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Feb 2017

Are Cash Incentives the Answer to Raising Breastfeeding Rates?

While walking thru the Oakland International Airport, I noticed a special pod set up for new moms that allows them to breastfeed their newborns in private. Perhaps one of the downside effects of our fast-paced world is the number of women who breastfeed has been decreasing. There are many reasons for the drop with financial, practical and social implications playing the largest roles. The topic is back in the news because of a controversial United Kingdom program that tackles the touchy issue with money vouchers. Is money a good way to encourage mothers to forsake the easy formula option?

The pros of breastfeeding for both mother and infant have been widely recorded and debated. Although the health benefits may be great given a mother’s health, there are also important financial factors to consider when it comes to nourishing a newborn.

According to the U.S. Department of Health and Human Services, mother’s electing to breastfeed may save $1,200 to $1,500 on formula. In the U.K., a Sheffield University research program is offering $191 to $318 to new moms in an effort to encourage more of them to breastfeed. The research comes at a time when a lack of support from the U.K.’s National Health Service has led the number of British women breastfeeding to dramatically decline.

The debate rages as to why it’s necessary to “bribe” women to perform a motherly act that is part of nature. However, in a modern society where the family resources may be lacking in education or emotional support, a financial push both in cash gains as well as savings from not buying formula may reverse the growth of baby formula use.

Just off the United States shores, one of the largest efforts to get more low-income women to breastfeed is part of the Women, Infants, and Children Program in Puerto Rico. This federal nutrition assistance program is serving close to 8 million mothers and young children. The program incentivizes breastfeeding by offering participating moms “a greater quantity and variety of foods” and “longer participation in the program.”

A new study recently published in Pediatrics explores what would happen if Women, Infants and Children (WIC) program upped the ante and gave breastfeeding moms a cash bonus as well. The study found this extra financial compensation was effective in raising breastfeeding rates. However, the opponents still have serious questions about the ethics of offering cash incentives.

The study’s research team, led by Dr. Yukiko Washio of Christiana Care Health System and the University of Delaware in Newark, divided 36 low-income, Puerto Rican new mothers enrolled in WIC into two groups. Half of the moms would receive cash incentives to breastfeed, totaling up to $270 during the course of six months. The other half would not receive any compensation.

One month into the study, the researchers found 89 percent of women who were being paid were still breastfeeding. That number raised eyebrows when compared with 44 percent of mothers who were not being paid still breastfeeding. After 90 days into the study, the cash-receiving group’s percentage that was still breastfeeding remained the same. However, the control group’s breastfeeding rates declined to 17 percent. Six months into the study, 72 percent of the mothers receiving payments were still breastfeeding their children, while none of the mothers in the control group were.

The study’s authors did warn that there are a few red flags with their own findings. The biggest issue is the sample size was too small to draw any important conclusions. The researchers are hopeful the program could be tested using a larger group of women before any large-scale program commences. Also of note, the health effects of the financial incentives were not clear. The study found no significant difference in hospital emergency room visits between the two groups: breastfeeding and control group using baby formula.

The researchers did publish a prediction that raising breastfeeding with financial incentives could lead to better infant health outcomes. Better infant health could save $17 million in United States healthcare costs. One obvious, positive outcome is the program would allow WIC to spend more budget money on food rather than formula, which is currently the most expensive line-item in the program’s budget.

Perhaps future studies could carefully track participating infants’ health outcomes to ensure the children are benefiting from breast milk. Finally, the researchers admit more research should be conducted on the psychological effects the financial incentives have on the mothers receiving the cash. What’s effective for the one party (newborns) isn’t always benign to the other party (mothers), especially when dollars are involved.

In an accompanying editorial in Pediatrics, Dr. Lydia Furman of Case Western Reserve University and Rainbow Babies and Children’s Hospital in Cleveland, Ohio questions whether these payments end up coercing low-income women into breastfeeding, including those who would otherwise have chosen not to. However, she ultimately concludes that such interventions can be “ethically defensible and socially responsible” if they manage to “level the playing field” for low-income women.

As an adopted child and a father, I have been on both sides of the study. There is no question breastfeeding is a major commitment for the mother and family. The physical act alone can be extremely taxing to the mother, particularly if she returns to work shortly after childbirth or has other young children. What drove our family to breastfeed our newborns (directly by mom or storing via a breast pump) were the health benefits. But formula was still utilized, especially as the newborn grew older and became more mobile.

Perhaps money incentives are not the long-term solution. Perhaps more education, more tolerance and, yes, perhaps even more breastfeeding pods, will encourage more new moms to take the route Mother Nature created for our offspring.

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