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The World Health Organization’s International Code of Marketing of Breast-Milk Substitutes, as well as most major medical authorities, opposes hospital-based distribution of free infant formula at discharge. The goal of this cross-sectional telephone survey of 3209 US maternity sites, conducted from 2006 to 2007, was to determine the extent of this practice. It was found that 91% of hospitals distributed formula sample packs, and a trend toward discontinuation of the practice was statistically significant (P < .001). It was concluded that most US hospitals distribute infant formula samples, in violation of the WHO Code and the recommendations of organizations including the US Government Accountability Office, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention. J Hum Lact. 26(4):363-367.

Objectives To determine the proportion of hospitals distributing free infant formula sample packs in 21 eastern states and the District of Columbia, to investigate any regional trends or timelines associated with discontinuation of formula pack distribution, and to catalog in 2 states the take-home items given to new mothers in addition to, or instead of, formula sample packs. Design Data were collected between October 1, 2006, and March 31, 2007, over the telephone by research assistants using a prepared script. We determined whether hospitals distributed a “formula company–sponsored diaper discharge bag” to new mothers. Setting Our sample comprised all mainland states in the US Department of Health and Human Services Health Resources and Services Administration regions 1 through 4. Participants We contacted 1295 hospitals in 21 eastern states and the District of Columbia. Intervention Hospital distribution of an infant formula sample pack. Main Outcome Measure The proportion of hospitals that distributed formula sample packs. Results Ninety-four percent of hospitals distributed formula sample packs. Regional trends were evident. The proportion of distributing hospitals ranged from 70.4% (New Hampshire) to 100.0% (4 states—New Jersey, Maryland, Mississippi, and West Virginia—and Washington, DC). The proportion of hospitals that do not distribute sample packs has risen significantly between 1979 and 2006 ( P Conclusion Most eastern US hospitals distributed formula sample packs to new mothers at hospital discharge, contrary to recommendations from the major medical organizations, but the practice is changing significantly.