Monda has reminded us that formula companies are willing to engage in  almost 
any manner of behavior to sell their product. Their formula-containing  gift 
bags, with or without the formula, have been shown to result in decreased  
rates of exclusive breastfeeding at all points measured between 0-6 months.  
Depressing milk production causes the mother to have to purchase the formula,  
thus creating a market where none existed before. HIPPA defines the gift bag as  
a form of marketing, therefore the hospital that gives these out is a direct  
marketer of the product. Many risk management departments require that the lot 
 number on the cans of formula be recorded in case a recall of the product is 
 issued. Powdered infant formula is not sterile and has caused the death of  
infants around the world from contamination with Enterobacter sakazakii.  
European health authorities recommend that no infant under the age of 4 weeks be  
given powdered formula. The FDA issued a warning about not using powdered  
formula in NICUs.
 
Infants with a family history of diabetes or allergy are at an increased  
risk of acquiring these conditions when given just one bottle of the formula  
contained in the discharge bag. Risk management needs to be informed of this as  
no mothers is ever asked whether she has such a history nor warned against the 
 use of the product.
 
Gift bags are easily made and paid for. Hospitals like to market their own  
services and a gift bag with their name and logo on it should be used. It can 
be  paid for by any number of funding sources: hospital auxiliary, hospital  
foundation, hospital marketing department, community service organizations such  
as the Kiwanas, Junior League, Rotary, etc. Many community merchants love to  
provide coupons for their products and services (house cleaning, takeout 
food,  baby clothes, children's books) that can be put in the gift bag.
 
There is nothing that you need that Ross provides. The Office on Women's  
Health has free breastfeeding booklets to put in the discharge bag. Nothing in a  
commercial bag is therapeutic and all items are designed to sell a product 
that  could be harmful to the patient's health. The cardiac unit does not give 
out  gift packs of coupons from tobacco firms for low tar cigarettes or samples 
of  high fat junk food.
 
The inspector general of the Department of Health and Human Services has  
also replied to my complaint about this practice, saying that it could be  
construed as violating the federal anti-kickback statute and possibly interfere  
with the hospital's reimbursement from Medicaid. The hospital should be  reminded 
that "fiscally responsible compromises" can harm patient health and  take a 
good look at their mission to see if patient harm is listed among it  goals.
 
Marsha Walker, RN, IBCLC
Weston, MA

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