Psst, here’s a bribe to breastfeed

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The contempt that lactivists evince for women who don’t mirror their own choices back to them beggars belief.

The latest example: an odious attempt to bribe women into breastfeeding.

According to the BBC:

Under the scheme mothers from specific parts of Sheffield and Chesterfield will be offered the vouchers, which they can then use in supermarkets and high street shops…

To qualify for the full £200 of rewards, the women will have to breastfeed until six months.

However, it will be frontloaded – enabling those taking part to get £120 for breastfeeding for the first six weeks.

Midwives and health visitors will be asked to verify whether the women are breastfeeding.

The team behind the project said breastfeeding was a cause of health inequalities, pointing to research that showed it helped prevent health problems such as upset stomachs and chest infections as well as leading to better educational attainment.

Dr Clare Relton, the Sheffield University expert leading the project, said she hoped the financial incentives would create a culture where breastfeeding was seen as the norm.

Bullshit!

Breastfeeding is a cause of health inequalities? An increase in colds and upset stomachs qualifies as a health inequality?

Do lactivists believe the crap that they spout?

There is NO EVIDENCE, zero, zip, nada, that breastfeeding is a cause of health inequities. There is no remotely plausible reason to believe such nonsense. Breastfeeding has real benefits, but for term babies those benefits are so trivial as to be limited to a population wide minor decrease in infant colds and diarrheal illnesses.

Furthermore, we KNOW that breastfeeding tracks with the real causes of health inequities: race, socioeconomic status, and education levels. When those confounding variables are removed, breastfeeding term babies doesn’t seem to have much benefit at all.

Bribing women will create a culture where breastfeeding will be seen as the norm?

Earth to lactivists: if you have to bribe someone to do it, you are sending the exact OPPOSITE message. You are sending the message that it is difficult, expensive and distasteful. Otherwise you wouldn’t be offering bribes.

Most importantly, there is NO EVIDENCE that either carrots or sticks works to get women to breastfeed. To my knowledge, not a single program specifically designed to increase breasting rates has actually worked. Bribing women with food didn’t work. Banning gifts of formula samples won’t work, and neither will locking up formula in hospitals.

So if bribing women to breastfeed won’t increase breastfeeding rates, why are lactivists promoting it? It’s because it is yet another way for them to demonstrate their contempt for women who bottle feed. Apparently lactivists believe that these economically deprived women are so stupid and so uncaring that they can’t be motivated by “educating” them on the benefits of breastfeeding. Lactivists assume that poor women love money more than they love their babies and therefore money will do the trick.

What is particularly execrable is that lactivists figure that these women are so poor and so venal that they can be bribed with trivial amounts of money. Offering £ 200 for 6 months of breastfeeding works out to slightly more than a pound per day. That’s a bit more than $1.50 per day. Is that really an incentive? It’s less than the cost of formula per day. If the money were really an incentive, those women would be breastfeeding already.

It’s particularly infuriating that lactivists refuse to use the money to address the real reasons for low breastfeeding rates. Breastfeeding is difficult, painful and often inconvenient. But acknowledging the reality of breastfeeding, and helping women to cope with real breastfeeding difficulties would involve admitting the truth about breastfeeding. Lactivists would rather pretend that women who don’t breastfeed are stupid and capable of being bribed with trivial amounts of money than to admit that breastfeeding is anything other than perfect bliss.

So a £ 200 bribe is going to be wasted in a doomed attempt to increase breastfeeding rates. What’s even more galling is how many ways it the money could be better spent to improve the health of infant. How about spending the money to improve the quality of British maternity care overall? According to SkyNews:

Between April and September 2012, more than a quarter (28%) of maternity units were forced to close their doors to patients for at least half a day because of a lack of space or a shortage of midwives.

Of these units, 11% closed for the equivalent of a fortnight or more, the report found.

The result?

A fifth of maternity services funding is spent on insurance against malpractice, according to a review by the National Audit Office (NAO).

The report found the NHS in England spent £482m on clinical negligence cover in the last year – the equivalent of £700 per birth.

The most common reasons for maternity claims are mistakes during labour or caesarean sections and errors resulting in cerebral palsy, the review said.

Public Accounts Committee chairwoman Margaret Hodge said the figures were “absolutely scandalous”.

“The current system is not working as it should,” she said.

“The Department of Health needs to buck up and take responsibility for this.

“It needs to review its monitoring and reporting process to ensure that all relevant bodies can work effectively together to deliver maternity services that are value for money and fit for purpose.”

The British maternity system is in critical condition and babies are suffering and dying as a result. Diverting money from maternity care to bribe women to breastfeed isn’t just loathsome, it’s downright immoral.

  • Basic maths isn’t hard.

