- Margaret McCartney, general practitioner, Glasgow
Bagsful of freebies are given to expectant parents from companies keen to promote their products—nappy creams, vouchers for photos, washing powder samples, and “special offers” to buy bibs, workout books, and buggies. What’s wrong with that? Why shouldn’t products associated with pregnancy and childbirth be advertised to expectant parents?
The point is that the UK National Health Service, Royal College of General Practitioners, Royal College of Obstetricians and Gynaecologists, and government have embedded commercial advertising into routine contact with pregnant women during antenatal and postnatal care.
The RCOG is setting up Baby and You magazine, which it plans to give for free to pregnant women. Mark Green, managing director of the commercial company Bednest, which sells bedside cribs for newborn babies, was contacted by a sales representative from B+Y Publishing, using the RCOG logo, who offered a “guaranteed minimum” audience of 500 000 mothers and parents through “their Obstetrician/midwife … the most trusted and influential person throughout this entire time.”
The representative offered Green an “educational/advertorial piece, presenting you as a thought leader, as well as a trusted solution provider.” The package, costing £15 000 (€17 500; $22 500) for six months, included an “up to date database of 100 000 families.”
Green, horrified at how easy it seemed to pay for influence, contacted the RCOG. The college is investigating and told the BMJ, “If such practice is happening, it is unacceptable and the RCOG in no way approves.” It said that it is “concerned to be associated with this practice,” which it described as “ethically questionable,” and that it has “strict policies on its advertising and sponsorship and does not seek advertorials for any of its publications.”
The college receives £90k a year from B+Y Publishing Limited, the company that publishes the magazines. The RCOG told the BMJ that senior clinicians vet all adverts and editorial content.
Bounty is another promotions company, with several points of contact with new families. It gives out a total of 2.6 million “baby bags” a year. Some are distributed by NHS healthcare professionals and others by Bounty representatives in postnatal wards.
Most NHS hospitals condone the giving of 812 000 newborn “packs” each year, and the NHS benefits from allowing access to its wards. Bounty told the BMJ that it paid £2.3m to the NHS annually for access in fees and as equipment—for example, televisions. Bounty said that over 90% of mothers were “satisfied” with the packs, citing its own survey of 4000 parents in January 2013.
However Belinda Phipps, chief executive officer of the National Childbirth Trust, is angry about the way that the NHS allows Bounty access to new mothers. “Within hours of giving birth, they are being asked questions—their name and address, details of life insurance—and they give them in good faith, thinking they’re speaking to a hospital person. In fact it’s a commercial person. The NHS is condoning a sales team collecting data from mothers in order to sell their name on to commercial interests.”
Bounty profits by selling the parents’ details to companies. Although the section on contact details that parents fill in includes the information that “by providing your email address and/or telephone number you agree to be contacted by these channels as well as post,” many parents have told Phipps that they did not understand what they were signing up to. Bounty told the BMJ that 3% of parents “opt out”; the details of those who do not are sold on to other companies.
The bag given in pregnancy is described as containing “information support and ideas every mum-to-be needs” and contains a dozen advertising flyers and samples of decaffeinated drinks and emollient, supposedly for stretch marks. The “newborn pack” says that it will “save you money and guide you through your exciting new journey as a mum.” Additionally, the Bounty packs have an air of officialdom: the bag given after birth contains application forms for child benefit, together with samples of washing powder, nappies, and advertising flyers. But child benefit forms are available online, and they could be distributed by midwives or hospitals.
A written question asked by a member of the House of Lords revealed, bizarrely, that HM Revenue and Customs pays Bounty more than £90 000 pounds a year to distribute the child benefit forms. So families supply their details, which can be sold on by a commercial company, which in turn is paid by the government to supply freely available child benefit claim forms. Why?
A spokesman for Bounty told the BMJ that “over a decade ago Bounty offered to conduct a small scale pilot which satisfied HMRC that Bounty could distribute child benefit forms directly and quickly into the hands of parents as soon as they need them.”
Meanwhile, HM Revenue and Customs told the BMJ that “Bounty distributed 82% of all child benefit claim forms in 2011-12, averaging about 10p for each claim. If HMRC posted the forms individually the cost would rise to around 33p for each claim.”
A survey done by the National Childbirth Trust in January 2010 tells a different story from Bounty’s. It found that half of just over 1000 parents did not know, and were unhappy, that their details could be used to target advertising to them. A further 37% knew that their details would be used in this way and were unhappy with it; the remainder were unconcerned.
The lack of knowledge about what signing over your details means is troubling in a hospital environment, which should take consent and confidentiality seriously. The hours after birth are hardly an optimal time to obtain formal consent. And is the presence of a non-essential Bounty worker on the ward desirable?
Over at the Royal College of General Practitioners, Emma’s Diary is an A5 book that is posted in bulk to general practices to pass on to pregnant women. It also offers “gift packs” on the receipt of information such as the woman’s and her family’s dates of birth, which supermarket the family usually shops at, and a telephone number and email address.
Emma’s Diary is validated by the large RCGP stamp on the front, and inside says, “Presented with the compliments of your General Practitioner.” It comprises 25 pages of medical information and 119 pages of adverts. The accompanying website contains some medical information as well as “celebrity baby news,” including a report on a celebrity who arranged a caesarean section to coincide with a special date. Is this helpful knowledge deserving of the stamp of RCGP approval?
In the RCGP’s accounts, more than £214 000 is entered as “other income including grants and sponsorships”; the RCGP would not tell the BMJ how much of this was the net gain from advertising through Emma’s Diary. In a statement it said that “all content is quality assured by our RCGP editorial board who do a sterling job in ensuring that it is updated to reflect any changes to medical working practices, latest research findings [and] government guidelines.”
Is it right that the NHS imply its approval for the thousands of products being promoted at parents? Do we really want parents placed under advertising pressure and for NHS doctors, radiographers, and midwives to be the conduit? Some conflicts of interest in medicine are hard to avoid. Others are not. These should be easy.
Cite this as: BMJ 2013;346:f3448