Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

Abstract

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women's positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates.

Costing a Maternity Leave Cash Transfer to Support Breastfeeding Among Informally Employed Mexican Women

“…Formative research and engaging stakeholders will indeed be central to the success in the rollout of the maternity benefit proposed in our study. 46,47 As documented in research centered in financial incentives in the United Kingdom, it is important to describe to society that a key rationale for the additional CT is to improve breastfeeding outcomes. 15 Another aspect that is worth noting from prior studies 13,15 is that despite the fact that financial incentives have been used to encourage other health behaviors, there has been a lack of effort toward linking financial incentives to breastfeeding.…”

The yearly financing need of providing paid maternity leave in the informal sector in Indonesia

“…However, the proposed MCT approach would require, among other things, sound monitoring to ensure that breastfeeding actually took place, consistency in the best timing of delivery of cash distribution and breastfeeding counselling visits, recognizing that many mothers receiving the cash transfer face major social determinants of health challenges. These need to be addressed through supportive social protection, efficacy evaluation of the intervention, and economic policies [41,42,[67][68][69]. In addition, it should also be stressed that there is evidence showing that maternity leave schemes have other benefits beyond in addition to breastfeeding such as a larger share of women returning to work [70], improved mothers' mental health [66], and lower neonatal mortality [71].…”

“…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 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].…”

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

“…However, the proposed MCT approach would require, among other things, sound monitoring to ensure that breastfeeding actually took place, consistency in the best timing of delivery of cash distribution and breastfeeding counselling visits, recognizing that many mothers receiving the cash transfer face major social determinants of health challenges. These need to be addressed through supportive social protection, efficacy evaluation of the intervention, and economic policies [41,42,[68][69][70].…”

“…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].…”