Breastfeeding affects only mother and child, but over the years, has become something of a political issue – from overzealous staff stopping women from doing it in public places, to Facebook banning (and then unbanning) photos. Yesterday, it hit the headlines because of a pilot scheme to see if offering women a financial incentive will encourage them to breastfeed their babies.
The study will be run by Sheffield University, with funding from the government. It will focus on low income areas in Derbyshire and South Yorkshire, where bottle feeding is the norm and, according to researchers, breastfeeding is effectively stigmatised. Women will be offered up to £200 in shopping vouchers if they breastfeed. They will be receive £120 of this if they breastfeed until the baby is six weeks old, and a further £80 if they continue to do so until the baby is six months old. If the scheme goes well with an initial 130 women, it will be tested nationwide over the next two years.
Breastfeeding has health benefits for both mother and child. Research shows that breast-fed babies are less likely to develop diabetes when older, and are protected from respiratory and gut problems, and ear infections. Breastfeeding also reduces the likelihood of the mother getting breast cancer. Yet levels in the UK are low, with one of the lowest numbers of breastfeeding mothers in Europe. In some parts of the UK, fewer than 20 per cent of mothers breastfeed for even six to eight weeks. Across the country, just 35 per cent do it for six months, the World Health Organisation’s recommended time. The academics running the Sheffield study say that in some white working-class areas of the UK, breastfeeding has become culturally unacceptable, with women seeing it as immoral, wrong or embarrassing. “The skills required have been lost in some communities,” said Dr Clare Relton, leading the project.
Yet this raises the question: is offering a financial incentive really the best way of addressing this? Experts are divided. Speaking to the Guardian, Susan Jebb, professor of population health at Oxford University, said that “despite years of health promotion breast feeding rates are still low and socially patterned” and that the scheme should be given a chance. Conversely, others have expressed concern about bribing women. The National Childbirth Trust points to research showing that four out of five women who stop breastfeeding in the first six weeks would like to do so for longer, saying that this suggests that they need more support and information, not a pay off.
The decision to try financial incentives should be put in context. The government’s “nudge unit”, also known as the Cabinet Office’s behavioural insights team, has been experimenting with financial incentives (along with other tactics). The NHS has previously spent funds on cash payments of up to £425 for people who lose weight, and on shopping vouchers to encourage teenage girls to walk to school. Some of these schemes have had modest success, although the jury is out on whether they can be effective in the long-term. A recent article in the British Medical Journal pointed to “moral” concerns. Looking at financial incentives in a different context, many development workers I have spoken to in Pakistan have expressed frustration that certain organisations had started offering payment to people to take part in agricultural or educational projects; it meant that people were not seeing the schemes on their merits, merely for the short-term personal gain offered.
On top of this, offering women money in return for breastfeeding risks overlooking the many and complex reasons why women may choose not to do so. I know several young mothers who found breastfeeding painful and difficult, and felt deeply inadequate when they decided to switch to formula milk. Quite apart from questions of efficacy and fairness (what is to stop someone from accepting payment and then not breastfeeding, and what if those who choose to breastfeed anyway feel penalised?), offering mothers payment risks compounding this sense of inadequacy. It also suggests that it is a lightly taken choice that could be reversed for the sake of a few extra items of clothing.
Researchers rightly point to a cultural problem, whereby breastfeeding is stigmatised, but paying women off does not seem the best way to tackle this attitude. Surely it would be better to continue to work at educating people and investing resources in proper support.
