Early results from the “bribe a woman to breastfeed” trial


I first wrote about the “bribe a woman to breastfeed” trial a year ago.

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.

The early results are in and lactivists are calling them promising, but if this is what “promising” looks like, I’d hate to see failure.

According to the BBC:

Initial results of a controversial scheme offering shopping vouchers to persuade mothers to breastfeed have shown promise, researchers say.

Mothers in three areas of Derbyshire and South Yorkshire where breastfeeding rates were low – between 21% and 29% – were offered vouchers of up to £200…

Of the 108 eligible for the trial scheme, 37 (34%) earned vouchers for breastfeeding at six-to-eight weeks…

Of the mothers eligible for the scheme, 58 signed up.

So let’s see if I get this straight. They raised the breastfeeding rate from approximately 25% to 34%. If 108 women were eligible, that means they raised the number of women breastfeeding from 27 to 37; 10 additional women breastfed for 6-8 weeks who might not have done so.

How much did it cost? At £200 ($300) per participant, it cost $11,100.

In other words, the government spent $1100 PER WOMAN to increase the breastfeeding rate and the bulk of that $1100 went to women who were planning to breastfeed anyway.

Dr Clare Relton, from Sheffield University’s School of Health And Related Research public health section, is running the scheme, part of a four-year research project.

She said: “The UK has one of the worst breastfeeding rates in the world – yet it gives better health outcomes to mums and babies, and saves the NHS money.

“We think this idea has the potential to increase breastfeeding rates in the UK, but we don’t have enough information yet.

“So we are conducting a large-scale trial [4000 women] to help us find out how acceptable and effective the scheme is – and whether it would a good use of public money in the future.”

How much will it cost the government to reproduce these “promising” results on a large scale?

Out of 4000 women, we would expect 2148 women to sign up and 1,360 women to successfully breastfeed for 6-8 weeks, compared to 1000 women who would have breastfed anyway. At £200 ($300) per participant, it would cost the government $408,000! Of that amount, fully $300,000 would go to women who were planning to breastfeed anyway.

There is no possible way that an investment of more than $400,000 can be justified by getting 360 additional women to breastfeed for 6-8 weeks. The pediatric health savings from such short term breastfeeding are likely to be negligible, if they exist at all.

This scheme is all the more odious when you consider that the government is struggling to pay for obstetric care. 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.

For $408,000 you could hire a few more midwives. Which is likely to have a greater impact on perinatal health? Hiring the midwives, of course.

So why are lactivists pushing a program that costs a fortune and has few, if any demonstrable health benefits? It’s because it is yet another way for them to get women to validate lactivists by having their own choices mirrored back to them. In addition, it is a fabulous way for them to demonstrate their contempt for women who bottle feed.

I’m not the only person who has questioned the wisdom of bribing low income women to breastfeed.

As Eliane Glaser points out in The Guardian, It’s class, not whether a baby is breastfed, that determines life chances:

The scheme’s supporters cite the power of financial reward to trump social conditioning, but that undermines the claim that the women are acting as free agents. If the women are regarded as entirely self-determining, then the conclusion must be that their reason for not breastfeeding is a negligent lack of inclination.

Thus what appears to be a straightforward transaction sends a set of troubling messages to the women in the study and beyond. It begs the question of why middle-class mothers are so in tune with what’s best for baby that they don’t need incentivising. And it reinforces the guilt felt by mothers who have problems breastfeeding, or for whatever reason choose not to do it. The implication for them is that the controversy generated by the voucher scheme must be worth it. Not only is breast best; formula must be actually harmful.

Her critical points:

But the scientific evidence is not what it seems. The only really consistent finding is that breastfeeding reduces a baby’s chance of getting a stomach bug. The protection only lasts for as long as you breastfeed. And it’s not clear whether the protection comes from something in the breast milk or from not using dirty bottles. The other supposed benefits are derived from contradictory and disputed evidence, suggesting that what is at stake in a country such as the UK with access to clean water, is not so much medical outcomes as an idealised version of motherhood that serves to stigmatise working-class women…

The more that social and educational background is taken into account, the smaller the differences between breast and bottle become. Crudely speaking, researchers see that children who were breastfed turn out better and regard breast milk as the determining factor, when it might well be because they’ve been given organic kale and flute lessons. When Clare Relton, who led the voucher scheme, defends it by saying that “not breastfeeding is a cause of inequality”, she is putting the cart before the horse. Class determines whether or not you breastfeed, but being breastfed doesn’t make you middle-class. (my emphasis)

The bottom line is that bribing women to breastfeed is extraordinarily expensive, offers no demonstrable health savings, ignores the real reasons for difference in health among social classes, and reinforces the stigmatization of women who don’t validate lactivists by mirroring their own choices back to them.

