Effect of Financial Incentives on Breastfeeding

Abstract

IMPORTANCE Although breastfeeding has a positive effect on an infant's health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown.OBJECTIVE To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum. DESIGN, SETTING, AND PARTICIPANTSThe Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015, and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant's estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads).INTERVENTIONS Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk. MAIN OUTCOMES AND MEASURESThe primary outcome was electoral ward area-level 6-to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6-to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks. RESULTSIn the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6-to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, −0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, −0.2 to 4.8; P = .07).CONCLUSIONS AND RELEVANCE Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at ...

Cost-effectiveness of offering an area-level financial incentive on breast feeding: a within-cluster randomised controlled trial analysis

“…Cost per baby/trial arm was derived by dividing the estimated mean cost per ward by the number of babies per ward. A negative binomial model was used to estimate the intervention effect following the study by Relton et al, 7 although with different estimator. The outcome used in the study by Relton et al ,7 percentage point increase in breastfeeding outcome, is a relative measure and not applicable to cost-effectiveness analysis.…”

“…The choice of distributional family for models was based on modified Park test12 and comparison of observed and predicted values. The covariates of the models included correlates of breastfeeding-related outcomes7 13 14: deprivation (Index Multiple Deprivation) score for the wards, baseline breastfeeding rate and ethnicity, and the inverse of the variance of breastfeeding rate (to account for the number of births in relation to breast feeding). The choice of covariates was based on a literature review conducted as part of this study to identify the potential predictors of breastfeeding-related outcomes.…”

“…The first UK-based RCT of financial incentives for breast feeding was conducted as part of the Nourishing Start for Health (NOSH) project 7. This project developed and then trialled a structured population-level financial incentive for breastfeeding intervention that offered shopping vouchers to women if their infant was receiving breastmilk.…”

Food insecurity and breastfeeding

“…A recent randomized clin ical trial showed that in the United Kingdom, financial incentives improved breastfeeding rates in areas with low breastfeeding prevalence. 13 In Canada, the recent introduction of the nation wide Canada Child Benefit might have an important impact on household food insecurity. However, a rigorous evaluation of this income support program is needed, with specific focus on mater nal and child health outcomes, to answer key questions; for example, "Will mothers who report food insecurity have equita ble access to these benefits?"…”

The annual cost of providing paid maternity leave in the informal sector in Indonesia&nbsp;

“…Furthermore, the few studies available have analyzed cash transfers targeting several outcomes (e.g. education and health) and not specifically paid maternity leave, in spite that some of these studies have shown that cash transfer may have positive impact on breastfeeding outcomes [39][40][41][42][43][44]. This study is the first to provide such cost estimates for Indonesia, and as such can provide urgently needed evidence for policy making purposes in the context of supporting recommended breastfeeding practices, especially given the relatively low health budget in Indonesia (under 5% share of GDP as of 2014) [45].…”