“Paid” to breastfeed – crazy or cost-effective?

It’s been a while since I wrote a post on breastfeeding. I’ve been thinking about writing one now that we’ve somehow got to a point where I’m tandem nursing 2 toddlers, but with everything going on, it’s not actually happened yet. However, something in the news this week has prompted me to write because I’d like to note and share my thoughts on this.

According to the BBC news article that I read at first, a trial scheme is being run in deprived areas of South Yorkshire and Derbyshire which will offer new mums £200 in shopping vouchers if they breastfeed their baby for 6 months; this is being funded through both government and medical research money. My first thought when I read this was “are they crazy?! is this a joke?!” The very fact that breastfeeding saves you more than £200 in formula milk per baby should be a financial incentive in itself.

And then I thought about it some more, in an attempt to understand it some more, and still came to the conclusion that it was a bad idea. Of course if money was no object to the government, then why not encourage mums to breastfeed with a sum of money, but as funds are limited, I believe this money would be far better spent on NHS resources to support breast-feeding mums in a useful way.

When we had issues breastfeeding, the best help that we got in the local community was from volunteer peer supporters – mums at our local La Leche League (LLL) group who give all their time and energy to help out struggling mums for free, out of the desire to help each mum reach their own breastfeeding goal, whatever that might be. If we’d have relied on overworked midwife and health visitor advice, I am convinced that I would not be sitting here writing this, despite my own determination, because we were given at best no and at worst factually inaccurate advice from health professionals whom we thought we could rely on. If money is to be spent trying to improve breastfeeding rates, this, in my opinion, is where it needs to go – providing more up-to-date and evidence-based training for (and just more!) midwives and health visitors who see these new mums on a regular basis before and after the birth of their baby.

What good will it do to get more mums to start out breastfeeding if there is little means of supporting them if they hit issues? I can imagine a scenario where a mum is encouraged by the financial incentive to give breastfeeding a go when her baby is born, but who then faces a problem which ultimately leads her to give up, because she is not given any support, or is told something that is not helpful, or worse not true, by people that she trusts (maybe a health professional, maybe a family member). The fact that she would then miss out on the £200 could lead to even more of a feeling of failure and guilt that many mums, in my experience, describe when they feel they have had no option but to give up breastfeeding even though they really wanted to.

Having said all this, as I thought about this trial more, and read more commentaries on it, I realised that I am of course looking at it through my middle class eyes. I grew up knowing that breastfeeding is the ‘normal’ way that a human infant is born to be nourished, though I also knew that formula is an option which many mums choose for whatever reason to use instead. I was breastfed, my brother was breastfed (not that I can remember either of those cases!), and my younger cousins were breastfed – I saw them and remember this.  I also did well in a good school, went to university and got 3 degrees, and through this education and my own reading because I’m interested in finding out more, I have understood why breastfeeding is important.

If I had grown up in a family whose babies were all bottle fed by default, hung out with friends whose families all bottle fed their babies, and left school with few qualifications or general interest in reading, then things could well have turned out very differently. This is the situation in the more deprived areas of the UK, where breastfeeding uptake rates are much lower than in better off areas, because new mums just don’t know about the importance of it, and why would they if bottle feeding is the norm where they live? It is in some of these more deprived areas that the trial is taking place, specifically because for mums to succeed in breastfeeding, they’ve got to know that it is even an option in the first place. If these vouchers address the uptake issue then that can’t be a bad thing, although I would still be concerned about the lack of support once they’ve started. According to the Lonely Scribe blog, Derbyshire, one county in which this trial is taking place, already has a strong network of good breastfeeding support available to new mums, so this should not be a concern here.

This blog also points out that the media reporting of this trial hasn’t exactly been to clear – it’s NOT a government  policy that is definitely going to be brought in across the country, rather it is a scientific study by researchers who are trying to assess how a financial incentive might impact public health and therefore whether it would be something the government could consider as they are ultimately in charge of the public health budget in this country. As breastfeeding has significant benefits to child and adult health, breastfeeding rates affect how much money will be needed later in babies’ lives in terms of their health.

As a researcher myself I understand the importance of setting up a study which will provide evidence for or against a certain hypothesis, and waiting for the results of the study before jumping to any conclusions. So that is what I should do with this trial too – wait and see whether it provides any evidence for or against the hypothesis that offering mums money to breastfeed increases breastfeeding rates in specific areas. I’m still not convinced that, even if evidence for this case is shown in the results, it could be generalised to other areas where breastfeeding uptake rates are higher.

A similar point of view of “wait and see” was expressed in the statement from Anna Burbidge, Chair of LLL Great Britain, on this study. She notes that LLL GB “will be looking with interest at this scheme to see if offering vouchers to mothers who breastfeed as a way of acknowledging the value of breastfeeding to babies, mothers and society, will increase the numbers of babies being breastfed.” If more mums breastfeed, then this would help make breastfeeding the norm, and help create a culture that encourages breastfeeding because it is the norm. So if this study shows that money can help in the areas where increasing numbers of breastfeeding mums is most needed, then great.

Breastfeeding seems to be one of those topics that reveals some very strong feelings in many mums – whether they did or didn’t do it. I’m sure that in the discussion of this voucher trial this week there have been many emotive comments from people’s experiences of breastfeeding, good or bad. My personal conclusion on what I’ve read about the trial is that it sounds ridiculous and far removed from how I myself see and experience breastfeeding, but I look forward to hearing about the results and whether this financial incentive could benefit mums in social circumstances different from mine. I’d be interested to hear what you think too.