    The single greatest leap in British maternity healthcare came during World War II, when rations were in practice, and pregnant women attending antenatal care received extra rations. It was a wonderful example of the carrot vs stick approach, and this comes from the same ethos.
    The NHS insurance bill is for the ENTIRE service, the majority of which are malpractice cases during SURGERY. Each birth in a home setting costs the NHS under £900, on a midwifery-led centre it is £1100 and on a consultant-led centre it is over £1300 (for the same birth – please see the Birthplace In England study for details) – including indemnity insurance.

  • Kayleigh Herbertson

    Few years back they gave “Fruit and veg” money to pregnant women to get them to eat better. That failed and so will this. It’s a test scheme and if it fails they will stop. You don’t seem to know how many women are getting this money so maybe you’re overreacting a tad with all the overblown finance arguments?

  • Chuck Cirino

    I’ve seen supermen. They are my sons. Each grew to be at least 5 inches taller than me, healthier than I was at their age, and of course they’re smarter. They rarely get sick or contract the flu. My oldest is the best-performing high school water polo goalie in Los Angeles county. They’re supermen. And they each breastfed until they were three years old. Never had a formula.You can listen to someone who’s had way too much education. Or you can look at real results. Your choice.

    • Mishimoo

      Wait, there’s such a thing as “too much education”?

    • Amy Tuteur, MD

      The plural of anecdote is anecdotes, not data.

    • Bombshellrisa

      A study that only involved three test subjects would hardly produce data that people could draw significant conclusions from.

      • Certified Hamster Midwife

        Especially when all three subjects are related. Maybe their “super” qualities come from their mom’s genes.

        • Bombshellrisa

          Let’s hope: isn’t it the mother who passes on the chromosome that determines intellectual capacity as well? Since she isn’t the one bragging about home birth or breastfeeding, maybe she has a trifle more sense than the father of her children.

  • Guest

    There was no amount of money that would have made it worth continuing with bleeding, cracked nipples that nothing invented by man could ever heal. Of course you couldn’t pay me enough to go through pregnancy or childbirth again, so I suspect I’m an outlier there.

  • yentavegan

    To state the obvious, infants whose mothers are breastfeeding or hand expressing breastmilk fair better during natural disasters.re; the Phillipines

    • Guesteleh

      Only if the mother was with her infant when the disaster struck, or if the mother wasn’t injured or killed, or lost her milk from the stress. Which is why even if you’re breastfeeding you should stock your emergency disaster kit with formula.

      • yentavegan

        stress does not cause loss of milk supply…dehydration of mother coupled with not emptying breasts causes milk supply to drop.

        • Lisa the Raptor

          Two things that might be hard to maintain during a natural disaster. Water and breast pumps. I do feel you here, but after having two emergency surgeries while nursing I totally support all babies being able to use a bottle and to take formula (because one usually has to dump after being on all those meds). At four months my first son would not take a bottle but I had to return to work. I left him with a saint of a baby sitter who finally got him to drink formula by doing something most would frown at. She rolled that nipple in pure sugar until he took the bottle. Hell, it worked, but it would have been easier had I just started him with it young.

          • Wren

            I never even thought of trying that! I kind of wish I had. My son was OK with a bottle but my daughter never did take one. I left her once at 4 months for 6 hours without me but with bottles of pumped milk. No way, no how would she take it and I felt awful when I got home.

          • Lisa the Raptor

            It worked well. In fact my husband used to roll my third child’s paci in sugar to keep him occupied while we did chores. He took about 15 minutes to suck off every grain. Poor third kids. How do any of them survive?

  • Name

    That kind of money is insulting to me. I am still breastfeeding after a year. It is a lot of work. Way to put a price on breastfeeding so now I can not get paid for all of the housework/childcare that I do and only get paid fractions of pennies for all of the hours that I have spent breastfeeding.

  • Wren

    I don’t know who thinks this is a good idea. Even the lactivists I know here in the UK aren’t happy about this.

  • Hannah

    On topic: hey if I’d sign up. If I can’t I can’t, but if I can, hey, free money! Though if can’t, the first shaming word out of any nurse’s mouth and they’d be kicked out immediately.

    Off topic: http://www.mcsweeneys.net/articles/jamie-and-jeffs-birth-plan I love whoever wrote this.

    • Certified Hamster Midwife

      The last line is devastating.

      • Hannah

        It is. Both the saddest line in there and the most stunningly brilliant satirical sentence ever written.

  • fiftyfifty1

    I have to quibble with 2 things:
    1. There has been at least one large-scale intervention that has successfully increased breastfeeding rates: the Belarus PROBIT study. IIRC they used a lot of techniques that are part of being a “Baby Friendly” hospital and it worked. Then again, the background rate of breastfeeding prior to the intervention was lower than the rate is here in the U.S. In the U.S., the low lying fruit has already been picked.
    2. Modest bribes have actually proven very effective in changing the behavior of poor people. In my state, many of the Medicaid managed care programs offer $20 bribes to bring babies in for their shots. Works like a charm.

