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Financial incentives for breast-feeding slightly increase prevalence
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Although providing a financial incentive for the promotion of breast-feeding in areas with low breast-feeding prevalence did not increase exclusive feeding or new initiations, the intervention was able to modestly increase any breast-feeding, according to findings published in JAMA Pediatrics.
“There is increasing interest in the role of financial incentive programs to meet the health needs of children, and financial incentives are increasingly being used to improve maternal and newborn health,” Clare Relton, PhD, from the School of Health and Related Research at the University of Sheffield, and colleagues wrote. “However, evidence as to whether financial incentives are effective in increasing breast-feeding prevalence is weak.”
To examine the impact of financial incentives for breast-feeding on breast-feeding prevalence between 6 and 8 weeks after birth, the researchers conducted The Nourishing Start for Health trial. This cluster randomized trial included 6 to 8 weeks follow-up and was conducted from April 1, 2015, and March 31, 2016. Of the 92 electoral ward areas located within England included in the study, all had a breast-feeding prevalence below 40%.
Relton and colleagues included 10,010 mother and infant pairs. All infants were born between Feb. 18, 2015, and Feb. 17, 2016. Half of the areas involved in this study were administered a U.S. $50 voucher incentive in addition to usual care (n = 46), whereas the other half received only usual care. The financial incentive was given up to five times when their infant received any breast milk. Care was administered by both midwives and health visitors.
In addition to breast-feeding prevalence at 6 to 8 weeks after birth, the researchers also observed the prevalence of breast-feeding initiation and exclusive breast-feeding by area.
Of the 5,398 mother-infant pairs in the intervention, a median percentage of 36.2% were aged between 16 and 44 years. The control group (n = 4,612 pairs) had a median percentage of 37.4% for women aged between 16 and 44 years. When baseline breast-feeding prevalence, local government area and weighting to mirror imbalanced prevalence variances were considered, the intervention was more effective than regular care at promoting breast-feeding for children aged between 6 and 8 weeks (37.9% vs. 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001).
Although any breast-feeding increased with the use of a financial incentive, no significant changes were made to the prevalence of breast-feeding initiation (61.9% vs. 57.5%; adjusted mean difference, 2.9 percentage points; 95% CI, –0.4 to 6.2; P = .08) or exclusive breast-feeding for children aged between 6 and 8 weeks (27.0% vs. 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, –0.2 to 4.8; P = .07).
“Social support and social interventions — eg, financial incentives — can influence health-related behaviors by transforming unhealthy behaviors into healthy behaviors that are witnessed, actively encouraged, and rewarded, and healthy behavior goals are shared,” Relton and colleagues wrote.
“Because social relationships play key roles in supporting and protecting women who breast-feed, it was hypothesized that offering the intervention to communities would help to communicate the value of breast-feeding and have a positive influence on those who support women, and thus address some of the complex, financial, organizational and cultural barriers for breast-feeding,” they continued. “Despite financial incentives for breast-feeding being viewed as contentious by some, almost half (46.2%) of all eligible women joined the scheme.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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