Full story

Breastfeeding voucher scheme 'shows promise'

11:50am Friday 21st November 2014 content supplied byNHS Choices

"Initial results of a controversial scheme offering shopping vouchers to persuade mothers to breastfeed have shown promise," BBC News reports.

The scheme, which has attracted controversy since it was announced, aimed to tackle the problem of low rates of breastfeeding in the UK compared with other developed nations. Mothers who live in the poorest areas of the country have been found to be more likely to prefer bottle feeding.

This pilot scheme has tested whether it is possible to try to boost breastfeeding rates by offering new mothers shopping vouchers if they breastfeed their baby until specific ages.

The scheme was available to just over 100 women who gave birth to babies over a six-week period and lived in three areas of Derbyshire and south Yorkshire. The breastfeeding rate in these areas at six to eight weeks was 21-29%.

In the period where vouchers were available, 34.3% of women were breastfeeding at six to eight weeks. Both mothers and healthcare staff reported high levels of satisfaction with the scheme.

The researchers report they are now planning further studies in the form of a randomised controlled trial to see how effective the voucher scheme is at boosting breastfeeding rates.

 

What are the benefits of breastfeeding?

Breastfed babies have:

  • less chance of diarrhoea and vomiting
  • fewer chest and ear infections
  • less chance of being constipated
  • less likelihood of becoming obese and developing type 2 diabetes in later life
  • less chance of developing eczema

Health benefits for the mother include:

  • a lower risk of breast and ovarian cancer
  • naturally using up to 500 calories a day
  • saving money
  • helping bonding with their baby

Read more about the health benefits of breastfeeding

Where did the story come from?

The study was carried out by researchers from the University of Sheffield and was funded by the Medical Research Council National Prevention Research Initiative.

The meeting abstract was published in the peer-reviewed medical journal, The Lancet.

It has been published prior to being presented at The Lancet's annual conference on Public Health Science, held jointly with the London School of Hygiene and Tropical Medicine, University College London, the UK Health Forum, and in partnership with the European Public Health Association.

The media reporting of the study was good, providing background information about the scheme and why some people are opposed to it - most critics have questioned why a scheme should reward mothers for doing the best for their child while penalising mothers who are unable to breastfeed.

It is a fair point, though a pragmatic answer would be that it's not about the mother, but the child. Also, increased breastfeeding rates may lead to a reduction in the number of childhood illnesses the NHS has to deal with, so a voucher scheme could actually save the NHS money in the long term.

But we will need to wait for the results of the planned randomised controlled trial before more detailed effectiveness and cost benefit information becomes available.

 

What kind of research was this?

This was a feasibility study to see whether it was both acceptable and possible to give women financial incentives to increase breastfeeding rates, prior to performing a randomised controlled trial to see if these financial incentives were effective. 

The results of this study have been published in the form of a meeting abstract. This means the method and results are only described briefly, and a full appraisal of the strengths and limitations of the study can't be performed. This study is actually still ongoing and the results from some time points are still being collected.

 

What did the research involve?

The researchers wanted to test whether it was acceptable and possible to give women financial incentives for breastfeeding, as young women in deprived areas are less likely to breastfeed.

They offered vouchers for breastfeeding to women with babies born within a 16-week period who lived in three neighbourhoods in Derbyshire and south Yorkshire, where breastfeeding rates were less than 30%.

The vouchers were available when their babies were five different ages:

  • two days
  • 10 days
  • six weeks
  • three months
  • six months

The vouchers were for supermarkets and high street shops for a value of £40 at each time point, so each woman could receive a maximum of £200.

To receive the vouchers, the woman and her healthcare professional had to sign statements saying she had been breastfeeding.

The researchers then interviewed 36 healthcare providers and 18 women to get their views on the scheme.

 

What were the basic results?

Fifty-eight of the 108 women (53.7%) who could have joined the scheme chose to do so.

  • 48 women (44.4%) claimed vouchers when their babies were two days old
  • 45 women (41.7%) claimed vouchers when their babies were 10 days old
  • 37 women (34.3%) claimed vouchers when their babies were six to eight weeks old

The researchers are still collecting data for the three and six-month time points.

Mothers and healthcare staff who participated reported high levels of satisfaction with the scheme.

 

How did the researchers interpret the results?

The researchers say that, "The scheme was both deliverable and acceptable to mothers and healthcare staff in this field of 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."

 

Conclusion

This study tested whether it is possible and acceptable to try to boost breastfeeding rates by offering new mothers vouchers if they breastfeed their baby until specific ages.

The scheme was available to just over 100 women who gave birth over a six-week period, and who lived in three areas of Derbyshire and South Yorkshire. In these areas, the breastfeeding rate at six to eight weeks was 21-29%.

In the period where vouchers were available, 34.3% of women were breastfeeding at six to eight weeks. Both mothers and healthcare staff reported high levels of satisfaction with the scheme.

The researchers report they are now planning a randomised controlled trial to see how effective the voucher scheme is at boosting breastfeeding rates.

The results of this study have been published in the form of a meeting abstract. This means the methods and results are only described briefly, and a full appraisal of the strengths and limitations of the study can't be performed.

Similarly, there is no information provided about the women who took part in the study, such as their age, medical history, family circumstances and support network.

In addition, this study is actually still ongoing and the results from some time points are still being collected.

Hopefully, the publication of the upcoming randomised controlled trial, which could be in either 2015 or 2016, will help assess how effective the scheme is and whether it is likely to be cost effective.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Summary

"Initial results of a controversial scheme offering shopping vouchers to persuade mothers to breastfeed have shown promise," BBC News reports. The scheme, which has attracted controversy.

Links to Headlines

Early results in breastfeeding vouchers trial. BBC News, November 20 2014

Scheme offering shopping vouchers to mothers who breastfeed to be extended. The Guardian, November 20 2014

NHS to 'bribe' thousands of mothers to breastfeed. The Daily Telegraph, November 20 2014

Links to Science

Relton C, Whelan B, Strong M, et al. Are financial incentives for breastfeeding feasible in the UK? A mixed methods field study. The Lancet. Published online November 19 2014

Useful Links

Further Readings

University of Sheffield - Press Release. Shopping vouchers for breastfeeding set for wide-scale trial. November 20 2014

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