    • FormerPhysicist

      It’s a LOT easier to bring a baby in for shots (once, five times?) than to breastfeed multiple times every day for 6 months.

    • Young CC Prof

      But $20 to run an errand is worth it. It’ll pay for the bus and your time. If the doctor’s office is relatively close, it’ll even cover a cab.

      A modest financial reward will get you to do something simple. I don’t think it’ll get people to commit to breastfeeding.

      • Kumquatwriter

        $20 wouldn’t even cover the damn copay here.

        • fiftyfifty1

          There is no copay for well child checks under Medicaid, and Medicaid also covers the cab to and from the clinic.

          • Kumquatwriter

            I was just grumbling – obv am not eligible for any free money just for, you know, parenting.

      • fiftyfifty1

        I agree that breastfeeding is quite different than bringing in a baby for shots. A bribe may work for breastfeeding or it may not, time will tell. But Dr. Amy actually argued that bribes would *backfire* because “You are sending the message that it is difficult, expensive and distasteful. Otherwise you wouldn’t be offering bribes.” That’s the part I quibble with because in my experience with the bribes for shots, it didn’t backfire at all. It didn’t cause the parents to view shots in a bad light or start asking suspicious questions or anything bad. They just started showing up for well child checks where before they hadn’t. Dr. Amy thinks it’s insulting to assume that that “women are so poor and so venal that they can be bribed with trivial amounts of money”. Perhaps it is insulting, but it’s also true.

        • Antigonos CNM

          There is a vast difference between a planned intention, committment, and practice. I saw this on home visits. In hospital, very few women, when asked, [especially when asked in a way that implied that admitting to wanting to bottle feed would be a wrong choice] would tell the questioner [in this case, a person of authority such as the ward sister] that they wanted to give their baby a bottle. The minute they were out of the hospital, that changed, with a substantial number immediately changing to formula, and an additional, and larger number stopping breastfeeding before 3 months were up, as family responsibilities and work made it increasingly onerous and time-consuming.

          Going for shots is an investment of maybe an hour of a woman’s time. It isn’t a 6 month committment.

          • Clarissa Darling

            $20 to hit the gym once–OK! $200 to train for a marathon–not so much.

    • DiomedesV

      Of course bribes can be effective. Anyone who thinks differently is naive.

      In this case the bribe will ineffective because it’s simply not enough money. I would think they need to at least triple the offering.

      It’s not a matter of whether people can be bribed. It’s a matter of how much the bribe needs to be.

  • rh1985

    I never had a drop of formula, I was breastfed until 9 months then I got cow’s milk (the horror) because my mother was done but I hated formula so the doctor let her try whole milk in a bottle instead. I had constant colds as a baby and child which continued into adulthood. I feel ripped off! Where is my magical immunity?

    • Zornorph

      Your mum forgot to baby-wear.

      • KarenJJ

        You had a hat on your head as an infant which caused your mum to forget about you and/or hate you?

        • Pillabi

          I’ve read several times here this thing about “wearing a hat” but I don’t grasp the meaning of it; can someone please explain it to me? I feel like the one who hasn’t understood the joke while everyone else is laughing… 😉

          • Young CC Prof

            Some extreme natural-childbirth advocates claim that putting a hat on the baby right after birth will interfere with bonding, by preventing the mother from smelling the birthy smells, whatever that means. Look up “no hatting, chatting or patting.”

          • Pillabi

            ok thanks! as far as I know, this bright idea has not yet arrived here, but I’ll ask the “all natural lotus homebirth mothers” I know for more information…

          • Pillabi

            OT!

            While looking up “no hatting, chatting or patting” I ended here:

            http://drewstarr.wordpress.com/2012/03/16/the-limbic-imprint/

            I already regret the ten minutes I’ve spent reading the amount of crap this article is full of (it could be summarized in “the world would be perfect and humankind peaceful and happy if only there weren’t unnecessary medical interventions in pregnancy and childbirth”), nevertheless I feel somewhat curious about this premise:

            “The limbic lobe is not directly connected with the cortex. During gestation, birth and early childhood, the limbic system registers all of our sensations and feelings, but cannot translate them into memory, because the cortex hasn’t developed yet.
            Nonetheless, the echo of these sensations lives in the body throughout the rest of our lives, whether we realize it or not.”

            Does this all make sense from a scientific / biological point of view? Whenever I come across theories about the limbic system I’m totally puzzled, I don’t have the knowledge to determine if it’s all crap or if there is scientific basis to it. Can you help me?

          • Young CC Prof

            The idea that chronic stress in infancy or early life has an effect on brain development makes a lot of sense and has substantial evidence behind it, regardless of the precise mechanism. However, the kind of stressors that affect children this way are things that everyone knows are bad, like ongoing malnutrition, abuse or neglect.

