SINGAPORE - Conference and training course fees and materials for staff, and hospital dinner and dance functions are some examples of sponsorship that milk formula companies provide to hospitals with maternity services, the competition watchdog has found.

Infant formula manufacturers provide such sponsorships and/or payments to private hospitals for participation in their milk rotation systems, according to an inquiry report by the Competition Commission of Singapore (CCS) released on Wednesday (May 10).

Milk formulas are provided to infants who need it in hospitals on a rotation basis. But the report found that milk formula manufacters could ensure their products stayed on the rotation for longer periods if they provided better sponsorship support to the hospital or paid "rotation fees".

Formula companies have invested significant efforts and resources into hospital marketing activities to gain a "first-mover" advantage, given that the majority of parents who use formula milk in hospitals do not have a preferred brand and tend not to switch brands after leaving the hospital, the report said.

While manufacturers also sponsor activities at public hospitals, this does not influence the milk rotation schedule, it said.

This practice of sponsorship and fees is widespread, despite the fact that no financial inducements are allowed to be offered to hospitals, clinics and retail pharmacies to promote products according to the Sale of Infant Foods Ethics Committee Singapore's (Sifecs) code of ethics.

Adherence to the Sifecs code, which is under review by the Health Promotion Board, is considered obligatory for the baby food industry operating in Singapore, though there are no specific remedies set out in the event of a breach of the code, the CCS noted in its report.

In response to queries, Sifecs chairman professor Ho Lai Yun said that the current code does not cover sponsorship by infant milk formula companies to participate in the milk rotation system, as it "does not dictate nor propose any system of milk rotation in the hospital to the milk companies and the hospitals".

According to the hospitals contacted by CCS, such payments and 'in-kind' monetary sponsorship by formula milk manufacturers helps to reduce the costs of running such activities, and to defray the cost of nursing education and training.

Partnerships with formula milk manufacturers also offer resources for hospitals to educate and prepare parents and would-be parents for parenthood, while other educational events for healthcare and nursing staff may also benefit other patients, the hospitals told CCS.

Manufacturers' sponsorships span a wide range of activities typically targeted at parents and parents-to-be, as well as hospital staff such as nurses. Examples include talks on pregnancy and parenting for first-time parents as well as supporting venue rental. Hospital discharge gift bags, maternity bags and complimentary "starter-kits" are sponsored by hospital partners, which include formula milk manufacturers, the report said.

Manufacturers also provide sponsorship for some hospital activities such as shuttle buses for staff, patients and visitors, printing of maternity brochures as well as corporate dinner and dance events.

Hospitals either indicate their sponsorship needs to manufacturers, or manufacturers approach hospitals to indicate that they can contribute in certain areas.

Monetary contributions by some manufacturers have also been made based on a per-month rotation value, multiplied by the number of months of milk rotation allocated to or requested, or as a lump sum per cycle of rotation.

CCS noted in its report that such sponsorships and contributions by milk formula companies have been on an increasing trend, possibly reflecting hospitals' increasing needs and the importance of the hospital channel to the manufacturers as a form of marketing and brand outreach.

Manufacturers' representatives also contact hospitals and healthcare professionals regularly to keep them up to date on new formula milk products or ingredients.

The sponsorships and outreach to healthcare professionals could subtly influence the formula milk that doctors recommend to parents with children experiencing reactions or difficulties with some brands, the report said.

The Ministry of Health said it will strongly encourage all hospitals providing maternity services to achieve the international Baby-Friendly Hospital Initiative (BFHI) certification. To avoid conflict of interest, BFHI-certified hospitals are not allowed to enter into sponsorship arrangements with formula milk companies.

All three public hospitals offering maternity services - KK Women's and Children's Hospital (KKH), National University Hospital and Singapore General Hospital - are BFHI certified, and have a rotation system that ensures an equal duration for manufacturers.

CCS noted in its report that more babies are born in private than public hospitals, with 59.2 per cent of births occurring in private hospitals in 2014.

Dr Chua Mei Chien, head of neonatology at KKH, said that the hospital's rotation programme involves writing to major milk formula companies yearly to invite them to participate, and dividing the months in the year by the number of interested companies.

The Straits Times has reached out to private hospitals for comment.