New York City's hospitals have banned infant formula from their gift bags for new mothers — a policy that they hope will encourage nursing and healthier babies.
The new policy kicked off during World Breast Feeding Week and calls attention to the increasingly acrimonious debate over the feeding of newborns.
The World Alliance for Breastfeeding Action's Web site states that breast-feeding within the first hour of birth "is the first and most vital step" toward reducing the nation's neonatal mortality rate — one of the highest in the industrialized world.
"Save 1 million babies beginning with one action," the site says.
It is this kind of rhetoric that fuels the great divide between those who choose breast-feeding as a maternal mission and those who opt for bottle-feeding, feeling guilty and inadequate.
In April, the World Health Organization set new international standards, saying that breast-feeding is an "unequaled way of providing ideal food for the healthy growth and development of infants."
Breast-feeding is also deemed healthy for mothers and the American Academy of Pediatrics recommends they breast-feed for six months and preferably one year.
An estimated 70 percent of new mothers start breast-feeding right after childbirth, but by six months, less than 20 percent are still exclusively nursing, according to the 2004 National Immunization Survey.
The rate of breast-feeding increases with education, income and age; black women are less likely to breast-feed, while Hispanics have higher breast-feeding rates.
In New York City's $2 million plan, new mothers will each be given a breast-milk bottle cooler, disposable nursing pads, breast-feeding tips and a baby T-shirt with the slogan, "I Eat at Mom's."
Coaches will work with mothers to begin breast-feeding within the first hour after birth. Mothers will also receive free breast pumps and, for those whose babies remain in the hospital, electric breast pumps.
Other hospitals across the nation have also stopped giving away formula.
Brigham and Women's Hospital in Boston stopped last year after reviewing extensive data showing formula marketing packs undermined mothers who wished to exclusively breast-feed. Children's Hospital in Philadelphia made the same move.
"The bags imply the hospital's endorsement of branded infant formula, leading formula-feeding families to spend hundreds of dollars more each year on high-priced branded formula," said Alison Stuebe of Brigham and Women's maternity unit.
Sen. Tom Harkin, D-Iowa, has proposed required labeling on cans of infant formula and in advertisements, similar to those on cigarettes.
This spring, a television ad compared bottle-feeding with a pregnant woman straddling a mechanical bull at a bar. "You wouldn't take risks before your baby's born," the advertisement says. "Why start after?"
The breast-feeding campaign is designed to persuade women to make good choices. But for some women, because of personal choice or medical problems, encouragement can feel like pressure.
Assenka Hoffman, a New York City college professor whose son is now 6, can barely talk about her breast-feeding experience without choking up. She had undergone a difficult delivery, losing blood and feeling "completely weakened and exhausted."