            As to what the actual article is claiming: Natural birth is incredibly stressful for a baby. Most of them are born a bit blue around the edges from oxygen deprivation, faces squashed from the birth canal. The entire skull is slightly squashed. Then, once out, the stress ain’t over, because they have to reroute their entire circulatory system in under a minute. The fight to open their lungs for the first time must be awful. Still, they’re built to handle it. The skull flexes to fit through the birth canal, and it’s the stress hormones in their bodies than help open those lungs in the first place.

            In short, nothing that normally happens in a delivery room could possibly compete with what the baby’s already been through on the stress scale, and folks who claim otherwise are just demonstrating their profound ignorance of what birth is actually like.

          • Pillabi

            But what about the “limbic stuff” itself? Is that science or pseudo-science?

          • Young CC Prof

            Limbic imprinting is a common theory among the more new-agey antiscience types, but it’s probably not real.

            Physically, stress affects babies and toddlers through limited growth in stature and in nerves. Also, neglected babies don’t feed as well, and don’t develop verbal and motor skills well. None of this requires hidden changes in the limbic system, though.

          • Pillabi

            Thank you for the explanation. I’ve elected you my scientific advisor 😉

          • auntbea

            Don’t worry. We don’t have all that many inside jokes here. Just the same few we play over and over. 🙂

          • Susan

            Oh and if someone mentions Unicorn Scouts it’s sort of synonymous with Crystal Gazing Granolaphile.

    • palma fm

      I am currently breastfeeding my son of 5 months who has a throat and ear infection and I honestly got told yesterday that its strange that hes sick because I’m still bfing. Sorry baby no magical immunity for you either.

      • rh1985

        I actually have a terrible head cold right now. So fun being sick while pregnant! (not)

  • Adelaide GP

    I don’t like it when a government policy forces health care workers to “police” it at ground level. It interferes with the therapeutic relationship, for example what if a domiciliary midwife had more important concerns eg had detected post natal depression and wanted to help with that but yet at the same time had to “report” that the mother had not been breast feeding and therefore take away her 120 pounds. It might be enough to make the mother not trust the midwife and therefore hide more worrying signs of other problems.

    • KarenJJ

      Good point, what if someone delays necessary medication to breastfeed?

  • thepragmatist

    I just want to respond to your first sentence with a responding YES, BULLSHIT! I busted myself over breastfeeding my son. He had lots and lots of breastmilk, nursing at times EBF and later, 6-7 times a day with supplemental formula. This kid is home sick today from daycare. He has been sick since the start of the school season. He has had croup, an ear infection, two colds, and a sinus infection– all in two months. He nursed until almost 2. I ruefully told his daycare provider that I expected better for all the breast milk. I guess mine were lacking the sparkles. OR it might be that he started daycare again… it appears to me that he has just inherited my side of the family’s staggering lack of immunity to illness. Sorry buddy. But yes, BULLSHIT! One of the biggest reasons I pushed and pushed myself to breastfeed is that I had terrible, terrible illness as a child, nearly costing my mother her job. One school year I missed nearly two months of school in total. Looks like we’re headed that way over here. I was formula fed (my terrible mother wanted to finish her law degree) and he was mostly breast fed and I would even go as far to say his socioeconomic circumstances were better in many ways… and here we are…

    • araikwao

      I can sympathise. My son has had back-to-back colds the last 3 months, with and ear infection and a UTI thrown in there just for fun. So much for all the IgA 🙁
      Edit: and he’s not even in daycare yet..

  • Lynnie

    Slightly off topic, but it still applies because the breastfeeding/respiratory infection “link” was mentioned in their reasoning. We just got home yesterday from a 2 day stay in the hospital because my 3 year old son had a lung infection that could have easily escalated into full blown pneumonia. They asked if any of us smoked, they asked if he was in daycare, they asked if he had brothers and sisters, they asked all sorts of questions. They NEVER asked if he was breast or bottle fed (both actually for his first 6 weeks, then bottle after that). He was only really sick, beyond like colds and a few days of stomach flu, only once before and I was sicker than he was. There is just a very nasty infection that is going around and for some reason it settled in my son’s lungs. He’s fine now, sleeping off the nasty germs and the stress of being in a hospital.

    On to the topic of bribing mothers to breastfeed. I’m sure if I told my son when he was a newborn that we would get some money if he would just latch long enough to breastfeed, he would have. I’m sure that if I told my breasts, who never really did like giving milk, that if they would just keep producing we would get some money, they would have rallied together to keep up with production. I was a pumper, an barely made enough milk his first week, and after that he kept requiring more and more formula even though my supply was dropping off no matter how hard I pumped. Sure, I probably COULD have tried harder to breastfeed, but I was turning into a basket case from the stress and the lack of sleep and the hours and hours I spent pumping and not doing anything else, even hold my baby got to me. I tried to pump and hold him, didn’t work.

