Vulnerable families and costly formula: a

Overview

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Key numbers

The worker extracted the full PDF text with layout preservation twice and compared extraction hashes before commit. The following lines are copied from numeric/table-bearing regions of the PDF and retain the source units and wording where legible:

and societies at large (1–3). Worldwide, less than 40% of tervals between feeds (24–27). Also, concerns about
mula feeding is particularly pronounced among poor 93.0% of infants breastfeeding within the first 24 h
vertising and indirectly through the health system (17, 2018, with a modest decrease from 67.2 to 66.4%, re-
19–21). spectively (34). Median duration of any breastfeeding
rica and Indonesia, analyses of the protein concentra- have risen slightly from 17.2% in 2004 to 19.4% in
approximately one-third of samples were severely by 159.7% in Peru between 2008 and 2013, as
compared to an average rate of growth of 40.8% in all purchasing practices. Here we report on findings from
nearly half (47.2%) of all infants received mixed feeding Participants and sample selection
Meanwhile, breastfeeding promotion efforts (largely necessary. The response rate was 93.5%, as two of the 31
as commercial milk (Table 1). through supplemental questionnaires. These included
Table 1 Definition of terms for breast milk substitutes
reflected the “manifest content” or visible elements of Table 2 Participant characteristics
years of age (N = 2), written informed consent was pro-
(Table 2). Infants weighed an average of 3139 g at birth chased by the study population: Enfamil, NAN, Similac
< 2500 g), and 44.8% were male. Ten households (34.5%) ranges of different brands are displayed in Table 3. All
to their land), and 17 (58.6%) were moderately or se- mixed with water upon preparation. Several brands mar-
(Table 2). More than 40% of mother’s initiated infant Confort or “Enfamil Comfort”), and an anti-constipation
(Table 2). After beginning mixed feeding, most study These brands also offer follow-on formulas, such as
tions that motivated their decisions to begin mixed feed- as displayed in Table 4. Twelve (41.4%) mothers
ing. Of 29 mothers, 19 (65.5%) received a verbal expressed concerns about their infant’s weight gain as
vider (Table 4), often without prompting. In these cases, Eight (27.6%) mothers mentioned the perception of in-
a problem or concern. The one exception involved the Table 4, nearly all of the participants who perceived
that it was medically necessary to give infant formula more than 40% of women who reported concerns about
Table 4 Reported reasons for initiating formula use
Although Table 4 presents mothers’ primary motives Consequences of formula expenses
and acceptable (56). To address this issue, health pro- urban Lima, there is a need for health providers to sup-
Fieldwork was conducted by JDR and JP under guidance from LZC. JDR 10. Lodge CJ, Tan DJ, Lau MX, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and

Methods (brief)

approximately one-third of samples were severely by 159.7% in Peru between 2008 and 2013, as
nearly half (47.2%) of all infants received mixed feeding Participants and sample selection
Qualitative data collected from IDIs with mothers and cluded documenting each study participant’s infant feed-
national Code of Marketing of Breast-milk Substitutes proximately 30 interview participants; this sample size
representatives would leave infant formula samples based on criteria outlined by Malterud et al., including
incentivize providers to promote their products. linguistic diversity, a larger sample size was not deemed
inattentive and less trustworthy as compared to doc- We sampled purposively to recruit a minimum of five
course of the study to probe on emerging themes, and lysis described by Graneheim and Lundman, codes were
All infants in our sample were initially breastfed, Enfamil line includes the standard product (Enfamil con
mother of the only LBW baby in our sample, who re- breast milk insufficiency, initiated infant formula use be-
Fieldwork was conducted by JDR and JP under guidance from LZC. JDR 10. Lodge CJ, Tan DJ, Lau MX, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and
dilution of milk in infant feeding bottles. J Trop Pediatr. 1980;26:58– 48. Graneheim UH, Lundman B. Qualitative content analysis in nursing research:
a sample of low-income mothers in the southeastern US. J Nutr Educ 2003;8:419–21.
1. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative 66. Nyati M, Kim HY, Goga A, Violari A, Kuhn L, Gray G. Support for relactation

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Update history

The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.

Commit	Date	Change	Description
b01ec52c	2026-08-04	major	2 sections added
d49e450f	2026-08-03	major	5 sections added; narrative text revised