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Subject:
From:
Christine Pillado <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 6 Jul 2004 13:14:09 EDT
Content-Type:
text/plain
Parts/Attachments:
text/plain (160 lines)
Crystal, This is the info that I sent from my other email account as an 
attachment.  In case you could not open the attachment and for all others in the 
list who are interested in this information.

v/r
Christine Pillado
El Paso, TX


FROM THE EVIDENCE IN SUPPORT OF TEN STEPS
pg. 51
6.6 Effect of commercial samples of breastmilk substitutes on breastfeeding
A longitudinal study in Mexico (Margen et al, 1991) reported a significant 
association between
the distribution of formula samples and the use of formula. When interviewed 
2 weeks after
discharge, 50% of mothers reported receiving free formula samples at 
discharge . These
numbers did not include mothers from social security facilities who received 
prescriptions for
free formula at discharge. Mothers who received free formula samples at 
discharge were more likely to use formula at 2 weeks postpartum than mothers who 
did not receive samples
(P<0.05), irrespective of infant feeding intentions at admission. Among 
mothers initially
planning to use formula, 100% were using it if they had received free sample
s, and only 50%
if they had not received free samples. Among mothers initially planning not 
to use formula,
75% were using it if they had received free samples, and 62% if they did not 
receive samples.
The difference remained significant after controlling for maternal age, 
educational level and
plans to return to work.
Perez-Escamilla et al (1994) performed a meta-analysis of six experimental 
studies (Bergevin,
Dougherty & Kramer, 1983; Guthrie et al, 1985; Evans, Lyons & Killien, 1986; 
Feinstein et
al, 1986; Frank et al, 1987; Dungy et al, 1992). Studies compared groups 
receiving
commercial discharge packs which included samples of breastmilk substitutes 
with groups that
received no formula but educational pamphlets, breast pads, breast cream, 
breast pumps,
bottles of water, non-specified materials or nothing at all. Five studies 
were performed in
industrialized countries, one in the Philippines. The rates of full 
breastfeeding at 1 month and
any breastfeeding at 4 months were significantly lower in the groups 
receiving samples of
formula or other breastmilk substitutes. Perez-Escamilla concluded that 
commercial discharge
packs are associated with reduced breastfeeding rates, especially among 
groups at risk such as
primiparae and low-income women in developing countries.
Two more recent experimental studies by Bliss et al (1997) and Dungy et al 
(1997) do not
clearly confirm these conclusions, but they need to be interpreted with 
caution as they have
methodological limitations. Bliss et al followed three groups of mothers 
randomized by weeks,
who received discharge packs with formula and/or a breast pump, and a control 
group who
received neither. Overall duration of any breastfeeding was similar for all 
groups. However,
confounding variables were not controlled for, and prebirth breastfeeding 
plans differed
between groups (P<0.05). Among a subsample of mothers who planned to 
breastfeed for 6
months or more, full breastfeeding at 6 weeks was more likely (P<0.05) for 
those who
received a breast pump (78%) or only pamphlets (72%) than those who received 
formula only
or formula and a breast pump (64% each). In another subsample of mothers 
(n=1351) who
had not returned to school or work outside the home by 6 weeks full 
breastfeeding at 6 weeks
was also more likely for those receiving only a breast pump or pamphlets and 
no formula
sample.
Dungy et al (1997) followed 725 women randomly assigned to receive a 
discharge pack
containing formula and/or a breast pump. There were no “no item” controls. 
The rates of full
and partial breastfeeding were similar in all the groups during the full 
16-week follow-up
period. However, the type of breastfeeding before distribution of discharge 
packs was not
mentioned, and mothers lost to follow-up after discharge (n=38) tended to be 
less educated,
unmarried, of lower socioeconomic status and members of minority groups, so 
the results may
not be valid for these high-risk subgroups.
The authors acknowledge that “direct marketing of infant formula products to 
consumers and
the distribution of infant formula samples to pregnant women” is increasing. 
These marketing
practices were not controlled as potential confounders. The effect of giving 
breast pumps is not
necessarily helpful for breastfeeding, especially if feeding bottles are 
included, which is not
clear in this study. The lack of a control group receiving “no item” is thus 
an important
limitation.6.7 Impact and cost-effectiveness of restricting formula in 
maternity wards
A three-country study in Brazil, Honduras and Mexico (Horton et al, 1996; TG 
Sanghvi,
unpublished document, 1996) compared 3 hospitals with well-developed 
programmes and 3
control hospitals in the same cities serving similar populations. Mothers 
were interviewed at
discharge (n=200-400) and followed at one month and again at 2 (Honduras), 3 
(Brazil) or 4
months (Mexico) to compare the proportions of exclusive, partial and no 
breastfeeding as a
measure of programme impact on breastfeeding practices. In Brazil and 
Honduras, the
programme hospitals had significantly higher rates of exclusive 
breastfeeding; in Mexico, the
programme hospital had a higher rate of any breastfeeding.
The data on breastfeeding impact were then translated into more generalizable 
health units, to
percentage reduction in diarrhoea mortality, acute respiratory infection 
(ARI) mortality and
diarrhoea morbidity. Disability-adjusted life years (DALYs) were calculated 
based on death
estimates from ARI and diarrhoea. *
The costs of breastfeeding promotion activities, mainly programme maintenance 
costs were
calculated and incremental costs (i.e. the difference in costs of activities 
between programme
and control hospitals) were obtained. These costs were combined (separately) 
with mortality,
morbidity and DALY impacts to obtain a set of cost-effectiveness measures. It 
was found that
restricting formula and glucose water and medications during delivery 
(oxytocic drugs) can be
highly cost-effective for preventing cases of diarrhoea, preventing deaths 
from diarrhoea and
gaining DALYs.
By investing US $0.30 to $0.40 per birth annually in a hospital where formula 
feeding and
medications during delivery were still used, diarrhoea cases could be 
prevented for $0.65-$
1.10 per case. Similarly, diarrhoea deaths can be averted for $100 to $200 
per death, and
DALYs can be gained for $2 to $4 per DALY.

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