Incentives to Promote Breastfeeding: A Systematic Review

Morán, Victoria Hall; Morgan, Heather; Rothnie, Kieran J; MacLennan, Graeme; Stewart, Fiona; Thomson, Gill; Crossland, Nicola; Tappin, David; Campbell, Marion K; Hoddinott, Pat

doi:10.1542/peds.2014-2221

Cited by 32 publications

(29 citation statements)

References 39 publications

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“…In contrast, a significant decrease in breastfeeding was observed over time for the control group (P = .001). The mean duration of breastfeeding was 149 (54) days in the incentive group and 49 (44) days in the control group (P < .001).…”

Section: Participant Characteristicsmentioning

confidence: 94%

“…44 Tangible incentives with a lower value than $270 (ie, $25 for father participation in 2 breastfeeding classes 61 ) did not result in significant differences in breastfeeding duration. Tangible incentives (eg, $40 for dinner, $100 for groceries 56 ) provided at 3 months postpartum contingent on exclusive breastfeeding resulted in significant increases; however, this was based on mothers' self-report.…”

Section: Figurementioning

confidence: 97%

“…39 -43 Incentives have been used to attempt to increase breastfeeding continuation rates, although these were not contingent on observed breastfeeding behavior, and mixed findings have been reported. 44 Support for household chores and child care by nurses for 6 weeks postpartum and weekly gifts and vouchers for 8 weeks postpartum resulted in a nonsignificant increase in breastfeeding rates. 45,46 Gift packages for infant and postpartum care for attending prenatal and postpartum breastfeeding support sessions resulted in a significant increase in breastfeeding rates between 3 and 6 weeks postpartum.…”

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confidence: 99%

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Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Washio

Humphreys²,

Colchado³

et al. 2017

Pediatrics

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BACKGROUND AND OBJECTIVE: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers.

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Section: Participant Characteristicsmentioning

confidence: 94%

Section: Figurementioning

confidence: 97%

mentioning

confidence: 99%

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Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Washio

Humphreys²,

Colchado³

et al. 2017

Pediatrics

View full text Add to dashboard Cite

show abstract

“…The low prevalence of breast feeding is estimated to cost high-income countries US$231 billion (0.5% of gross national income) annually 1. Policy makers in high-income countries are seeking effective and cost-effective interventions to encourage breastfeeding 3…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of offering an area-level financial incentive on breast feeding: a within-cluster randomised controlled trial analysis

et al. 2019

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ObjectiveTo provide the first estimate of the cost-effectiveness of financial incentive for breastfeeding intervention compared with usual care.DesignWithin-cluster (‘ward’-level) randomised controlled trial cost-effectiveness analysis (trial registration number ISRCTN44898617).SettingFive local authority districts in the North of England.Participants5398 mother-infant dyads (intervention arm), 4612 mother-infant dyads (control arm).InterventionsOffering a financial incentive (over a 6-month period) on breast feeding to women living in areas with low breastfeeding prevalence (<40% at 6–8 weeks).Main outcome measuresBabies breast fed (receiving breastmilk) at 6–8 weeks, and cost per additional baby breast fed.MethodsCosts were compared with differences in area-level data on babies’ breast fed in order to estimate a cost per additional baby breast fed and the quality-adjusted life year (QALY) gains required over the lifetime of babies to justify intervention cost.ResultsIn the trial, the total cost of providing the intervention in 46 wards was £462 600, with an average cost per ward of £9989 and per baby of £91. At follow-up, area-level breastfeeding prevalence at 6–8 weeks was 31.7% (95% CI 29.4 to 34.0) in control areas and 37.9% (95% CI 35.0 to 40.8) in intervention areas. The adjusted difference between intervention and control was 5.7 percentage points (95% CI 2.7 to 8.6; p<0.001), resulting in 10 (95% CI 6 to 14) more additional babies breast fed in the intervention wards (39 vs 29). The cost per additional baby breast fed at 6–8 weeks was £974. At a cost per QALY threshold of £20 000 (recommended in England), an additional breastfed baby would need to show a QALY gain of 0.05 over their lifetime to justify the intervention cost. If decision makers are willing to pay £974 (or more) per additional baby breast fed at a QALY gain of 0.05, then this intervention could be cost-effective. Results were robust to sensitivity analyses.ConclusionThis study provides information to help inform public health guidance on breast feeding. To make the economic case unequivocal, evidence on the varied and long-term health benefits of breast feeding to both the baby and mother and the effectiveness of financial incentives for breastfeeding beyond 6–8 weeks is required.

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“…In comparison, other incentive studies, of which there are few, have used gifts, small personal items, and vouchers rather than direct financial payments and maternal self-report rather than objective measures of breastfeeding success. 3 Spoiler alert: the incentive worked! As a small pilot, the authors readily acknowledge that their study was not adequately powered for the outcome measure of any breastfeeding at 6 months.…”

mentioning

confidence: 99%

Should We Pay Mothers Who Receive WIC to Breastfeed?

Furman

2017

Pediatrics

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Incentives to Promote Breastfeeding: A Systematic Review

Cited by 32 publications

References 39 publications

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Cost-effectiveness of offering an area-level financial incentive on breast feeding: a within-cluster randomised controlled trial analysis

Should We Pay Mothers Who Receive WIC to Breastfeed?

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