    Well, I’m rambling.

    • Amy M

      Ugh, so sorry your son was sick, and glad he is feeling a bit better now. About 3yr ago, my whole family got a nasty upper respiratory virus that did lead to full blown pneumonia for me and one of my sons, who was at the time, almost 2. You know why? Because we have asthma. You know why? Because it runs in the family. I am not at all convinced that (either of us) being breastfed would have led to a different outcome there. And even if we weren’t asthmatic, sometimes, shiat happens, you know? Viruses can be really, really awful even to the healthiest of people. 1918 Spanish flu, anyone? Breastmilk didn’t do anything to help anyone in that lovely epidemic.

      • thepragmatist

        My brother and I couldn’t be more different. His wife did everything PERFECTLY. Breast-fed their girls, eats organic, no smoking anything ever or near smoke, in a much higher income bracket than me, and guess what… our genetics seem to be much stronger than any of that… his girls are actually more sickly than my son, although my son is now giving his girls a run for their money. Both girls have been in and out of hospital with pneumonia this year and my boy has been at home more than he’s been out– he even missed Hallowe’en. And me, I get pneumonia just looking at a box of Kleenex.

        • Amy M

          Yeah, I don’t think it matters too much what a baby eats, once they are exposed to a new population of children, they’ll catch all the bugs their immune systems have never “seen” before. It seems to take about 2yrs of exposure to the general local population before the rate of infections falls to the lowest common denominator (everyone is going to get a couple of colds no matter what you do.) I saw this with a friend whose daughter was rarely sick when she was with grandma all day, but then went to daycare/preschool when she was about 2.5yrs old at which point, she was sick all the time for about 1.5-2yrs. My boys were in daycare from 3mos old, and starting around 6mos old, they were sick all the time until about age 2.5yrs. I know those are anecdotes, but they are examples of what I have seen over and over with everyone I know with small children. The pediatrician confirmed this theory once when we in his office for some ear infection or other.

          • KarenJJ

            We’re just getting past this now that my second is 2.5years. It’s been a rough couple of years for illnesses. We had a weekend where both my husband and 2yo were feverish and very unwell (and I was in my first trimester and worn out and anaemic) which ended up being pneumonia.. Probably one of our worst weekends aside from the gastro bugs.

          • Courtney84

            This for sure. More anecdata: one nephew started daycare just shy if three years (switching from a retired in-home couple). He had 17 (SEVENTEEN!) bouts of “vomit virus” in the first 15 months. That’s a lot of puke.

          • Young CC Prof

            I think that’s pretty much the rule. Whenever you send your kids “out,” whether it’s to daycare at 3 months or nursery school at 3 years or kindergarten at 5, they’re going to get sick over and over again until they adjust.

            Still, I’m going to see if we can avoid group daycare for the first year. It’s easier for a toddler to handle that sort of thing than it is for a tiny infant.

          • Amy M

            6 of one, half dozen of the other, as long as we’re talking colds and not serious illness like pneumonia. They all get cranky, sniffly, snotty, don’t sleep well at night and get you sick.

          • AmyP

            Yes, the size of the child makes a huge difference.

            Just before the rotavirus vaccine came out, my 3 year-old and my around 10-month-old infant both got it. They weren’t feeding and rapidly got dehydrated. When we went to ER with the 3-year-old, they put her on an IV with fluids in the ER and they plumped her up good in just a few hours. Meanwhile, when it was the infants turn, he had to be put in the hospital for the night to rehydrate. Same illness, dramatically different results. Oh, and the infant was breastfed at the time. Big sister was in preschool, though, and that’s how the whole thing happened.

            Yay, rotavirus vaccine!

          • Young CC Prof

            I was thinking just the other week, the only major illnesses that marred my childhood or those of my brother, classmates and cousins: Flu, meningitis, chicken pox, rotavirus. And what do those 4 have in common, class? Yup, they’re now vaccine preventable.

            That’s… actually really nice to know.

      • Spanish Flu was special- it was actually worse for people with healthy immune systems, because it overstimulated the immune system so much that healthy people went into cytokine storms while sicklier people were less likely to have that much of an immune overreaction.

    • Young CC Prof

      You know why they didn’t ask? Because they know perfectly well that breast milk has no effect on the immune system of a 3-year-old! Infant, maybe, but it’s marginal. By about 6 months, there are very few maternal antibodies left whether you breastfeed or not.

    • thepragmatist

      I think we have this as well. My brother’s kids have been in and out of hospital since the school year started and my kid has missed most of his daycare days since September. I ended up with pneumonia at one point. My neighbour is now on her way there. It’s been a vicious year. And I hate to see what happens when influenza really arrives on the scene for the year, with all these people who have already been super sick. This has been a bad year for my friends too.

