Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Abstract

BACKGROUND AND OBJECTIVE: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers.

A systematic review and meta-analysis of interventions incorporating behaviour change techniques to promote breastfeeding among postpartum women

“…A few studies reported a declining of the intervention effect over time (Ahmed, Roumani, Szucs, Zhang, & King, 2016;Aksu et al, 2011;Washio et al, 2017). Similarly, this meta-analysis revealed weaker intervention effects on exclusive breastfeeding beyond thirteen weeks postpartum.…”

“…There were also promising BCTs, which need to be further investigated, such as 'material incentive', and 'material reward'. For example, one study (Washio et al, 2017) demonstrated the effectiveness of financial incentives provided within one month after delivery for promoting exclusive breastfeeding. Payments were provided at each session and for up to six months if breastfeeding was demonstrated in front of an expert.…”

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

“…Offering incentives to women to breast feed have been identified as an effective intervention to increase breast feeding and have been implemented in the USA,4 France5 and Canada 6. The first ever randomised controlled trial (RCT) of a financial incentive for breast feeding was conducted among 36 low-income Puerto Rican mothers who had initiated breast feeding.…”

“…The first ever randomised controlled trial (RCT) of a financial incentive for breast feeding was conducted among 36 low-income Puerto Rican mothers who had initiated breast feeding. This US-based RCT found higher rates of continued breast feeding in the intervention group compared with control (89% vs 44% at 1 month; 89% vs 17%, at 3 months; 72% vs 0%, at 6 months) 4. The authors recommended large-scale studies to assess clinical and cost-effectiveness of incentive-based breastfeeding interventions.…”

Should We Pay Mothers Who Receive WIC to Breastfeed?

“…Make no mistake: Dr Washio and colleagues 1 have courageously conducted a trial about which many have whispered but few have dared to have open discussions. Paying women to breastfeed is a strategy that most investigators have assiduously avoided.…”