Ban the Bags Campaign:

1
Ban the Bags Campaign The Halt of Infant
Formula Marketing in Oregon Maternity
Hospitals Rachel Burdon, MPH(c) 1,2 Amelia
Psmythe 2,3 1Portland State University, Portland,
Oregon 2Breastfeeding Coalition of Oregon,
Portland, Oregon 3Nursing Mothers Counsel of
Oregon, Portland, Oregon.
Sponsored by Community Health Partnership
Context
Ban the Bags Campaign
Bag Free Oregon
Babies were born to be breastfed
Campaign Mission Ban the Bags (BTB) is a
national campaign to stop formula company
marketing in maternity hospitals Slogan
Hospitals should market health and nothing else
Portland, Oregon The first bag free city in
the U.S.

• Exclusively for 6 months
• Addition of appropriate solids at 6 months
• AAP for a minimum of 1 year
• WHO for a minimum of 2 years
• As long thereafter as is mutually desired

Process

• In 2007, all 15 city hospitals banned formula
  bags
• Local public health director, Dr. Susan Allan
  presented awards to
• bag free hospitals at event
• Event had media pre-commitments and prominent
  keynote
• Oregon House Speaker, Jeff Merkley.
• Local public health director presented awards
  to bag free
• hospitals at event

AAP all substitute feeding preparations differ
markedly from it breastmilk, making human milk
uniquely superior for infant feeding. Exclusive
breastfeeding is the reference or normative model
against which all alternative feeding methods
must be measured .
Campaign Objective halt the distribution of
formula containing pharmaceutical sponsored
discharge gift bags to mothers in maternity
hospitals nationally Hospital-based distribution
of formula gift bags is an established marketing
technique which undermines exclusive
breastfeeding National rates of distribution
vary from 57-100
Benefits of breastfeeding Child decreased risk
of infectious diseases, significant risk
reduction for chronic disease including obesity,
enhanced cognitive development. Breastfeeding
reduces risk of obesity in a linear
dose-dependent manner the longer and more
intensely a mother breastfeeds, the lower her
childs risk of obesity. Mother decreased risk
of breast ovarian cancer and osteoporosis,
post-partum depression, faster post-partum
recovery Interpersonal mother/child/family
bonding, happier more attached families, better
self-image, less child abuse Community decreased
health care costs, healthier workforce, decreased
environmental burden
Key Learning Points (From Portland and other
coalitions nationally)

• Breastfeeding coalition activity impacts the
  prevalence of formula gift bag distribution
• Institutional change happens fast with good local
  relationships and incentives
• Most successful strategy across many states was
  grass-roots advocacy combined with local health
  department support

• Campaign Strategies
• Educate the public about the issue via outreach
  media
• Encourage families and health care
  professionals to act for change
• Support local, regional, and state coalition
  building

Next Steps
BTB Toolkit outlines tactics for campaign action
in the following areas

• Relationship Building
• Form local coalitions where they do not exist
• Connect local and state-wide coalition
  activities
• Build on exiting relationship between
  Breastfeeding Coalition of
• Oregon, local health departments birthing
  hospitals
• Build and strengthen relationships with other
  state coalitions
• Community Capacity
• Differentiate communities (and hospitals) most
  ready for change
• Identify change(s) agent within each community
• Assess national, state, and local data sources
  to understand issue
• Assemble resources and plan for needed tactics
• Action Plan
• Educate relevant healthcare professionals,
  administrators,
• community members
• Support communities with appropriate tools
  (BTB toolkit)
• Connect communities with similar
  issues/struggles
• Provide incentive for action/change (DHS
  award)
• Create media message

• State government legislative or policy change
  that mandates elimination of formula marketing
  via discharge gift bags
• Institutional (maternity hospitals) change to
  affect policy and/or practice
• Check marketing policy
• Is marketing formula in violation of HIPAA
  regulation?
• Does hospital mission statement align with
  marketing formula?
• Work within professional scope of practice
• Investigate purchasing agreement/contract
• Contact ethics committee
• Form hospital task force for quality improvement
• 3) Coalition building and support to join active
  interested individuals and groups to work at the
  state, local and institutional level

Infant Formula

• Impacts exclusivity, intensity, and duration of
  breastfeeding
• (even one can)
• Stimulates insulin production
• Interferes with immune and GI development
• Increases health care costs (by at least 3.6
  billion annually)

Breastfeeding Statistics
CDC National Immunization Survey, 2005.
BTB Campaign is active in many states due to
application of a variety of campaign tactics,
however no state or city is entirely bag free
ExceptPortland, Oregon (as of 2007)
Oregon is a leader in breastfeeding health and
is exceeding the Healthy People 2010 goals at
each interval.