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

<jats:title>Abstract</jats:title><jats:sec id="S1368980015000117_abs1" sec-type="general"><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S1368980015000117_abs2" sec-type="general"><jats:title>Design</jats:title><jats:p>Prospective cohort study.</jats:p></jats:sec><jats:sec id="S1368980015000117_abs3" sec-type="general"><jats:title>Setting</jats:title><jats:p>In-patient postnatal units of four public hospitals in Hong Kong.</jats:p></jats:sec><jats:sec id="S1368980015000117_abs4" sec-type="subjects"><jats:title>Subjects</jats:title><jats:p>Two cohorts of breast-feeding mother–infant pairs (<jats:italic>n</jats:italic> 2560). Cohort 1 (<jats:italic>n</jats:italic> 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (<jats:italic>n</jats:italic> 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.</jats:p></jats:sec><jats:sec id="S1368980015000117_abs5" sec-type="results"><jats:title>Results</jats:title><jats:p>The mean number of formula supplements given to infants in the first 24 h was 2·70 (<jats:sc>sd</jats:sc> 3·11) in cohort 1 and 1·17 (<jats:sc>sd</jats:sc> 1·94) in cohort 2 (<jats:italic>P</jats:italic>&lt;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 (<jats:italic>P</jats:italic>&lt;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.</jats:p></jats:sec><jats:sec id="S1368980015000117_abs6" sec-type="conclusions"><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>