Documents associated with AB 2447 in the 2001-2002 Session
1: Cochrane Database Syst Rev
2000;(2):CD002075
Commercial hospital discharge packs
for breastfeeding women.
Donnelly A, Snowden HM, Renfrew MJ,
Woolridge MW.
Mother and Infant Research Unit, 22 Hyde
Terrace, Leeds, UK, LS2 9LN.
h.m.snowden@leeds.ac.uk
BACKGROUND:
Exclusive breastfeeding until around six
months of age, followed by the introduction of solids with continued
breastfeeding, is considered to be the optimal nutritional start for
newborn infants.
OBJECTIVES:
To determine whether the exclusivity and
duration of breastfeeding is affected by giving mothers commercial
discharge packs in hospital which contain artificial formula or
promotional material for artificial formula. These packs are those which
are commonly given to mothers on leaving hospital after giving birth
(thus discharge packs).
SEARCH STRATEGY:
Comprehensive electronic search of the
register of clinical trials maintained and updated by the Cochrane
Pregnancy and Childbirth Group and CINAHL and MEDLINE.
SELECTION CRITERIA:
All randomized controlled trials with or
without blinding to examine the effects of commercial discharge packs on
breastfeeding. Participants: Consenting postpartum women who initiate
breastfeeding while in hospital or immediately upon discharge.
Interventions:
Commercial discharge packs which contain
free samples of infant formula or promotional material versus non
commercial discharge packs (specifically those from which free samples
of infant formula have been removed or have been
replaced with e.g. breast pads) or no
pack.
Main outcome measures:
The proportion of women breastfeeding at
six weeks and 3 months (13 weeks) postpartum. Other outcomes: Rates of
breastfeeding at other fixed time points between 0 and 6 months
postpartum.
DATA COLLECTION AND ANALYSIS:
Data were extracted by one reviewer and
checked by a second reviewer.
MAIN RESULTS:
Nine randomized controlled trials
involving a total of 3730 women were analyzed. The studies only included
women from North America. The meta-analysis showed that when comparing
commercial discharge packs with any of the controls (no intervention,
non-commercial pack and combinations of these), exclusive breastfeeding
was reduced at all time points in the presence of commercial hospital
discharge packs. There was no evidence to support the conjecture that
use of hospital discharge packs causes the early termination of
non-exclusive breastfeeding. Where the introduction of solid food was
measured, giving a commercial pack (with or without formula) reduced the
time before solid food was introduced.
REVIEWER'S CONCLUSIONS:
The giving of commercial hospital
discharge packs (with or without formula) appears to reduce the number
of women exclusively breastfeeding at all
times but has no significant effect upon the earlier termination of
non-exclusive breastfeeding.
Publication Types: Review Review,
Academic
PMID: 10796281 [PubMed - indexed for
MEDLINE]
****
2: Can J Public Health 1999
Nov-Dec;90(6):408-11
Breastfeeding outcomes of women
following uncomplicated birth in
Hamilton-Wentworth.
Sheehan D, Bridle B, Hillier T, Feightner
K, Hayward S, Lee KS, Krueger P, Sword W,
James M.
Hamilton-Wentworth Social and Public
Health Services Division, Dundas, ON.
dsheehan@hamilton-went.on.ca
OBJECTIVE:
To examine infant feeding practices up to
8 weeks postpartum in Hamilton-Wentworth.
METHODS: A cross-sectional survey of 227
women using a pre-discharge, self-administered questionnaire, medical
record review and follow-up telephone interview.
RESULTS: Breastfeeding initiation rate
was 85%. By 6-8 weeks postpartum, 30% of women had stopped
breastfeeding; 55% had switched to formula within the first 14 days.
Infants who did not receive supplementation in hospital were 2.49 times
more likely than infants who received supplementation to breastfeed for
at least 6 weeks. Although 54% of mothers who
initiated breastfeeding reported receiving formula gift packs, no
association was found.
CONCLUSIONS: The breastfeeding initiation
rate appears to have increased in Hamilton-Wentworth since 1995.
However, this study reinforces the need to address early cessation and
infant supplementation, and raises concern about violation of the
WHO/UNICEF International Code of Marketing of Breastmilk Substitutes
through mailing of formula coupons.
PMID: 10680268 [PubMed - indexed for
MEDLINE]
****
3: Obstet Gynecol 2000 Feb;95(2):296-303
Office prenatal formula advertising
and its effect on breast-feeding patterns.