    • Something From Nothing

      It’s the intrinsic message that if you are a good mother, you will give your child breast milk that makes otherwise rational women make irrational choices when it comes to breastfeeding. I know you felt like you were rambling, but what comes through in your post is the recognition on looking back at how ridiculous it all seems, and how we just keep on keeping on, until one day we sort of think, “what the hell am I doing this for?” I pumped way past the point of obviously dwindling supply, took medication to boost milk supply, you name it. I was really upset when my first baby refused to latch at 8 months. Now I think, why? It seems that even when we know rationally that it’s ok to give your baby formula, that ” good mother” message sure does toy with our emotions. And so do the droves of women seemingly lined up to tsk tsk at our choices. It’s a strange culture.

      • It is a very toxic culture. One that needs to (quite desperately) change.

      • palma fm

        That message is everywhere…even the most rational person will believe it. And even though I had no problems with giving my son formula I STILL pumped 2-3 times at work and twice in the night for over a month just to be able to give him expressed milk at daycare instead of just supplementing from the get go.

      • Clarissa Darling

        I agree. I did my best to do real research and make a truly informed decision regarding formula. I told myself I wouldn’t feel guilty but, lately I’m finding it impossible not to. Since he’s been born I’ve been looking for advice on formula feeding as he’s been a little fussy-do I need to switch brands, bottles, try a different feeding position etc….. Ironically the best site I came up with was from and LC. It had lots of good suggestions on bottle feeding but, also came with all the regular caveats- formula is not sterile! formula is expensive! formula is inconvenient! breast milk is best! Still want formula? Ok here is what you do…… It’s kind of like having the worlds most annoying personal trainer following you around saying “are you *sure* you want that chocolate cake?” How could you not feel guilty?
        PS. I know rationally that formula is NOT the nutritional equivalent of junk food so many the chocolate cake analogy was a little off…….

    • MichelleJo

      I noticed the same thing. Over the two years of getting our daughter evaluated and diagnosed (she is autistic), we were asked all sorts of weird and wonderful questions, but never was I asked what I fed her as a baby, or about painkillers or other procedures during labor. They were interested in the peri-natal period which makes sense.

      • Young CC Prof

        That does make sense. If, for example, a baby is oxygen deprived during labor to the point of being born totally blue and needing resuscitation, that could definitely cause developmental delays. But yeah, the other stuff is pretty irrelevant.

  • Carolina

    I cannot imagine $1.50/day would be enough to incentivize me to do something that I did not want to do, even back in the days when I was a poor student. Unless someone is direly impoverished, this is no incentive

  • That’s a pathetic bribe. Fetishists will pay a woman WAY more than £200 to lactate.

    • Zornorph

      I actually watched a lactating porno movie once. It was called ‘Battle of the Ultra-Milkmaids’.

      • The Bofa on the Sofa

        Rule 39.

  • DaisyGrrl

    This is so freaking insulting to women. What do they tell women who want to breastfeed but can’t for medical reasons? Sorry, no $$ for you, your body is defective?? I imagine the reasons behind the low breastfeeding rate are complex and rooted in socio-economic factors that have a far greater impact on baby’s health than breastfeeding.
    What about women with HIV, or women on medication that is contraindicated for breastfeeding? What about illicit drug users? These are not women who should feel bad for formula feeding. They are making the best possible choices for their babies, even if it doesn’t jive with some stated public health goal.

    • Amy M

      Seriously. Way more important to get your child to eat a healthy breakfast, get a good night’s sleep and get to school on time than whether or not it is breastfed. I realize those issues are for older children, but by then, how they were fed as infants is totally moot, and I would suspect that way more children have issues related to hunger and poor sleep habits than lack of breastmilk.

  • Zornorph

    The real problem isn’t even the pounds that the limey lactavists want to give the poor mums to breastfeed, but the amount that this program is going to actually cost to run and administer. Who keeps track of all of it and issues the pay? And what makes you think that midwives/health visitors will even be able to tell if the kid is EBF or if there is supplementation? The Minister of Health is Jeremy Hunt, who, when he was the Culture Minister, a radio announcer famously messed up his name during a live broadcast – calling him Jeremy ‘C’unt. Somebody needs to write him and tell him not to act like one and cancel this program now.

    • Antigonos CNM

      Based on my experience of home visiting in the UK, I can’t imagine how midwives [who hand over to health visitors on the 10th postpartum day, as required by law] or the home visitors can actually certify that a woman is nursing or not. Search the home for bottles? Force the mother to submit to having her breasts squeezed to see if she’s still producing milk? Check the baby’s stools to see if they are the characteristic stools of a breast-fed baby?

      • Kate B

        They ask women to sign contracts saying that they are breastfeeding, and have breastfed for x amount of time.
        Of course, that is ridiculously open to abuse.
        Not that I would have a problem with women who DO abuse this scheme. Such a patently unfair and unworkable scheme is just ASKING to be abused.

