12 Nov

Incentivising Breastfeeding

Much excitement this afternoon when I was asked to speak to Anne Diamond on BBC Radio Berkshire, with a response to the news that researchers from the University of Sheffield are running a study where 130 new mothers are offered £200 vouchers if they breastfeed their babies. This is aimed at mothers in communities where breastfeeding rates are low, with the intention of increasing initiation rates and reducing health inequalities. The Guardian has a good explanation of the project and some responses to it here.

Inevitably this has been misreported as a ‘bribe‘ to breastfeed, and even, on one objectionable blog, as state interference in parental choice. It has also provoked much ranting at the government for supposedly introducing a truly terrible initiative. So it’s important to note that this is a small study into the effects of incentives on this particular demographic. In fact some similar research has already been done; a study from last year concluded that:

whilst the provision of incentives might not influence women’s intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters.

That is, peer supporters bringing gifts made supportive relationships with new mothers, which helped to facilitate breastfeeding.

I don’t disagree with doing research, and I’m surprised that such a small study has provoked such an uproar, but I can’t help feeling frustrated about the amount of breastfeeding support that could be funded with that amount of money. The total cost of vouchers, if all were taken up, would be £26,000. It cost £2,400 to run the breastfeeding support group at Brambles Children’s Centre in Wokingham, until Wokingham Borough Council decided they no longer had the money to fund this well-attended and effective support group.

I do have some concerns about this research, though. We know that the majority of women do start breastfeeding (81% in Berkshire; 79% nationally), and that nearly half of them have stopped by six weeks. Most of those women, the ones who had stopped, report feeling sadness, regret, guilt, disappointment; they would have liked to continue for longer. I can only imagine how deeply the withdrawal of a voucher would compound their sense of failure. The alternative, of course, is that some people do battle on through six months of misery just to claim their voucher, with the consequent spreading of very negative messages about their experience of breastfeeding. Though I concede this is less likely.

It seems a bit of a bait and switch, to me, to promote or incentivise an outcome without providing the tools with which to achieve it. In the case of breastfeeding, women need support, ideally antenatal education about breastfeeding and about life with a new baby, so that they can develop realistic expectations. They need effective, patient and knowledgeable support in the very first days of their baby’s life. They need a society that understands and accepts breastfeeding and babies, and doesn’t push the first quick-fix solution that comes to hand. I don’t think these tools will magically appear alongside a shopping voucher.

It’s very interesting that the subject has received so much attention today, and I really hope the need for education and support has been shouted about loudly enough to raise the real issues and show what a complex and emotive topic breastfeeding is.

Update: Here’s the UNICEF response. I swear I didn’t copy it! Gratified at how similar it is to my own.

3 thoughts on “Incentivising Breastfeeding

  1. Susan, you’re so right, the Hawthorne Effect has been shown to be quite strong in breastfeeding; just having someone kindly ask how mothers are getting on with it seems to be motivating. I don’t think I’ve seen a full description of the methodology here, but the sample size of 130, presumably to be split into two groups, is surely to small to give a useful result.
    Here‘s a study where the Hawthorne Effect was observed.

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