Breastfeeding Incentives: a pilot scheme with young parents

As part of the nutrition outcome, Small Steps Big Changes (SSBC) delivers a breastfeeding incentive voucher scheme to encourage breastfeeding

We know that a significant drop in breastfeeding occurs in the first six weeks of life. According to 2018/19 data breastfeeding rates at birth in Nottingham (58.7%) are lower than the England average (67.4%) with lower rates still in some of the more deprived parts of the city; half of babies in the city aren’t receiving any breastmilk at six - eight weeks old. 
Breastfeeding has a positive impact on both the short and long-term health and development of children and their mothers. UNICEF report that increased breastfeeding rates would contribute to significant savings to the NHS; breastfeeding provides protective factors to babies and children [First Steps Nutrition 2023]. 

Previous research has shown that financial incentives in areas of low breastfeeding can increase the number of babies being breastfed.  The 2018 NOSH trial in neighbouring South Yorkshire and North Derbyshire showed that breastfeeding incentives had a modest but significant effect on breastfeeding continuation rates at six to eight weeks. 
Building on this evidence, we wanted to consider whether an incentive scheme could impact on breastfeeding rates in Nottingham. Using a ‘test and learn’ approach, the aim was to determine whether financial incentives would contribute to more children receiving breastmilk at birth and on the continuation rates, to understand the impact of breastfeeding parents feeling valued for their efforts.

The pilot scheme has been delivered with the Family Nurse Partnership since March 2022. Family nurses support first time mum’s and babies up to the age of two years who are under the age of 19 with their transition to parenthood.
Young parents receiving the support of a Family Nurse received a £20 digital voucher if they were providing breastmilk to their baby.

To date the pilot has supported 60 families, who have received 178 retail vouchers totalling £3,560. 
Unfortunately, the cohort was not large enough to offer any statistical analysis when comparing breastfeeding rates, but the qualitative evaluation has offered some powerful insights. Nottingham Trent University Centre for Children and Young People completed an evaluation of the pilot exploring the young mothers’ perceptions and experiences of the incentive scheme and what influenced their infant feeding decisions.

Parents told us a financial reward was appreciated, but the validation it gave them was more valuable. The incentives were successful when provided alongside support with breastfeeding. A combination of support and the voucher was particularly validating for those who had experienced trauma. Some parents shared that they had become advocates for breastfeeding and had shared their knowledge with their friends. The Family Nurses who delivered the pilot felt the vouchers were well received by families and supported them as a team to have conversations about feeding decisions. 

A recent workforce online survey running from October – November 2023 also identified some key learning from six Family Nurses delivering the breastfeeding incentive scheme. There was some indication that the incentives could encourage women to ‘give it a go’ particularly if they had not thought about or planned to breastfeed. One Family Nurse told us that the incentives helped her to have discussions around breastfeeding with the younger mothers, which they otherwise would not have wanted to engage in due to finding it ‘too embarrassing.’ Another Family Nurse said that she also encouraged mothers who had not started breastfeeding in the hospital to try it by offering them the vouchers, and that some of these mothers eventually mixed-fed for a couple weeks.
Family Nurses also mentioned how mothers had used the vouchers for breastfeeding equipment, such as ‘buying an electric breast pump or a comfy breastfeeding pillow which they wouldn't have brought otherwise.’ 

With this learning in place, SSBC is now working with partners to identify means of extending the pilot in Nottingham to further explore the effect incentives can have on increasing breastfeeding initiation and continuation rates whilst supporting feelings of recognition and validation for parents. 
Jill Smith, Senior Project Officer, Small Steps Big Changes 

References
First Steps Nutrition Trust 2023 Costs-of-IF-FOF-and-milks-marketed-as-FSMP-available-over-the-counter-in-the-UK_April_2023.pdf (infantmilkinfo.org)
UNICEF, 2023 The benefits of breastfeeding - Baby Friendly Initiative (unicef.org.uk)
Family Hubs and Start for Life Programme Guide (publishing.service.gov.uk)
Effect of Financial Incentives on Breastfeeding A Cluster Randomized Clinical Trial Clare Relton, PhD; Mark Strong, PhD; Kate J. Thomas, MA; Barbara Whelan, PhD; Stephen J. Walters, PhD; Julia Burrows, MA; Elaine Scott, MPhil; Petter Viksveen, PhD; Maxine Johnson, PhD; Helen Baston, PhD; Julia Fox-Rushby, PhD; Nana Anokye, PhD; Darren Umney, PhD; Mary J. Renfrew, PhD 2017