by Daniela Philipp
Some weeks ago BBC News published an article on a new public policy approach that is being discussed in the UK that offers breastfeeding mothers 200 GBP (about US$300) as a one-time payment in form of shopping vouchers to encourage women to breastfeed their infants. The target population of this pilot program is women living in low-income areas of South Yorkshire and Derbishyre.
When I first read about this program, I thought this was a very interesting and innovative approach to promote breastfeeding. This is not the first attempt of giving financial incentives to people to stay healthy, of course. The National Health Service (NHS) in the UK has already explored financial incentives to tackle smoking, drinking and obesity, such as the “Pounds for Pounds” weight loss financial scheme in Kent. Then I wondered whether breastfeeding can be promoted through the same types of incentives as quitting smoking or drinking.
What do you think determines a woman’s decision to breastfeed or not? Among the many different reasons there might be, would any of them have a monetary value? Well, we actually don’t really know, as no study yet has looked into this issue in depth (should you know of studies that, for example, look into the effect of income on breastfeeding, please share them with us in the comments section below or through Twitter).
Before we talk more about the relevance of income for breastfeeding, let’s check out the numbers we have on breastfeeding in general. According to UNICEF, less than 40% of babies worldwide receive exclusive breastfeeding during their first six months of life. In Latin America and the Caribbean, this number is even lower, only 37% of infants under 6 months of age are exclusively breastfed. In several articles in this blog we’ve talked about the benefits of breastfeeding at large (for example “Mother’s milk or formula” and “The Nurse-in and the Gorillas”). Seeing how low these numbers are, I think we could do a lot better. I wonder if the approach the UK is taking could as well be successful in our region.
Latest findings of an article published by the Oxford Journal for Health Policy Planning touches in a way the question on the impact of income and breastfeeding we’ve asked earlier. The authors analyze the increase of breastfeeding in Latin America and the Caribbean and give us some insight on who is breastfeeding and what the possible causes are.
The researchers conclude that while the total number of breastfeeding increased in the studied countries (Bolivia, Brazil, Colombia, Dominican Republic, Guatemala, Haiti, Nicaragua and Peru), this did not happen uniformly across different population groups. Rather, in most countries breastfeeding increased mainly among urban and more educated women, with better access to health care and where fathers had higher levels of education. Breastfeeding numbers actually decreased or stayed stagnant among groups where the risk of infant morbidity and mortality was higher, women were poorer or living in rural areas with less access to quality health services and education.
It will be interesting to see the results of the UK pilot program. If it turns out to be successful, more research should be done to find out if monetary contributions could improve breastfeeding numbers. What seems clear to me is that money alone cannot be the driving force for behavioral changes in breastfeeding. There are many more variables involved: the quantity and quality of time, rest and nutrition for the mother, better information (for all parties involved), support networks (home, work-place and community), to name a few.
In any case, I think other health promotion approaches need to be explored further as well. During the last World Breastfeeding Week 2013, PAHO promoted providing breastfeeding support to mothers through “peer counselors”, women with experience in breastfeeding of similar ethnic, socioeconomic, and cultural background to the mothers they are supporting. None of the options are very common in our region, but they may help.
Do you think women will breastfeed for money? Do you think programs like that would work?