摘要：Objectives. Commercial hospital discharge packs are commonly given to new mothers at the time of newborn hospital discharge. We evaluated the relationship between exclusive breastfeeding and the receipt of commercial hospital discharge packs in a population-based sample of Oregon women who initiated breastfeeding before newborn hospital discharge. Methods. We analyzed data from the 2000 and 2001 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum women (n=3895; unweighted response rate=71.6%). Results. Among women who had initiated breastfeeding, 66.8% reported having received commercial hospital discharge packs. We found that women who received these packs were more likely to exclusively breastfeed for fewer than 10 weeks than were women who had not received the packs (multivariate adjusted odds ratio=1.39; 95% confidence interval=1.05, 1.84). Conclusions. Commercial hospital discharge packs are one of several factors that influence breastfeeding duration and exclusivity. The distribution of these packs to new mothers at hospitals is part of a longstanding marketing campaign by infant formula manufacturers and implies hospital and staff endorsement of infant formula. Commercial hospital discharge pack distribution should be reconsidered in light of its negative impact on exclusive breastfeeding. The American Academy of Pediatrics recommends exclusive breastfeeding until an infant is 6 months old. 1 Numerous studies have demonstrated the beneficial effects of breastfeeding, including decreased risk of infectious diseases (e.g., diarrhea, ear infections, and respiratory infections) and chronic diseases (e.g., asthma, allergies, and obesity). 2 – 10 Despite the well-documented evidence that supports breastfeeding, only 66% of US women initiate breastfeeding and only 33% exclusively or partially breast-feed for 6 months. 11 These figures fall short of the Healthy People 2010 goals to increase the proportion of women who initiate breast-feeding to 75% and who breastfeed for at least 6 months to 50%. 12 Since the late 19th century, infant formula manufacturers have encouraged mothers to substitute formula for breastmilk. Formula advertisements often claimed or implied that breastmilk alone was not sufficient to raise a healthy infant. 13 – 17 For more than 40 years, formula manufacturers have supplied US hospitals with free formula and newborn starter pack gifts (most of which contain either formula or coupons for formula) for distribution to new mothers. 17 – 18 These free starter packs are an efficient and effective marketing method by which formula manufacturers get new mothers to try their company’s formula. Formula manufacturers also have sought to create partnerships and brand loyalty with hospitals and their staff by providing free formula for use in the hospital, support for fellowships and conferences, and funds to support supplies. 17 – 20 These “gifts” have strings attached, as noted by the ethics committee of one hospital that blocked the routine distribution of free formula company discharge packs because the members viewed such distribution as distorting informed consent, prioritizing financial issues above patient care, exploiting some women’s fear of inadequacy, and implying medical endorsement of formula. 21 The 1970s boycott of Nestlé (because of the company’s aggressive marketing of formula, especially in developing countries) led to international discussions about the role of formula manufacturers and ways in which hospitals could increase support for breast-feeding. These discussions culminated in the Baby-Friendly Hospital Initiative, a 1991 codification of practices by the World Health Organization. Some of the Initiative’s methods have been incorporated into routine practice in US hospital nurseries. In a 1998 study of newborn hospital breastfeeding support practices in Oregon, we found that more than 60% of Oregon newborn hospital nurseries reported moderate or high compliance with some Baby-Friendly hospital practices, such as providing rooming-in (baby stays in mother’s hospital room rather than nursery) on a routine basis, encouraging breastfeeding on demand, and refraining from offering pacifiers to newborns. Hospital practice compliance was low, however, for supplementation (including providing mothers with formula promotion items as well as giving infants formula or water). 22 New mothers who responded to the 1998–1999 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) survey reported that rooming-in and breastfeeding on demand were common practices (94% and 84%, respectively) in Oregon hospitals and birthing centers. However, only 27% of the women who responded to the PRAMS survey reported that they had not received a commercial hospital discharge pack (CHDP) that contained formula. 23 We sought to estimate the proportion of new mothers in Oregon who received CHDPs after initiation of breastfeeding and to examine the association between receipt of CHDPs and exclusive breastfeeding duration.
