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

AbstractObjectiveTo 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.DesignProspective cohort study.SettingIn-patient postnatal units of four public hospitals in Hong Kong.SubjectsTwo cohorts of breast-feeding mother–infant pairs (n2560). Cohort 1 (n1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.ResultsThe mean number of formula supplements given to infants in the first 24 h was 2·70 (sd3·11) in cohort 1 and 1·17 (sd1·94) 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.ConclusionsAfter 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.