If that’s success, I’d hate to see failure.

282 Responses to “Early results from the “bribe a woman to breastfeed” trial”

  1. December 9, 2014 at 10:04 am #

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  2. DiomedesV
    December 2, 2014 at 11:35 pm #

    I don’t see anything wrong with this study. And I am well aware that the long-term benefits of breastfeeding are largely nonexistent.

    This is an interesting experiment in social science. The reaction to the study is itself interesting and valuable to know. I agree that the cost is not worth it in terms of cost/BF mom, but it’s not irrelevant to know what the cost is and whether society at large feels that it is justified. Finally, it is interesting to know, purely from a human behavioral viewpoint, what it takes to convince someone–anyone–to do something they think they don’t want to do, and that actually does require some effort.

    As for the idea that this infantalizes women? Rubbish. We offer positive incentives via tax breaks, social reinforcement, etc, all the time to people of both sexes and we don’t regard it is as infantalizing. People, women included, can reject the offer, and they often do.

    Frankly, a whole lot of public meddling by “do-gooders” involves trying to make poor people act rich. This is just the latest example. Big deal.

  3. Guest
    December 1, 2014 at 2:58 am #

    Why do most formula feeding moms always have to play the victim card? ” In addition, it is a fabulous way for them to demonstrate their contempt for women who bottle feed.” Give me a break.

  4. Guest
    December 1, 2014 at 2:49 am #

    ROFL this site is incredibly laughable.

  5. November 27, 2014 at 11:32 am #

    Your calculations on the rate of return on financial investment in infant’s physical and emotional health is incomplete. How much does it cost a new parent to bottle feed vs breast feed? But the deeper question is why these women would bottle feed in the first place? Where are they getting the idea that formula is a substitute for breast milk? It is so inferior in so many ways as to be a form of child abuse. How is it possible for a new mother to leave a modern “science based” obstetrical ward without knowing why and how to avoid the harms of formula?

    • Sarah
      November 27, 2014 at 3:39 pm #

      Because formula is the tits.

    • Maya Manship
      November 27, 2014 at 3:59 pm #

      Child abuse? So I’m a child abuser, an unfit parent because I feed my baby formula when my nipples are raw from her latching incorrectly and she’s screaming from hunger after trying to breastfeed for half an hour or more on just one side? I’ve been using my breast pump too but the truth is I’m not getting enough out for every feeding. What do you suggest I do? Let her starve? I believe it’s been stated by some of the posters here that the milk bank is reserved for critically ill preemies, as it should be. Wet nurses are not readily available. My younger sister is also breastfeeding right now but I can not ask her to feed my child as well as her nine month old twins! By the way, she lives a good hour and a half away from me to boot and is also supplementing with formula because she is not producing enough to feed two babies. How about you stop and thing for a minute before you label formula feeding child abuse. HOW DARE YOU!!!

      • November 28, 2014 at 1:21 am #

        I’m sorry you’re having problems doing something that women have done for millennia, but that’s not my fault. The fact is your baby is not getting important immunological, nutritional and emotional support that would have come naturally with breast feeding. Perhaps something went wrong at the beginning, like needless induction, epidural, cesarian, medical experimentation, human vivisection, the possibilities are endless. But don’t blame me for it.

        • Mishimoo
          November 28, 2014 at 1:47 am #

          Babies have also been dying for millennia due to starvation or lack of medical care. We can do better now and thanks to living in a first world country, we have the option of doing so.

          • November 28, 2014 at 1:58 am #

            First world country? Try again. The US has the highest rate of first day infant mortality in the industrialized world. But I suppose we should be thankful that it’s still legal to ask why babies are being so mistreated in this country.

          • Mishimoo
            November 28, 2014 at 2:03 am #

            See, you need to actually look at the reasons behind that statistic instead of just screaming about it like it’s a valid point. Also, try not being America-centric. The US is not the only industrialised nation in the world.