Howard C, Howard F, Lawrence R, Andresen
E, DeBlieck E, Weitzman M.
Department of Pediatrics, University of
Rochester School of Medicine, New York, USA.
cindy.howard@viahealth.org
OBJECTIVE:
To compare the effect of formula
company-produced materials about infant feeding to breast-feeding
promotion materials without formula advertising on breast-feeding
initiation and duration.
METHODS:
Five hundred forty-seven pregnant women
were randomized to receive either formula company (commercial; n
= 277) or specially designed (research; n
= 270) educational packs about infant feeding at their first prenatal
visit. Feeding method was determined at delivery. Breast-feeding
duration of the 294 women who chose to breast-feed was ascertained at 2,
6, 12, and 24 weeks. Survival analyses were used to evaluate continuous
outcomes, and chi2 and logistic regression analyses were used to
evaluate discrete outcomes.
RESULTS:
Breast-feeding initiation (relative risk
[RR] 0.93, 95% confidence interval [CI] 0.61, 1.43) and duration after 2
weeks (hazard ratio 1.19, 95% CI 0.86, 1.64) were not affected. Women in
the commercial group were more likely to cease breast-feeding before
hospital discharge (RR 5.80, 95% CI 1.25, 54.01) and before 2 weeks
(adjusted odds ratio [OR] 1.91, 95% CI 1.02, 3.55). In subgroup
analyses, women with uncertain goals for breast-feeding or goals of 12
weeks or less experienced shortened exclusive (hazard ratio 1.53, 95% CI
1.06, 2.21), full (hazard ratio 1.70, 95% CI 1.18, 2.48), and overall
(hazard ratio 1.75, 95% CI 1.16, 2.64) breast-feeding duration when
exposed to the commercial intervention.
CONCLUSION:
Although breast-feeding initiation and
long-term duration were not affected, exposure to formula promotion
materials increased significantly breast-feeding cessation in the first
2 weeks. Additionally, among women with uncertain goals or
breast-feeding goals of 12 weeks or less, exclusive, full, and overall
breast-feeding duration were shortened. Educational materials about
infant feeding should support unequivocally breast-feeding as optimal
nutrition for infants; formula promotion products should be eliminated
from prenatal settings.
Publication Types: Clinical Trial
Randomized Controlled Trial
PMID: 10674597 [PubMed - indexed for
MEDLINE]
***
4: Birth 1997 Jun;24(2):90-7
Comment in:
Birth. 1997 Jun;24(2):98-101.
Birth. 1997 Sep;24(3):202.
The effect of discharge pack formula
and breast pumps on breastfeeding duration and choice of infant feeding
method.
Bliss MC, Wilkie J, Acredolo C, Berman S,
Tebb KP.
Sutter Center for Women's Health, Sutter
Community Hospital, Sacramento, CA 95819, USA.
BACKGROUND:
A study of breastfeeding mothers was
conducted from October 1993 through July 1994 in the western United
States to determine the influence of components of hospital discharge
packs on the duration of breastfeeding.
METHOD:
On discharge from the hospital, over 1600
breastfeeding mothers were given one of four free discharge packs,
identical in all ways except that one contained a can of powdered
formula, one a manual breast pump, one both formula and pump, and one
neither. During the following 6 months, mothers were interviewed by
telephone three times by an independent research firm to determine how
and what they were feeding their infants. Analysis of the independent
and interactive
effects of both formula and pump was
performed, and the moderating effects of age, ethnicity, marital and
insurance status, prebirth feeding plan, and the effect of returning to
outside employment or school were examined.
RESULTS:
Across the entire sample, the contents of
the discharge packs had a negligible effect on feeding method and
breastfeeding duration. Examination of select subgroups revealed modest
discharge pack effects, wherein the presence of
discharge pack formula increased the likelihoof2p4 introducing
supplementation during the first 6 weeks whereas receipt of pumps
prolonged full breastfeeding. Even in these select groups, however, no
effect was observed on the overall duration of
breastfeeding.
CONCLUSION:
Relative to other known influences on the
choice of feeding method and on breastfeeding duration, discharge pack
contents do not merit great concern.
Publication Types: Clinical Trial
PMID: 9271974 [PubMed - indexed for
MEDLINE]
****
5: Pediatrics 1996 May;97(5):669-75
Changing hospital practices to
increase the duration of breastfeeding.
Wright A, Rice S, Wells S.
