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To the Editor.—
Contrary to the assumption of Li et al1 regarding Ross Products Division of Abbott Laboratories, Ross advocates breastfeeding and believes that it is the best form of infant nutrition. Ross agrees with Li et al1 that there is more work to be done to support breastfeeding mothers. The government, the health care industry, nonprofit and advocacy organizations, and the private sector all have an important role to play. It is a shared responsibility.
In addition, statements about the Ross Mothers Survey (RMS) were inaccurate. According to Li et al,1 "RMS has a relatively low response rate (50%), and it cannot be used to estimate the exclusive breastfeeding rate." In fact, the response rate is excellent for a mail survey. Over 1 million questionnaires are mailed annually through the RMS, making it the largest survey of breastfeeding in the United States. Questionnaires are mailed to a probability sample of new mothers selected from a database that covers >1.3 million expectant mothers and >3 million families with newborns in the United States. The responses are weighted to account for varying geographical coverage and response rates. Rates for breastfeeding are representative of the entire infant population in the United States. RMS rates for exclusive breastfeeding in the hospital and at 6 months of age since 1965 were published recently in Pediatrics.2
RMS breastfeeding rates have been compared with those from government surveys, including the 1988 National Surveys of Family Growth,3 the 1988 National Maternal and Infant Health Survey,4 and the third National Health and Nutrition Examination Survey 1988–1994 (NHANES III).5 Results of all these comparisons show similar trends and rates of breastfeeding across several demographic characteristics. Rates for exclusive breastfeeding from phase II (1991–1994) of NHANES III, as reported by Li et al,6 are also comparable to those from the RMS. An advantage of the RMS is its ability to provide breastfeeding data on a continuous basis since 1954. It is the only source of long-term infant-feeding trends available.
It should be noted that Ross is under no obligation to publish its data. It does so because they are of interest and value to health professionals, professional organizations, and government agencies. The RMS is one of the most comprehensive, accurate, and widely used data sets for tracking US infant-feeding trends. Ross is pleased to have the RMS serve as the data baseline and monitoring source for the Healthy People 2010 breastfeeding goals.
REFERENCES
In Reply.—
We agree that the Ross Mothers Survey (RMS) has been a valuable resource to establish national breastfeeding goals and monitor infant-feeding trends in the United States over the past 2 decades. It is the largest survey of breastfeeding in the United States, and most of the quoted statistics on breastfeeding rates have been derived from the RMS.
Nonetheless, the low response rate of 50% in the RMS remains a concern. Although Ryan may be correct that this is higher than often found in mail surveys, for most epidemiologic studies, this response rate is low. The most recent publication of RMS indicates that the response rate was only 28%.1 The respondents to the RMS were those people who were willing to fill out the questionnaire sent by Ross Laboratories. Such women may have different breastfeeding practices than do others.
It is true that the rates of breastfeeding in hospital and at 6 months of age obtained in the RMS were compatible with those from other national surveillance systems. However, the rates of exclusive breastfeeding cannot be estimated by using RMS data, because its questionnaire only surveyed the consumption of infant formula, human milk, and cow’s milk. By definition, exclusive breastfeeding requires breastfeeding with no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines.2 Therefore, additional questions regarding other baby foods need be included in the RMS to estimate the true exclusive-breastfeeding rates.
There are a number of surveys and surveillance systems that measure breastfeeding in the United States. Each of them faces its own challenges and problems.3 Although not perfect, we believe that the National Immunization Survey fills important gaps in our national monitoring of breastfeeding.
REFERENCES
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