Are financial incentives for breastfeeding feasible in the UK? A mixed methods field study

Abstract

BackgroundThe UK has one of the lowest breastfeeding rates (duration and exclusivity) in the world. Moreover, breastfeeding is strongly socially patterned, with young women in areas of high deprivation being less likely to breastfeed than women in areas of low deprivation. This study tested the feasibility of a financial incentive intervention to increase breastfeeding in areas with 6–8 week breastfeeding rates of 40% or less. MethodsThe intervention was the offer of a structured financial incentive scheme to women with babies aged up to 6 months old. If women were breastfeeding their baby, they could claim vouchers, at five different timepoints—ie, when their baby reached 2 days, 10 days, 6 weeks, 3 months, and 6 months old. Breastfeeding was verified by signed statements from the mother and health-care professional. Vouchers were for supermarkets and high street shops, to the value of £40, up to a maximum of £200. Starting in November, 2013, the scheme was offered to women with babies born during a 16-week period resident in three neighbourhoods in Derbyshire and South Yorkshire, UK, all of whom had historically persistent low 6–8 week breastfeeding rates, ranging from 21% to 29%. The feasibility (acceptability and deliverability) of the incentive scheme and the study design to key stakeholder groups was assessed with quantitative and qualitative methods, in advance of undertaking a full randomised controlled trial. 36 health-care providers and 18 women gave semi-structured interviews. FindingsRelevant approvals for the study were obtained. Women learnt about the scheme from their midwife or the media (print, radio, social media), or both. Of a total of 108 women eligible for the scheme, 58 (53·7%) joined the scheme, 48 (44·4%) claimed 2-day vouchers, 45 (41·7%) claimed 10-day vouchers, and 37 (34·3%) claimed 6–8 week vouchers. 3-month and 6-month data are still accruing. 53 health-care providers cosigned claim forms. Satisfaction with the scheme (including the method used to verify breastfeeding) was high among both mothers and health-care staff participating in the scheme. InterpretationThe scheme was both deliverable and acceptable to mothers and health-care staff in this field study. The scheme was extended (and will continue until at least December, 2014) in all three areas. A randomised controlled trial testing the effectiveness of the scheme is now planned. FundingMedical Research Council National Prevention Research Initiative (MR/J000434/1).