Tuesday, 12 November 2013

Is Offering Financial Inducement to Breastfeed Wrong?

I don't know.

Like many I have heard this news today on the BBC and wondered. To be honest 5 years ago I would have shouted "wrong are you out of your minds?" I believe in breastfeeding. I didn't feed for longer than 10 weeks due to a complex set of reasons. I really believe in breastfeeding in lower socio economic households (well all households really). Less money on formula can mean more money for healthy foods. Breastfeeding protects against gut complaints and offers support for the baby's immune system. Also there's some evidence that babies in lower socio economic areas are moved on to solids too quickly as formula is expensive, and that formula is watered down to make it last longer. If successful feeding is established there are benefits for the baby and the mother too, and indeed potentially the whole family.

Several things have happened over that time to me that makes me think, maybe it's worth trying, offering inducements. Let me tell you a story.

It's 9pm. I am never on the neonatal unit this late but Joseph has been unsettled and rather than fret at home I decide to stay by his cotside. However its time for a blood draw so I leave the room, pop my breast milk in the fridge that I've just expressed and go and sit in the visitors room. There is a mother crying.

I sit next to her and introduce myself, mum of a 27 weeker who is now six weeks old. She looks at me, tears staining her cheeks. "They want me to do that too", she says. "What?" I ask. "You know...." the disgust clear on her face "express milk, breastfeed." I smile "how do you feel about that?".

She tells me its disgusting she has never seen anyone do it, everyone uses baby milk in her family. I ask her why the nurses think she should "I don't know" she asks. There's a Bliss breast feeding leaflet nearby. I tell her I've found this helpful. She says to me "I'm only 16 I um, can't read very well". I offer to go through it with her. Together we learn about how it will protect her premature baby's stomach, it will offer protection from infection, it will help her baby grow. She stops "oh so its not just rubbish then, it could really help her? I could do something to help her?" I smile again and say "yes your breast milk is made just for her, by you, you are her mum".

The nurses tell us they are done and we go back to our babies.

A few days later I see her, she is showing me a pot of liquid gold, breast milk. She's done it, she's given it a try. I am beaming inside. By the time we leave 4 weeks later her baby is taking its first feeds from her mum. This girl had a reason and she's done it. When I run into her in clinic 4 months later, she's still feeding and she tells all her friends what a good idea breastfeeding is. Mum to mum, she is making a difference.

I believe 100% in professional and peer support. I totally agree there is lack of investment and lack of initative in these schemes. I totally accept people who say this is throwing the wrong type of money at the problem.

But in many areas in the UK breastfeeding rates are so very low they are almost non existent. Like it or lump it something drastic needs to happen to get these women breastfeeding.

I welcome the trial in as much as it might give some answers whether these sort of financial inducements work. In other countries they offer financial inducements for vaccination. Iin this country we've done it for smoking cessation and weight loss.

I don't think, to be honest, if someone is dead against feeding £200 will make a blind bit of difference, and I suspect the long term outcome will be that this does not work and it does not go wider than the trial area, which is only 120 women.

But we are left with this. How do we give women from these areas the incentive to even try?

What can we do better?


  1. Well, I agree with you. I think giving mums powdered milk tokens gives people the wrong idea ( which is what people on benefits get if they decide not to breast feed) now THAT is what I call throwing money at the wrong thing!

  2. I think your very touching story says it all; this money would be better spent on educating people about breast feeding. Then again, if a family is in desperate financial need and the money is needed to buy food so that mum can physically breast feed...well that's a different matter entirely. I don't know, it's a tough one. My gut instinct is opposed to the policy but if it does help families in very real need then it can be o bad thing.

  3. I think peer support and having an example set by previous generations is amazingly important - and well done to you for having helped someone else. Still not convinced on the vouchers though, for a few reasons. I've linked to you in my post about it this morning. I think we'll see a few of these posts today.

  4. Your story of encouraging the other young mother made me cry. I think you are quite right in that investment needs to be in peer support, like you I also don't think it will make a blind bit of difference but unless we try, we won't know.

  5. I really am in two minds about it, but it's a trial and let's suck it and see. I do think not enough time is spent antenatally with women, but how you get them to engage is a real issue. I am forming support services for women who have delivered early in communities with high social deprivation and quite honestly I am at the point where I think unless I have something tangible to offer I am not going to get anywhere.

  6. That's the key, in these communities they often have never seen breastfeeding. When I first moved to the UK I never saw anyone breastfeed until I saw an African woman in Tesco who shouted that there was no where to sit, it was a Tesco metro, so she sat on the floor! I think this is a quick, lazy attempt to change the culture but I support the trial to see if it works.

  7. But how do you do that if they won't engage? This is the key problem. Offering an inducement can artificially force engagement and that's what they are doing. It isn't a policy though, its a trial, it may not work, its an isolated trial of 120/130 women.

  8. That's a really important point. Why breastfeed if your milk is subsidised. I don't think anyone is really talking about that.

  9. What a great post. I love your story of helping the young Mum to breastfeed. It became clear to me when I was failing to breastfeed (and I WANTED to!) that what was needed was more support and education. particularly after birth. I'd much rather see investment in that than in financial incentives. There is ALREADY a financial incentive to breastfeed - you don't have to buy formula! Whilst that perhaps won;t save you £200 over 6 months it probably isn't far off. This is already used in all the literature and arguments for breastfeeding, so anyone who is swayed by this new £200 payment has clearly missed all the existing breastfeeding education, like the health benefits etc, just like the Mum you helped.

    I believe education, not bribery, is the long term way that breastfeeding rates will increase. And I desperately want to see more support for those who want to but can't.

  10. Brilliant post. My baby is 6 weeks old and breast feeding its going well, but I have had a huge amount of continued support from community midwives and I have had the benefit of watching other women around me breast feed successfully. Without those things it could have been a very different story...

  11. I think I'd rather see it spent on giving that trial group a visit from a breast feeding peer supporter or a lactation consultant, or if it has to be shopping, how about a voucher for a really comfy nursing bra, something that ties in more with the purpose behind the incentive, not just randomly throwing money at a problem. To me it smacks a little bit of we need to do something, this is something, therefore lets do it. It's certainly going to be interesting to see the results.

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