          • November 28, 2014 at 2:04 am #

            No, it’s just the most barbaric industrialized nation in its treatment of children.

          • Who?
            November 28, 2014 at 2:09 am #

            You are very broken. Can I take it from that you were bottlefed?

          • Mishimoo
            November 28, 2014 at 2:15 am #

            Those awful bottles, responsible for so much horror!

          • Who?
            November 28, 2014 at 2:46 am #

            If my supposition is correct that is a great burden for a bottle to bear. Perhaps I was too harsh? On bottles.

          • Young CC Prof
            November 28, 2014 at 2:27 am #

            You do know that the experiment this post is discussing was performed in Britain, not the USA, right?

          • Sarah
            November 28, 2014 at 2:51 am #

            There is no such place as Not America.

        • Samantha06
          November 28, 2014 at 2:12 am #

          Typical lactivist BS, blaming a mother…go bully someone else…

        • Maya Manship
          November 28, 2014 at 2:17 am #

          I didn’t blame you for anything going on with my baby. I called you out for labeling formula feeding as child abuse.You are being very judgmental and closed minded. Every baby, every situation is unique. To label formula feeding as child abuse is wrong. It is not child abuse. If I were to refuse to do anything but breastfeed knowing that it is not giving my baby enough to eat, at least right now, THAT would be child abuse because it entails deliberately withholding food and starving my child. By the way, a caesarian birth has nothing to do with it. Yes, she was a medically indicated caesarian but my milk came in fine, just like with my older child who was an emergency caesarian. As far as her not getting immunological, nutritional, and emotional support I guess you missed the part where I said that I am using a breast pump but I guess the milk I pump loses it’s value because it goes into a container before my child consumes it. As far as emotional support, I can provide plenty of that with or without breastfeeding.

          • November 28, 2014 at 2:25 am #

            This is not about you or me. Can you get that? It’s about the fact that formula fed babies are getting junk food as well as losing out on the pleasure of being held to the breast. I know such emotional loss isn’t syentifically quantifiable and so medicine can’t deal with it. But frankly medicine can’t deal with a lot of things, such as its own past.

          • Maya Manship
            November 28, 2014 at 2:31 am #

            Again, I never said you were. This is still about you labeling formula feeding as child abuse. Do you not see how wrong that is?

          • November 28, 2014 at 2:35 am #

            You’re taking it personally. Obviously you’re trying your best. I understand that. My critique is of medicine, not you. Who knows, maybe BF wouldn’t have worked out for you even if you had been in competent hands.

          • Samantha06
            November 28, 2014 at 2:38 am #

            Someone “competent” like you?

          • November 28, 2014 at 2:44 am #

            No, someone competent like herself without all the chemicals, medical “heroism” and general BS heaped on birthing women in the hospital.

          • Maya Manship
            November 28, 2014 at 3:10 am #

            I am a competent mother and I have an excellent OB/GYN who delivered both my babies. I posted before that my first child turned sideways during labor. If it wasn’t for my doctor I’m sure we would not be here and my new baby would never have been. Yes, my doctor is a hero in my eyes. I was in the right place at the right time with the right medical professional. Homebirth would have killed me. I’m glad I never tried it. And this baby was a medically indicated, scheduled C-section. My doctor said that due to the circumstances of my first child’s birth I was not a good candidate for a VBAC. I listened to her. She has years of experienced and has attended more births than I can count. You know what I have now? I have a healthy full term baby. That so-called “BS” is why my children and I are here today.

          • Mishimoo
            November 28, 2014 at 2:46 am #

            Oh dear, I shall have to award this attempt at gaslighting a rather low score. You would have received a solid 8/10 for the wording, but the timing resulted in a severe lack of subtlety and that is reflected in your final score of 2/10. Do try harder next time.

          • Samantha06
            November 28, 2014 at 2:42 am #

            “My critique is of medicine, not you. Who knows, maybe BF wouldn’t have worked out for you even if you had been in competent hands.”

            Good God!! He/she is almost quoting Patricia Robinett word-for-word… I’m too tired….

          • November 28, 2014 at 2:46 am #

            You mean someone agrees with me? OMG! It’s a conspiracy!

