Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration

Abstract

Objective: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. Design: Prospective cohort study. Setting: In-patient postnatal units of four public hospitals in Hong Kong. Subjects: Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. Results: The mean number of formula supplements given to infants in the first 24 h was 2·70 (SD 3·11) in cohort 1 and 1·17 (SD 1·94) in cohort 2 (P < 0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P < 0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio = 0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. Conclusions: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

What does the world think of ankyloglossia?

“…In Asian countries with low breastfeeding rates [e.g. Hong Kong and China, 6.2% at six months, ], the lack of support and emphasis on lactation may lead to underdiagnosis of ankyloglossia.…”

Predictors of breast milk substitute feeding among newborns in delivery facilities in urban Cambodia and Nepal

“…The length of stay after delivery ranged from less than 24 hr to over 9 days, meaning that complete data from the first 3 days after birth was not available for all mothers. Additionally, prelacteal feeding, along with other terms like “in‐hospital formula supplementation” used in similar studies, is often calculated only among mothers who ever breastfed (Chantry et al, ; P. H. Nguyen et al, ; Parry, Ip, et al, ; Tarrant et al, ). In the present study, the use of BMS and other foods was evaluated among all mothers, whether or not they ever breastfed, and adjusted models controlled for mothers' length of stay in the health facility.…”

“…Additionally, prelacteal feeding, along with other terms like "inhospital formula supplementation" used in similar studies, is often calculated only among mothers who ever breastfed (Chantry et al, 2014; P. H. Nguyen et al, 2013;Parry, Ip, et al, 2013;Tarrant et al, 2015). In the present study, the use of BMS and other foods was evaluated FIGURE 1 Conceptual framework for determinants of feeding of breast milk substitutes to newborns in health facilities prior to discharge, adapted from P. H. Nguyen et al (2013).…”

Family Members' Infant Feeding Preferences, Maternal Breastfeeding Exposures and Exclusive Breastfeeding Intentions

“…Factors that affect new mothers' exclusive breastfeeding intentions have not been adequately examined. The purpose of this study was to examine the association between family member's infant feeding preferences, breastfeeding exposures, and womens' exclusive breastfeeding intentions.This study was part of a large prospective cohort study investigating the impact of free infant formula supplied to hospitals and mothers on breastfeeding duration and exclusivity (3) . Briefly, 1277 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong.…”