I thought I would add a few comments regarding the formula containing
discharge bags.
1. The bags are designed as a marketing tool to cause brand recognition and
get a sample of the product into the consumer's hand. They have nothing to do
with giving cute gifts or distributing them because the mothers want them. The
Cochrane Review states that exclusive breastfeeding is reduced at all points
measured between 0-6 months in the presence of hospital discharge bags (whether
or not the formula had been removed). Donnelly A et al. Commercial hospital
discharge packs for breastfeeding women (Cochrane Review). In: The Cochrane
Library, 4, 2001. Oxford: Update Software.

Discharge bags are designed to cause breastfeeding mothers to supplement,
thereby reducing their milk supply and forcing the need to purchase formula. This
creates a market where none existed before. Each time you give out one of
these bags you directly contribute to the increased risk that breastfeeding will
cease by 7-10 days or that its intensity will be reduced, thereby increasing
the risk for disease and illness in mothers and babies.

2. Discharge bags given to breastfeeding mothers is defined as marketing by
the HIPAA regulations. While it does not require signed informed consent, at
least hospitals should understand that this is marketing, plain and simple. No
other unit in the hospital markets products to patients like this.

3. Corporate Compliance may tell you that they have a business partner
relationship with formula companies, but the Inspector General of the US Department
of Health and Human Services says that if a hospital takes bribes (I mean
accepts money) and in return hands out the bags as a condition of acceptance of
this money, and if this practice involves Medicaid patients, this act violates
the federal anti-kickback statute.

4. The Ross Employee Manual of a few years ago states that, "Never
underestimate the role of nurses. If they are sold and serviced properly, they can be
strong allies. A nurse who supports Ross is like another salesman." This
degrading statement reduces nurses to objects that need to be serviced and recruited
to carry out the process of selling a product that put infants at increased
health risks. What a job description.

5. This practice continues because of the money paid to and accepted by
hospitals to act as shills and peddle a product. Many of you who try and address
this issue are reprimanded by your administrators because they view the formula
salesman not as a vendor, but as a member of the health care team. They think
this person is actually important to the health of babies. The sales people
are there to make you their friend and to insinuate themselves into health care
decision making where they have no right to be. Their "educational" offerings
are carefully designed to promote their product but discuss none of the
adverse outcomes.

The formula culture in many hospital maternity units is carefully crafted to
make sure that nurses and physicians defend an unhealthy practice. This is so
ingrained in some units that health care professionals would rather put
babies' health at risk than break the cycle of formula dependency that permeates the
health care of patients. NABA picked this up in its Code monitoring project
in 2000 and has seen a continuing intensification of commercial pressure heaped
upon the health care provider. Too bad health care providers' time is wasted
on formula salesmen rather than on helping mothers breastfeed.

Marsha Walker, RN, IBCLC
Weston, MA

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