Valuing breastfeeding: a qualitative study of women’s experiences of a financial incentive scheme for breastfeeding

Abstract

BackgroundA cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6–8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial.MethodsSemi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach.ResultsWomen reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations.They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months.ConclusionsThe scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial.Trial registrationThe trial is registered with the ISRCTN registry, number 44898617, https://www.isrctn.comElectronic supplementary materialThe online version of this article (10.1186/s12884-017-1651-7) contains supplementary material, which is available to authorized users.

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

“…140 No previous research has studied the effectiveness of CCTs in increasing lactation rates for mothers of VLBW infants; however, several recent studies have examined whether CCTs and other financial incentives are effective strategies for increasing breastfeeding rates in term infants. [141][142][143][144][145] One RCT from the United Kingdom enrolled mothers who resided in communities with lower than the country's average SES and baseline breastfeeding rates. This study revealed higher rates of any but not of exclusive breastfeeding in the CCT group (receiving £200 total) at 6-8 weeks post-birth.…”

“…141 The CCT had no effect on mothers' decisions to initiate lactation, but mothers perceived CCT as showing "value" for breastfeeding, compensating for ongoing breastfeeding challenges and facilitating achievement of targeted breastfeeding milestones (e.g., 6 weeks, 3 months). 145 Research on the use of financial incentives to increase breastfeeding in healthy but primarily disadvantaged populations reveal that mothers value cash or cash equivalents more than other financial incentives such as grocery vouchers or baby supplies, 145,146 and healthcare providers are generally positive but cautioned about choosing the proper incentive. [147][148][149] One small US study randomized 36 Puerto Rican mothers of healthy term infants to receive either WIC-only or WIC + CCT (≤$270 total over 6 months) and found that mothers in the WIC + CCT group had significantly higher rates of any but not of exclusive breastfeeding at 1 (89% vs 44%), 3 (89% vs 17%) and 6 (72% vs 0%) months post-birth.…”

“…150 The existing research on CCTs has several implications for reducing disparities in MOM provision for VLBW infants. CCTs should (1) focus on sustaining not initiating MOM provision; 142,144,145 (2) use cash rather than non-cash payments; 145,146 (3) make payments frequently to strengthen the impact of the intervention; 150 (4) compensate mothers fairly for MOM provision; 140 and (5) focus on short-term behavior change, for which CCTs have been shown most effective vs long-term or lifelong behavior change. 151 Ongoing RCTs of CCT in US term 152 and VLBW infants 153 will provide evidence regarding the efficacy of this strategy in reducing disparities in MOM feedings.…”

Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

“…In this article, we do not report on women's perspectives of the NOSH scheme; however, these views have been sought as part of the wider study (Relton et al, 2016) and are reported in a separate article (Johnson et al, 2018). We aimed to interview HCPs involved in delivering the NOSH scheme, and our recruitment strategy was based on those with most experience of the scheme-those who had signed the most application and claim forms.…”

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

“…Over the past several decades, neonatal scholars have made their own recommendations to increase caregiver and community capacities (i.e., time and commitment to the infant, resources, caregiving skills and knowledge) and buffer infant stress. Successful efforts include providing institutional resources for family accommodations in the hospital (Franck, Ferguson, Fryda, & Rubin, 2015, socioemotional resources such as peer-to-peer parental support for NICU parents (Hall, Ryan, Beatty, & Grubbs, 2015;Macdonell et al, 2013;, psychological resources from mental health professionals , and even financial resources to promote optimal infant nutrition through breastfeeding in the NICU (Johnson et al, 2018;Morgan et al, 2015;Relton et al, 2018). Well-established parent education programs increase caregiver skills and knowledge; reduce parental distress, depression, and anxiety; and strengthen the parentinfant relationship in the NICU (Chertok, McCrone, Parker, & Leslie, 2014).…”