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Trial to test shopping vouchers as breastfeeding enticement

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Researchers have announced the wide-scale expansion of a trial in which women are offered shopping vouchers for breastfeeding, following success in a pilot study.

The pioneering project aimed at boosting breastfeeding rates in areas where levels remain stubbornly low will be tested in a large-scale trial by the universities of Sheffield, Dundee and Brunel.

“We have been delighted to see how enthusiastic local mothers and healthcare professionals have been”

Clare Relton

The NOurishing Start for Health (NOSH) scheme offers women £120 of shopping vouchers if they breastfeed their baby for up to six weeks and a further £80 if they continue for six months.

Breastfeeding rates in the UK are among the lowest in the world, with six to eight week breastfeeding levels as low as 12% in some areas.

The wide-scale trial builds on the success of the initial feasibility phase, launched in November 2013, involving over 100 women in three areas with low breastfeeding rates in Derbyshire and Yorkshire.

Over half of all eligible mothers signed up for the scheme, with almost two thirds claiming vouchers for breastfeeding their baby at six to eight weeks. The findings from the pilot study were published this week in The Lancet.

“Incentivising public health behaviour through monetary reward will always be contentious”

Cathy Warwick

Mothers reported that they felt acknowledged for their effort, with one mother describing her experience of the scheme as “getting something good for doing something good”.

In the feasibility phase, more than 50 midwives and health visitors helped women sign up to the scheme. They co-signed the forms used by breast-feeding mothers to claim the shopping vouchers.

One Sheffield midwife said: “I don’t think it’s difficult to tell if a woman is breastfeeding, as you are talking to them about breastfeeding anyway.”

Mothers taking part in the project reported spending the vouchers on groceries as well as nappies, baby clothes and toys. Some women used the scheme to set personal goals, and saw the vouchers as a reward for breastfeeding to two days, 10 days, six weeks, three months and six months.

University of Sheffield

Clare Relton

Lead investigator Dr Clare Relton, from Sheffield University’s school of health and related research, said: “We need to conduct the full trial to find out if offering vouchers for breastfeeding can significantly increase our stubbornly low breastfeeding rates and be a cost effective use of UK public funds.

“Last year, there was a lot of controversy about the scheme and we didn’t know if it would be acceptable, so we have been delighted to see how enthusiastic local mothers and healthcare professionals have been,” she said.

The forthcoming trial will now offer the NOSH Scheme to more than 4,000 mothers in Yorkshire and Derbyshire.

Cathy Warwick, chief executive of the Royal College of Midwives, said she would be interested in seeing initial findings from the study, given the “serious need to improve breastfeeding rates”.

Royal College of Midwives

Cathy Warwick

But she added: “Incentivising public health behaviour through monetary reward will always be contentious.

“The RCM believes that alternative ways of increasing breastfeeding rates also need attention,” she said. “There are also many innovative projects across the country that are improving breastfeeding rates such as using peer support groups.

“Women also need the right levels of postnatal advice and support,” she said. “This will not happen without the right health professionals in the right places.

“Investing in midwives and improving antenatal and postnatal care will go a long way to reversing the worryingly low levels of breastfeeding that we are seeing in some communities,” she added.

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