          • Samantha06
            November 28, 2014 at 2:48 am #

            It’s not about “agreeing with you”… you don’t get it….

          • Young CC Prof
            November 28, 2014 at 3:02 am #

            My son certainly wouldn’t have required bottles without medical intervention. He would have been dead.

          • Who?
            November 28, 2014 at 2:31 am #

            You say junk food , I say that’s wrong. You then appeal to an emotional response that your viciousness here shows to be insincere. You disgust me.

            Oh and it’s ‘scientific’, idiot.

          • yugaya
            November 28, 2014 at 5:49 am #

            Because feeding your newborn with big mac smoothies will produce the same detrimental effects as feeding them with formula milk.

          • demodocus' spouse
            November 28, 2014 at 10:30 am #

            You do know that when you’re bottle feeding an infant, you’re usually holding him/her against your chest, right?. You can certainly do it topless if you want.
            Calling my nephew’s formula child abuse is hyperbolic at best. So what if he didn’t get all those nice little doses of maternal hormones, he also didn’t get poisoned by chemo or starve when his mother didn’t live to see the turning of the season. Give a kid the basic fuel and 99.9 out of 100 s/he’ll make their own hormones soon enough. (Those odds are a guess, but how many people do you know who need to take extra hormones to live?)

        • yugaya
          November 28, 2014 at 5:26 am #

          Yeah, blame the mother because somewhere down the line she must have done something WRONG.

          Godawful creatures like this one make me feel ashamed that I was among the women who either had the privilege/opportunity or made the choice to breastfeed their children ( a choice which in a developed world is btw not in any way less beneficial than the choice not to breastfeed).

          If you are a mother who out of medical necessity, or because of circumstances beyond her control, or maybe out of exhaustion, or simply a woman who just chooses not to breastfeed for no “valid” reason at all because she can make that choice – remember that rwinkel is the kind of deluded people who think they are better at being a mother than you are based on performing a biological function in a certain way that they consider admirable.

          People who can fart the loudest or who can burp the longest are superior in the same way.

          • Roadstergal
            December 1, 2014 at 7:37 pm #

            If I could just persuade the government to offer bribes based on fart duration and potency, I would be set for life.

        • MLE
          November 28, 2014 at 11:37 am #

          It was because Venus was in the third house when she was born, under a harvest moon. Not a damn thing she can do about it.

        • Dr Kitty
          November 28, 2014 at 11:58 am #

          Human vivisection?
          Is this the new woo term for episiotomy?
          Did I miss the memo?

          • Who?
            November 28, 2014 at 5:48 pm #

            If you weren’t wearing your tinfoil hat the memo-rays wouldn’t have reached you.

      • yentavegan
        November 28, 2014 at 2:07 am #

        Rwinkel is pulling your leg. S/he is just parrotting some crunchy/crazy lactavist dogma.

        • November 28, 2014 at 2:17 am #

          No, actually I’m not pulling anyone’s leg. For some reason I thought I might be able to penetrate the echo chamber on this blog. My mistake.

          • Who?
            November 28, 2014 at 2:19 am #

            Not your first.

        • Maya Manship
          November 28, 2014 at 3:50 am #

          Oh, I agree. I’m just not letting him/her get away with the child abuse label. So far, absolutely no response to me calling it out. S/he completely danced around it and did not address it in any replies to me. Did you notice that?

    • Mishimoo
      November 27, 2014 at 4:58 pm #

      “Where are they getting the idea that formula is a substitute for breast milk?”
      Because it IS a substitute for breastmilk, and it works pretty damn well. I would rather have a live formula-fed baby than a dead breast-fed one.

      • November 28, 2014 at 1:11 am #

        OMG. Some brands STILL don’t have DHA. None of them have stem cells. None of them have oxytocin. All of them are far more expensive and far less enjoyable for the baby than being held to his mothers’ breast. I know babies aren’t supposed to enjoy anything, after all, they’re a medical emergency. But seriously, who would want a baby bottle for a mother?

        • Mishimoo
          November 28, 2014 at 1:21 am #

          Wait… so we’re only breastfeeding male babies now AND the feeding is the only thing a parent does?

          Not to mention – The posterior pituitary gland is responsible for the production of oxytocin, and if my baby was missing that, I think there would be more things to be concerned about than how they’re being fed.