Department of Pediatrics, Steele Memorial
Children's Research Center, University of Arizona, Tucson, USA.
OBJECTIVE.
To change the breastfeeding policy in a
university teaching hospital in accord with the Ten Steps to Successful
Breastfeeding of the United Nations Children's Fund and World Health
Organization and to assess the impact ofhospital practices on the
duration of breastfeeding.
METHODS.
One hundred ninety-two and 392 postpartum
women in a maternity ward were interviewed in 1990 and 1993,
respectively, regarding how they were feeding their infants and feeding
practices in the hospital. Between these two periods, the hospital
infant-feeding policy was reviewed and revised in accord with the Ten
Steps. Two hundred seventy of the mothers interviewed in 1993 were
interviewed again when their infants were 4 months old regarding the
duration of full and partial breastfeeding.
RESULTS.
By 1993, more newborns were put to the
breast in the first hour of life (63.2% vs 24.8%); fewer breastfed
infants were fed foods other than breast milk (27.9% vs 46.7%); and more
mothers received breastfeeding guidance from hospital staff (81.9% vs
61.3%). The duration of breastfeeding in 1993 was longer for women who
did not receive formula in the hospital, who were not given discharge
packs containing formula and/or coupons, and who roomed-in more than 60%
of the time. These associations persisted after controlling for
confounding.
CONCLUSION. Infant-feeding policies and
practices are amenable to change, and policies such as the Baby-Friendly
Hospital Initiative may contribute to an increase in the duration of
breastfeeding.
PMID: 8628605 [PubMed - indexed for
MEDLINE]
***
6: Am J Public Health 1994
Jan;84(1):89-97
Infant feeding policies in maternity
wards and their effect on breast-feeding
success: an analytical overview.
Perez-Escamilla R, Pollitt E, Lonnerdal
B, Dewey KG.
Department of Nutrition, University of
California at Davis 95616-8669.
OBJECTIVES.
The purpose of this review is to examine
the plausibility of a causal relationship between maternity ward
practices and lactation success.
METHODS.
Studies were located with MEDLINE, from
our personal files, and by contacting researchers working in this field.
Of the 65 studies originally reviewed, 18 met our inclusion criteria
(i.e., hospital-based intervention, experimental design with
randomization procedures, or quasi-experimental design with adequate
documentation).
RESULTS.
Meta-analysis indicated that commercial
discharge packs had an adverse effect on lactation performance. The
impact of early mother-infant contact on
lactation success was unclear. Rooming-in and breast-feeding guidance in
a rooming-in context had a beneficial impact on breast-feeding among
primiparae. Breast-feeding on demand was positively associated with
lactation success. In-hospital formula supplementation of 48 mL per day
was not associated with poor breast-feeding performance.
CONCLUSIONS.
Hospital-based breast-feeding
interventions can have a beneficial effect on lactation success,
particularly among primiparous women.
Publication Types: Meta-Analysis
PMID: 8279619 [PubMed - indexed for
MEDLINE]
***
7: J Hum Lact 1992 Jun;8(2):67-72
Erratum in: J Hum Lact 1992 Sep;8(3):135
Comment in:
J Hum Lact. 1993 Mar;9(1):6.
J Hum Lact. 1993 Mar;9(1):6-7.
The association of formula samples
given at hospital discharge with the early duration of breastfeeding.
Snell BJ, Krantz M, Keeton R, Delgado K,
Peckham C.
Conflicting results have been reported
regarding the association of formula samples given at hospital discharge
with breastfeeding duration. This study investigated the relationship
between the distribution of formula samples and breastfeeding duration
in low-income Hispanic women. A gift pack of formula was distributed
randomly to 88 breastfeeding women. All women received a telephone call
at one and three weeks to collect information about infant feeding.
Chi-square analysis revealed no significant difference in the proportion
of women exclusively breastfeeding at one week. However, fewer women
were exclusively breastfeeding in the gift pack group at three weeks (p
less than .004). Gift packs given to Hispanic breastfeeding women are
associated with a decrease in exclusively breastfeeding during the first
three weeks postpartum.
PMID: 1605843 [PubMed - indexed for
MEDLINE]
***
8: J Am Diet Assoc 1991 Aug;91(8):923-5
Breast-feeding policies and routines
among Arizona hospitals and nursery staff: results and implications of a
descriptive study.
Strembel S, Sass S, Cole G, Hartner J,
Fischer C.