        • Amy M

          Plus, most of it can be gotten for BFing for the first 6wks…the last 80 is for the last 4.5months. While I sort of see this logic, since it seems the first 6wks are the hardest, and after that things are generally easier if it is going to work out, anyone struggling will say “well, 120 ain’t so bad, thanks (20lb/week)!” and move on. Because that front-loading scheme makes each week past the first 6 worth about 4.4lbs (euros? what is that denomination)…total waste of time.

      • Dr Kitty

        I know of a family in Belfast that “rented out” their asthmatic children any time someone came to check that the people claiming DLA for asthmatic children actually had asthmatic children.

        If there is a way to fiddle the system so you can feed the baby formula and still get paid, believe me, someone will do it.

        *Sigh*
        If you want to increase BF rates in areas of socio-economic deprivation you need to make those women WANT to breastfeed. £200 won’t do it.

        Most of my female patients who don’t breastfeed actively choose FF.
        Because they think BF is icky
        Because they view BF as a chore which cannot be delegated
        Because the idea of BF in public weirds them out
        Because they want to be able to go out drinking with their friends and leave baby with granny or daddy
        Because they have FF siblings and cousins and are familiar with it
        Because BF hurts, and is hard work and inconvenient
        Because FF babies sleep through the night much earlier

        Work on all of those things.

        • Kate B

          Dr Kitty – I live on a council housing estate where the majority of people are in receipt of welfare benefits.
          Although I find lactivist tactics of shaming women who choose not to or are unable to breastfeed reprehensible; I certainly haven’t experienced any of that pressure.
          In fact, where I live, breastfeeding is regarded as a bit icky. A friend I have coffee with made it plain that she would have asked me to leave if I’d attempted to breastfeed in front of her sons; for example.
          When I do chat to other women about breastfeeding, the reasons you’ve mentioned all seem to play a huge part.
          Breastmilk might be seen as liquid gold in more middle class circles, but breastfeeding has not been ‘normalized’ in more deprived areas and I do think we need to work on changing that.

    • Kumquatwriter

      Totally OT… I went to high school with two unfortunately named kids – Michael Hunt and Shelley Hunt. Man, and I’d thought “FlabbyWhale” was an unfortunate nickname (was going by Abigail at the time) …

      • Jennifer2

        Mike Hunt? That is really, really unfortunate. It’s like his parents didn’t even try to sound it out first.

        • Kumquatwriter

          And nobody seemed to notice Shelley rhymes with Smelly. What a sad family. Also knew some kids who were named after different shades of green (which was their last name).

          • Jennifer2

            Kelli? Hunter? Forrest? Olive? Lime? Grass? Okay, I’m getting a little silly there…

            But I clearly went for the easy one and didn’t even think about rhyming Shelley with Smelly.

          • Kumquatwriter

            It was a weird school.

          • AmyP

            I kind of like that–it’s interesting without being obvious.

    • thepragmatist

      You know what would be great? If they gave that money to poor women so they and their babies could eat well. But then they’d have to value women and babies over ideology.

  • Josephine

    Gosh, for about $400 US you could do so much more. What about a groceries voucher just because to help out new mothers under a certain income that they could use for formula or regular food? A box with some seasonally-appropriate clothes, blankets, and crib sheets, or even a crib for heaven’s sake? I’m just spitballing here but there are so many other ways to actually provide social benefit to low income families. Ugh.

    • Antigonos CNM

      British moms actually do get — or did get, in my day — an extra couple of pints of milk a week [for them, not the baby] and there was something called a supplemental allowance which was dependent on having given birth, not how one fed one’s baby.

      • Sguest

        If you’re on a low income you are entitled to “Healthy Start” vouchers which are only to be spent on milk, formula, fruit and veg. I think that you can get them until the baby is 4?? Mothers also have free prescriptions and dental treatment whilst they’re pregnant and for 1 year after the baby is born. In Scotland all prescriptions are free anyway.

        • Kate B

          Yep,. we get free prescriptions in Wales too which is fab.
          Healthy Start vouchers are offered up to age 4, but they decrease in value when the child turns 1.
          What’s so frustrating is that, under this scheme, wealthy middle class mothers will get to congratulate themselves for being so much better at parenting than the rest of us with 200 pounds worth of tax-payer vouchers that they don’t even need and will probably see as a fairly trivial amount of money.
          Wheras, to a low-income mother who is formula feeding, 200 pounds could make the difference between her having to choose whether to switch on the electric or feed her baby.

      • Kate B

        Healthy start vouchers are 3.10 a week during pregnancy, going up to 6.30 a week for the first year after birth, then going back down to 3.10 a week for the following three years.
        The vouchers can be spent on milk, infant formula and fresh or frozen fruit and vegetables.
        But it doesn’t cover the cost of formula, it just supplements it.
        The idea if you are breastfeeding is that you can use the vouchers to nourish yourself because you won’t have to buy formula with it.

