New study – financial incentives for breastfeeding

A scientific paper out today in the journal JAMA Paediatrics has suggested mothers breast feed for longer if given financial incentives for breastfeeding.

The world health organisation recommends exclusive breast feeding for the first six months.  There are thousands of studies which show that breast milk is better than formula.  But the majority of women are not breast feeding.

In the UK, an infant feeding survey is done every five years.  The last published figures for 2010 show that at birth, 81% of women breast feed but by 3 months, women that exclusively breast feed drops to 17%.  At six months just 1% of women exclusively breast feed but 34% show ‘any breastfeeding’ which means they are also using formula.

In the study out today, the team from the UK and Norway wanted to assess the effect of a financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks after delivery.  The study was part of the Nourishing Start for Health (NOSH) trial.  They randomised 10010 mothers into either the financial incentive group (5398 mothers) and the control group (4612 mothers).  The trial was conducted in South Yorkshire, Derbyshire and North Nottinghamshire. ” The women were offered shopping vouchers worth up to £120 if their babies received breastmilk (breastfeeding or expressed milk) at two days, 10 days and six weeks old. A further £80 of vouchers was available if their babies continued to receive breastmilk up to six months.”

“The trial, funded by the National Prevention Research Initiative and Public Health England, saw an increase of six percentage points in the areas where the scheme was offered, compared with those areas where the scheme was not available.”

Principal investigator Dr Clare Relton, from the University of Sheffield’s School of Health and Related Research (ScHARR), said: “Our scheme offered vouchers to mothers as a way of acknowledging the value of breastfeeding to babies and mothers and the work involved in breastfeeding.

“As the scheme was tested in areas with low breastfeeding rates (just 28 per cent of babies were receiving any breastmilk at six-eight weeks), we were delighted that 46 per cent of all eligible mothers signed up to the scheme and over 40 per cent claimed at least one voucher. The trial found a significant increase in breastfeeding rates in areas where the scheme was offered.

“Eight out of 10 mothers in the UK who start to breastfeed stop before they really want to. It seems that the voucher scheme helped mothers to breastfeed for longer. Mothers reported they felt rewarded for breastfeeding.”

Mother Fiona Sutcliffe, 29, from Sheffield who took part in the scheme with her baby girl said: “Breastfeeding is quite difficult in the beginning. The scheme is a really good way of keeping going – keeping motivated to stay on track rather than giving up and going for the bottle. It provides little milestones, little stepping stones and helps you get breastfeeding established.”

Anahi Wheeldon, a community midwife from Eckington in Sheffield, said: “The vouchers really lifted mums and gave them recognition and acceptance.

“The scheme has really helped changed the culture and attitude towards breastfeeding. Particularly with young mums you used to be the odd one out if you breastfed, but now they know people who’ve breastfed, there is a network between mums, so it’s become more normal.”

Co-author of the study Mary Renfrew, Professor of Mother and Infant Health at the University of Dundee, said: “This is the first large-scale study to show an increase in breastfeeding in communities where rates have been low for generations, and where it can be particularly difficult for women to breastfeed without strong family and community support, because of strong societal barriers.

“In the UK these barriers include the difficulty some women encounter when breastfeeding in public, widespread misleading marketing that formula is equivalent to breastfeeding, a lack of high quality services to prevent and treat any problems if they arise, a lack of community support, a lack of education about breastfeeding for young children, and lack of support for women to breastfeed in the workplace.

“The incentive scheme was designed together with local women and staff to make sure it was feasible and appropriate, and breastfeeding support services were widely available in all the areas where the trial took place. Thanks to all the mothers and staff who supported this study, we now know much more about what might work to help new mothers to breastfeed.”

Read the paper here:  http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2017.4523

Global women – how many women breast feed?