Company-sponsored infant formula samples are still the norm at many hospitals, although fewer are giving out the freebies now than in 2007, according to a new report.
Experts worry that giving new moms the free samples could undermine official recommendations that they stick to breastfeeding until their baby is at least six months old.
"If a hospital gives it out... the patient thinks it's the best thing for the baby," said Anne Merewood from Boston Medical Center, who worked on the new study. "The bottom line is that the hospitals are marketing for the formula industry."
The free samples typically come in diaper bags that maternity wards give out to moms when they leave the hospital. Sometimes those bags are funded by the hospital. But as research has shown, more often than not they're provided by formula companies.
"The companies have an incentive to give as much away early on, because it kind of gets hospitals and mothers hooked on that," said Chessa Lutter, regional advisor on food and nutrition for the Pan American Health Organization, part of the World Health Organization.
In 2007, Merewood and her colleagues surveyed hospitals in every state and found that more than 90 percent of them gave company-sponsored formula to mothers.
To see if anything had changed, last year the researchers went back to all hospitals in the 10 states that were most likely to give out free formula and the 10 that were least likely to do so.
Of the more than 1,200 hospitals in those 20 states, 72 percent said they gave out company-sponsored samples to some or all mothers, compared to the 86 percent in 2007.
Merewood said that trend may be due to grassroots movements working to promote breastfeeding. The states least likely to hand out the freebies include California, Massachusetts and Minnesota.
Yet the 10 states most likely to give out samples, including Oklahoma, New Jersey and Texas still distribute them at 93 percent of their hospitals, the researchers reported Monday in Pediatrics.
"Most of them are still giving it out," Merewood told Reuters Health. "It's not too rosy a picture."
The free samples are an ethical issue for hospitals because mothers might think that their doctors endorse the formula, and that they should use it instead of, or in addition to breastfeeding, Merewood said.
She and Lutter said that just about all formula companies sponsor samples, because they're at a competitive disadvantage when moms shop for formula on their own if they don't.
Lutter, who wasn't involved in the new study, said there's no law in the U.S. saying formula companies can't use hospitals to give out samples of their products -- but the WHO has come out strongly against that practice in all countries.
Not accepting free formula, she said, "is essential for assuring that the knee-jerk reaction for hospital (staff) as well as moms is not to go to the formula when there's any question or any concerns" about breastfeeding.
Breastfeeding has a number of health benefits for kids, Lutter pointed out. That includes prevention against infection, and possibly an IQ boost. After six months of exclusive breastfeeding, the WHO recommends at least partial breastfeeding up to two years or longer.
While formula might be helpful when new mothers can't breastfeed for one reason or another, free samples usually do little good, Merewood said.
"Nurses like to give things to people, especially when they're not very wealthy," she told Reuters Health. "It's not really a gift, because it's not good for their health."
Abbott Nutrition, which makes formula, would not comment on the study.
The International Formula Council, which represents formula manufacturers and marketers, told Reuters Health that formula samples serve a valuable purpose.
"The IFC believes mothers should be trusted to make good choices for their babies according to their individual family circumstances," it said in an email to Reuters Health.
"Hospital discharge packs provide key educational materials, which may include an infant formula sample -- directing moms to the right type of formula and to proper use and storage instructions, if needed."
But Lutter and Merewood agreed that there's little room for debate about the right move for hospitals when it comes to company freebies.
"Hospitals should not accept any donations of a formula," Lutter said.