title: Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  In-patient postnatal units of four public hospitals in Hong Kong.
  
  
  METHODS
  Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.
  
  
  RESULTS
  The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Marie
authors.initials: M
authors.lastname: Tarrant
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Kris Yw
authors.identifier: http://orcid.org/0000-0002-1938-8805
authors.initials: KY
authors.lastname: Lok
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Daniel Yt
authors.identifier: http://orcid.org/0000-0001-7365-9146
authors.initials: DY
authors.lastname: Fong
authors.affiliation: 2Queen Mary Hospital,Hong Kong SAR,People's Republic of China.
authors.forename: Irene Ly
authors.initials: IL
authors.lastname: Lee
authors.affiliation: 3United Christian Hospital,Kowloon,Hong Kong SAR,People's Republic of China.
authors.forename: Alice
authors.initials: A
authors.lastname: Sham
authors.affiliation: 4Department of Obstetrics and Gynaecology,Queen Elizabeth Hospital,Kowloon,Hong Kong SAR,People's Republic of China.
authors.forename: Christine
authors.initials: C
authors.lastname: Lam
authors.affiliation: 5School of Public Health,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong SAR,People's Republic of China.
authors.forename: Kendra M
authors.initials: KM
authors.lastname: Wu
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Bai
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Ka Lun
authors.initials: KL
authors.lastname: Wong
authors.affiliation: 6Department of Health and Physical Education,The Hong Kong Institute of Education,New Territories,Hong Kong SAR,People's Republic of China.
authors.forename: Emmy My
authors.initials: EM
authors.lastname: Wong
authors.affiliation: 1School of Nursing, Li Ka Shing Faculty of Medicine,The University of Hong Kong,4/F William M.W. Mong Block,21 Sassoon Road,Hong Kong Special Administrative Region (SAR),People's Republic of China.
authors.forename: Noel Pt
authors.initials: NP
authors.lastname: Chan
authors.affiliation: 7College of Nursing and Healthcare Innovation,Arizona State University,Phoenix,AZ,USA.
authors.forename: Joan E
authors.initials: JE
authors.lastname: Dodgson
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D003365:Costs and Cost Analysis; D019587:Dietary Supplements; D005260:Female; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000191:economics; D057766:Policy; D011446:Prospective Studies; D055815:Young Adult
keywords: Breast-feeding; Formula supplementation; Hong Kong; Hospital practices; Infant feeding