Impact of the cessation of free infant formula in public hospitals on hospital practices and the duration and exclusivity of breastfeeding

In April 2010, all public obstetric hospitals in Hong Kong stopped accepting free infant formula from manufacturers and began paying market price for infant formula products. The aim of the study was to assess the impact of adopting a policy of paying market price for infant formula in public hospitals on in-hospital infant formula supplementation rates, baby-friendly hospital practices and breastfeeding duration and exclusivity. This study employed a quasi-experimental design. Two prospective cohorts of mother-infant pairs were recruited from the post-natal obstetric units of four public hospitals in Hong Kong. The first cohort (n=1417) was recruited prior to the policy implementation in 2006-07 and the second cohort (n=1287) was recruited after the policy implementation in 2011-12. The proportion of participants who exclusively breastfed during the first 24 and 48 hours after birth increased from 28.5% to 61.8% and from 17.1% to 41.5%, respectively. In 2011-12, 45.0% of participants initiated breastfeeding within the first hour after birth, compared with only 28.5% in 2006-07. The median duration of any breastfeeding increased from 8 weeks to 11 weeks while the median duration of exclusive breastfeeding remained unchanged at 2 weeks. The overall risk of weaning was significantly reduced after the policy change (HR=0.76; 95% CI 0.68 - 0.84). Stopping the acceptance of free infant formula in hospitals appears to improve in-hospital exclusive breastfeeding rates, increases compliance with baby-friendly practices such as the early initiation of breastfeeding and prolongs the duration of breastfeeding.