Cash incentives should be given to mothers to encourage breastfeeding, according to a “pioneering” pilot study.
More than 10,000 new mothers across South Yorkshire, Derbyshire and north Nottinghamshire were involved in the trial, which offered shopping vouchers worth up to £120 if babies received breast milk – either by breastfeeding or with expressed milk – at two days, 10 days and six weeks old. A further £80 of vouchers were given if babies continued to receive breast milk at up to six months.
The trial, conducted by the University of Sheffield and the University of Dundee and funded by the National Prevention Research Initiative and Public Health England, recorded an increase of six percentage points in areas where the scheme was offered, compared with areas where the scheme was not available – rising from 32% to 38% of mothers.
Breastfeeding levels in the UK are among the lowest in the world. In some areas, just 12% of six- to eight-week-old babies are breastfed, whereas 80% of Norwegian mothers still breastfeed after six months. It is estimated the NHS would save at least £17m every year in hospital admissions and GP visits if more women were supported to breastfeed for longer.
Some experts, however, were sceptical about the findings of the study, published in the journal JAMA Pediatrics, pointing out that it could not prove the women actually did breastfeed.
Andrew Whitelaw, the emeritus professor of neonatal medicine at the University of Bristol, said: “This is a pioneering trial tackling the important problem of low breastfeeding rates in low-income areas in the UK. However, the trial design could not avoid the possibility that an economically deprived mother would be tempted to report she was breastfeeding (when she was not) in order to receive a £200 reward.”
Kevin McConway, the emeritus professor of applied statistics at the Open University, said he thought it was a “well-designed and well-executed study”, but there were many reasons to be cautious.
He said: “The researchers’ primary outcome measure is based to a considerable extent on what mothers tell their healthcare professionals about how they are feeding their babies. That applies to all the mothers in the areas where vouchers were available, not just those who chose to sign up for the vouchers, but the existence of the voucher scheme may make it more likely that mothers mention to healthcare professionals that they have been breastfeeding. So we can’t be sure that all of the difference between areas with and without vouchers is because of real differences in breastfeeding.”
The study’s co-author Mary Renfrew, a professor of mother and infant health at the University of Dundee, said the incentive scheme had been designed together with women and staff to make sure it was feasible and appropriate and that breastfeeding support services were widely available in all the areas where the trial took place.
She said it was the first large-scale study to show an increase in breastfeeding in communities where rates have been low for generations, adding that it can be particularly difficult for women to breastfeed “without strong family and community support because of strong societal barriers”.
Community midwife Anahi Wheeldon, from Sheffield, said the scheme had helped normalise breastfeeding in areas where women found it embarrassing.
Fiona Sutcliffe, 29, from Sheffield, who took part in the trial with her daughter, 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.”