    • thepragmatist

      YES!

  • The real shame is that there is probably some economist who has done some study on the cost of not breastfeeding – and has then established an amount of bribe that is “cost-effective”, based on fairly wild assumptions about the impact of the intervention on breastfeeding rates and the impact a change on rates will have on those health inequities (again based on some rather faulty lactavist research).
    Meanwhile in Canada (BC) some health human resource modelers actually like to play with a scenario where 100% of low risk women are delivered by midwives. Despite the obviously awful results this seems to have had in both the Netherlands and the UK.
    I still think if this were a men’s health issue it would be handled entirely differently. There’d be no agressive campaigns to have “lay” urologists provide critical services. There’d be a whole lot more informed consent – and a whole lot less shaming for “less than ideal” choices. But because it’s women it seems like there’s a lot of appetite to minimize resource use even at the expense of our health and well-being…

    • Young CC Prof

      Yes. THAT is what bothers me about the news I’m hearing regarding the UK and a few other places. It’s not just that natural childbirth ideology is getting too much time, it’s actively being used as an excuse to justify cutting costs and denying necessary resources. Sometimes, by people who know perfectly well that babies will die as a result.

      What the hey, save money on 2,000 deliveries, lose one baby who absolutely never had to die. Acceptable losses. Oh, wait, not dead, just brain damaged? Going to cost NHS millions? Ooops.

  • omdg

    Actually, relative to other interventions, paying someone to adopt a particular health behavior, whether it be quitting smoking, losing weight, or (in this case) breastfeeding) has been remarkably effective at changing behavior. The question is whether it is “worth it” (i.e. cost-effective) from a societal standpoint.

    • Paying needy women to do something with their bodies that they otherwise would not be willing to do — it’s a grand tradition!

  • Young CC Prof

    If you really want to bribe low-income parents to make good choices, try bribing them to bring children to well-baby or dentist appointments. That actually works, since any mother should be able to get the baby to appointments, it’s just a question of time, organization, and transportation. Not all mothers CAN breastfeed.

    • thankfulmom

      They do that already with medicaid & Healthy Start. Coupons to local stores are offered when mothers attend all their prenatal appointments and take their babies in for vaccinations.

      • Kate B

        No, that’s not how Healthy Start works at least not in the UK. You don’t have to attend any appointments or anything like that to receive Healthy Start vouchers; you just have to be on a low income or under 18.

        • thepragmatist

          That’s how it works here. The Healthy Baby program requires attendance: and you will receive 10 dollars a session that can be used to buy fresh produce and the like at a local store. I just thought, cool, that’s handy, because I was actively using the service for my own health (I needed additional support)….

          • Kate B

            If they want to address health inequalities through bribery, that sounds like a much more effective way of doing it!
            Ensuring babies attend appointments, receive vaccinations and that mothers are getting all of the support they need seems like a much better way of addressing health inequality.
            We have programs called :’Sure Start’ or ‘Flying Start’ which offer childcare, parenting courses, more intensive health visiting, play schemes, classes for mothers/families (cookery, positive parenting, language and play etc), personal family support workers etc in the UK. I think this money would be much better spent by encouraging families to get involved with these sort of services.

        • thankfulmom

          Kate B., I was talking about Healthy Start here is in the US.

  • LynnetteHafkenIBCLC

    I’d really like to know how the health visitor is going to determine whether or not the baby is breastfed.

    • Something From Nothing

      They just look at it. Breastfed babies look smarter, wiser and more content in general. Formula fed babies have a vacant, unloved look…

      • Sguest

        Formula fed babies will be kept in sheds and kennels in the garden whereas breastfed babies are sewn into the mothers jumper using silk thread and glitter. Obviously.

        • AmyP

          No, breastfed babies are carried in a naturally occurring pouch, kangaroo style.

    • Amy M

      They’ll look for the Neglect-o-bot in the corner.

      Seriously though, I was wondering this too…if any supplementation occurs, even one bottle, do they make the women pay back the initial pay out and refuse them the rest?

      • Clarissa Darling

        Uh oh I’d better hide my Neglect-o-bot! I could use the $200, that thing was expensive.

    • Happy Sheep

      They will know only if the mother is topless or has the baby stuck to her the entire visit, or when she complains of pain or lack of sleep. If they hear the phrase AP, they won’t even need to ask.
      They will then check the cupboards for the work of the devil: formula or bottles. They may even search the whole house, if so much as a pacifier is found, no money!!!!

      • realityycheque

        I wonder how they get around women claiming that they’re pumping whilst actually giving their babies formula.

        I wouldn’t think it would be terribly difficult to hide the formula tin when the nurse came by and have a hand-held pump conveniently lying within view, all the while giving your baby the ‘inferior substance’ in a bottle and pretending that it’s breastmilk.