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. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html