.

Think that’s big? I really liked the kicker at the end:

“FISCAL NOTE: There would be no fiscal impact on the Academy, but it should be noted that there are documented cost savings with the improved health from breastfeeding.”

Anything but a good start. The AAP says pediatricians should no longer provide gift bags to new mothers.

Let’s get it straight. Medical staff are regularly compensated in various ways by formula companies as both direct and indirect attempts to promote their products. Formula companies make money out of sales of their imitation milk, and in order to increase those sales, they seek to have health professionals (the experts) on their side. It is not in formula companies’ interests to increase breastfeeding rates, and while healthcare professionals want to be ethical, it is easy to recognize that some women do not breastfeed for multiple reasons. And that’s where some of them are willing to work with formula companies.

But guess what? The AAP has gone a few steps further. It has included the following:

“The primary goal of infant formula manufacturers is to sell their product and maximize company and shareholder profits. One major way they achieve this goal is through strategic marketing via the health system. The distribution of formula company products by a health care provider – hospital, nurse, or doctor, is nothing more than advertising. It is not generosity on the part of manufacturers. There is no “gift” in a “gift bag” except that from the healthcare system applying a seal of approval to the formula manufacturer without compensation.”

These strong words follow the AAP’s policy statement on breastfeeding and the use of human milk, published in February this year. It includes this paragraph:

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.

Great stuff.

The breast vs bottle debate has its moments in the sun, but most often dwells in the darkest areas of women’s guilt-ridden hearts. Every single conversation thread includes personalization of an argument. “Well I had a hard time,” or “My babies were all…” We can’t seem to disconnect our personal passion and experience from a meta discussion of the problems that arise from deplorable rates of breastfeeding. For so many women, they can’t say “Breast fed is best fed” without adding a “but” and disclaimer at the end.

It’s time to grow up. The research and facts unequivocally state that breastmilk is better than any other method of feeding a child. But so many of us have a mediocre commitment to it. We got so beaten down that eventually many of us ended in the “lifestyle choice” category. Do what you want, as long as you check out all of the options. Everyone is different, yada yada yada.

Well, we should be taking a leaf out of the AAP’s stand this week. You’ll note the organization did not include any “buts” or “ifs” in its ruling. It didn’t say “unless the mother is working outside the home” or “unless breastfeeding is too hard and the family has no money to buy formula” or even one I’ve heard “Having a baby is tough, it’s nice to get a free bag of things in the hospital.”

Nope, the directive is clear to pediatricians everywhere. Don’t do it. If your pediatrician is being advised that way, then it’s good advice.

So no matter where you stand on your own opinions on breastfeeding, perhaps this revelation is one which could guide us in our ongoing commitment to the health of our children. If we want society to be full of healthy people, breastfeeding – and not free bags of formula branded company guff – is the way to go.

PS: I’ll be at BlogHer 2012 this week, and am looking forward to see what kinds of promotion (if any) formula companies are conducting there.


  • Breast-feeding is not always a choice. Those who say “breast is best” come at it from a place of privilege, and I don’t mean just economic or convenience.

    I mean biological and vital. As Stirrup Queens says here,, “Because you’ve never stood in my exact shoes, because if you had, you’d understand why formula is far from the evil concoction you paint it to be. It’s the reason I have children instead of corpses.”

    As an adoptive mom, I was thankful for infant formula I could take home from the hospital to try out.

    I realize free samples to dissuade otherwise-able-to-nurse mothers is what you’re talking about. But there are outliers that would be affected, too, by the AAP’s recommendation. Maybe there is room for ifs and buts.

    Thought provoking.

  • I agree that we need to grow up and be able to have the meta discussion away from the emotions of our personal experience.

    It is hard though because the “guilt” strings are there if women have not done it but that speak with “but” and all the other things that have stood in a mother’s way keep our rhetoric from taking that hard stance of this being a norm for more women to pursue.

  • It is hard to have this discussion without all of the emotions tied to it. I think the best approach is to just look at whether it’s ethical to hand out free samples at the doctor’s office. I don’t think it’s ethical to hand out pharmaceutical samples or formula samples. I made it clear to my OB that I planned to breastfeed (both verbally & in writing). As I’m leaving the first pre-natal appointment, the nurse asks me if I plan to breastfeed. I say, “yes,” so she grabs a “gift for breastfeeding moms” from the cabinet. What’s in there? Breastfeeding literature written by a company who makes a profit by my failure to nurse, along with a big can of formula. : /

    When my toddler was 9 months and slid a bit on the weight charts, what did our pediatrician do? Hand me a big box of formula. Thankfully, I had already found a local La Leche League meeting led by an IBCLC. I had oversupply, so when we decided to supplement, I did so with my own milk. The ped never explored the cause of low weight gain and jumped to the last recommended course of action. Because she had free formula in the office.

    This isn’t about breast vs. bottle. This is about profit and business ethics. It’s unethical to shove formula in the face of a mom who is struggling with or even planning to nurse her child.

  • This is great news! Formula has a purpose. Monogen saved my son’s life due to his fatty acid oxidation disorder. However, I agree that it is unethical to hand out formula samples to every new mom. Breastfeeding should be the norm. If a mom cannot or chooses not to breastfeed, fine. I have no problem with formula samples being available should a mom ask for them but they shouldn’t be handed out to everyone. Good job, AAP!

  • I don’t think it’s the handing out of formula that is unethical. Where we as women are truly robbed is having doctors that are so over scheduled they cannot or do not take the time to sit and listen to our needs and fears. Perhaps if we had other women role models in our lives who we could talk to about breast feeding ( I breast fed three children all different experiences and not always easy) then perhaps more people would breastfeed. What is unethical is making it impossible to discuss options. Every person is different and until you are in a position to try breast feeding you do not know what is gong to “work” for you.

  • I think it’s very hard for a doctor or nurse to appear breastfeeding friendly as they hand you formula. Formula has its place, but it’s hard to establish your supply etc if you aren’t nursing as you should be in the beginning.. then you have to rely on formula.

    I think that’s what gets to me… a mom can’t turn around and say, “nevermind, I want to nurse now” it’s very hard to reverse unlike most other choices in our lives.

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