Maricopa Department of Health Services,
Division of Public Health, Phoenix, AZ 85006.
In 1988, Arizona's 61 hospitals providing
obstetrical services were canvassed with regard to hospital routines
that favor either breast-feeding or bottle-feeding. Forty-five hospitals
provided responses that were used in the survey. Practices favoring
breast-feeding, which were reported by a majority of the hospitals (more
than 50%), were demand feeding, staff assessment for "latch-on" (the
action of nipple presentation and sucking initiation) and positioning,
"rooming-in" (the practice of minimal mother-infant separation), and
information about follow-up support services. Hospital practices
suggested to promote bottle-feeding were the provision of pacifiers and
supplemental water or glucose, issuance of formula packs at discharge,
and a first feed of sterile water. A positive significant relationship
was identified for policies advocating breast-feeding and the prevalence
of breast-feeding encouragement from professional staff. Of 44
respondents, 41 indicated that their hospital's policies endorse
breast-feeding as the ideal method of feeding healthy newborns. Hospital
staff perceived that they encourage mothers to breast-feed and offer
support to those who initiate breast-feeding. On the basis of this
information, we conclude that dietetics practitioners should evaluate
current breast-feeding practices and integrate policies supportive of
breast-feeding into the health care system.
PMID: 1894899 [PubMed - indexed for
MEDLINE]
***
9: J Adolesc Health Care 1988
Sep;9(5):411-3
Effect of two types of hospital
feeding gift packs on duration of breast-feeding among adolescent
mothers.
Neifert M, Gray J, Gary N, Camp B.
University Hospital, University of
Colorado Health Sciences Center, Denver.
Two hundred forty-four adolescent mothers
under 18 years of age were surveyed during a 15-month period, and 53%
elected to breast-feed. A subset of 60 primiparous breast-feeding
adolescents were enrolled in an investigator-blind, randomized,
prospective study to compare the effects on breast-feeding duration of a
standard hospital discharge feeding gift pack containing formula and a
specially designed study pack that was free of infant formula.
Thirty-five
percent of the 60 women breast-fed less
than 1 month; 22% nursed longer than 1 month but less than 2 months; and
43% breast-fed more than 2 months. There was no significant difference
in breast-feeding duration among mothers by gift pack group, although
those who received the study gift pack rated it higher in usefulness (p
less than (0.025). The provision of infant formula samples did not
appear to have a deleterious effect on the duration of breast-feeding
among a population of adolescent mothers.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 3049484 [PubMed - indexed for
MEDLINE]
***
10: Pediatrics 1987 Dec;80(6):845-54
Commercial discharge packs and
breast-feeding counseling: effects on infant-feeding practices in a
randomized trial.
Frank DA, Wirtz SJ, Sorenson JR, Heeren
T.
Department of
Pediatrics, Boston City Hospital, Boston University School of
Medicine, MA 02118.
A randomized
controlled trial was conducted to evaluate two interventions for
prolonging the duration of breast-feeding in a multiethnic sample of 343
low-income urban women. One intervention compared research
breast-feeding bedside counseling by a trained counselor, who also made
eight telephone calls during the first 3 months of the infant's life,
with the routine breast-feeding counseling provided in the hospital by
nurses. The other intervention compared commercial discharge packs
provided by formula companies with research discharge packs designed to
be consistent with the WHO Code of Marketing of Breastmilk Substitutes.
When infants were 4 months old, a telephone interviewer unaware of
treatment status contacted 95% (324/343) of the women to determine the
infants' feeding and health histories. Compared with routine counseling,
research counseling delayed the first introduction of solid foods to the
infant's diet (P =.03, one-tailed) but did not exert a statistically
significant effect on breast-feeding by 4 months' postpartum. Women who
received the research discharge pack, compared with those who received
the commercial pack, were more likely to prolong exclusive
breast-feeding (P = .004, one-tailed), to be partially breast-feeding at
4 months postpartum (P = .04, one-tailed), and to delay the daily use of
solid foods in the infant's diet (P = .017, one-tailed). Among the women
who received research counseling, the research discharge pack was
associated with lower rates of rehospitalization of infants than was the
commercial pack (1% v 14%; P = .014, two-tailed). We conclude that in
high-risk maternity populations, commercial discharge materials for
breast-feeding women should be replaced by materials consistent with the
WHO Code.
Publication Types:
Clinical Trial
Randomized
Controlled Trial