          • November 28, 2014 at 1:25 am #

            Breast milk contains oxytocin. What brand of formula contains oxytocin?

          • Mishimoo
            November 28, 2014 at 1:33 am #

            Re-read what I said and try again. Oxytocin isn’t this magical sparkly thing only found in breastmilk, your body produces it by itself.

          • November 28, 2014 at 1:50 am #

            If the baby’s body produces everything IT needs, why feed it at all? Oh yeah, I forgot, if “syence” can’t derive something from first principles, it doesn’t exist. That means babies don’t exist, so nothing to worry about.

          • Mishimoo
            November 28, 2014 at 1:56 am #

            Nothing truly exists, we’re all in a computer simulation. Now go and take your pixels some place where they’re actually appreciated.

          • November 28, 2014 at 2:00 am #

            Not as long as helpless children are entrusted to people like you.

          • Mishimoo
            November 28, 2014 at 2:06 am #

            Oh dear, how awful. I feed, vaccinate, shelter, and nurture my babies instead of allowing them to die of natural causes. I am such a terrible person.

          • November 28, 2014 at 2:07 am #

            Not terrible. Just deluded.

          • Mishimoo
            November 28, 2014 at 2:16 am #

            If deluded is the worst thing you can find to say about your assumptions of me, then you’re just not trying hard enough.

          • Samantha06
            November 28, 2014 at 2:20 am #

            I wonder if anyone wants to take bets that he/she is one of Patricia’s buddies?

          • Who?
            November 28, 2014 at 2:23 am #

            I’d feel sorry for Patricia in that case, she’s just broken this one is vicious with it.

          • Samantha06
            November 28, 2014 at 2:33 am #

            Vicious is right!

          • Mishimoo
            November 28, 2014 at 2:25 am #

            That really wouldn’t surprise me, sadly.

          • Samantha06
            November 28, 2014 at 2:45 am #

            I know.. he/she almost quotes her word for word… sigh… well, at least we know what to expect..

          • Sarah
            November 28, 2014 at 2:50 am #

            Who’s Patricia?

          • Samantha06
            November 28, 2014 at 2:53 am #

            Look on the Birth Rape post… huge discussion over the last few days.. he/she almost mirrors her conversations, but he/she is much nastier..

          • November 28, 2014 at 2:28 am #

            Forgive me, I thought you were a decent person.

          • Mishimoo
            November 28, 2014 at 2:31 am #

            Oh, so that’s why you were attempting to insult me. I completely understand now.

          • Who?
            November 28, 2014 at 2:33 am #

            Not a mistake anyone could make about you.

          • Samantha06
            November 28, 2014 at 2:27 am #

            OMG, you really need some edumacation… it’s time to call on Patricia… NOT! lol!

          • Samantha06
            November 28, 2014 at 2:08 am #

            Whoooooooooosh….. THONK….. the unmistakable sound of a troll in a parachute…. and a really hard landing…..

          • November 28, 2014 at 2:14 am #

            Really? I thought I was in the midst of a crowd of them. Sorry to question such high authorities as yourselves.

          • Who?
            November 28, 2014 at 2:17 am #

            Hateful. You should be ashamed to be so shallow and vicious, I sincerely hope you do not have the care of any sentient being as you are not fit.

          • Mishimoo
            November 28, 2014 at 3:20 am #

            I don’t know, I’m not sure that I’d leave non-sentient beings in their care either. Though…they’d get a nice close look at maternal and infant mortality rates if they kept guppies. (One of mine had an intervention-free ‘natural’ delivery of several fry, and naturally dropped dead as soon as she was finished)

          • Who?
            November 28, 2014 at 4:10 am #

            If only the guppy mum had trusted birth

          • Mishimoo
            November 28, 2014 at 4:19 am #

            Not all guppy fry are meant to come or stay earthside!

          • Siri
            November 28, 2014 at 7:56 am #

            Hush, my child; time for your nap. You have the debating skills of a carrot.

          • MLE
            November 28, 2014 at 11:34 am #

            Siri, that’s unfair. Carrots have no pretensions and contain useful vitamins. Score two for the carrot.

          • Sarah
            November 28, 2014 at 2:59 am #

            Your face.

          • Siri
            November 28, 2014 at 9:53 am #

            I want to marry your sense of humour.

          • Sarah
            November 28, 2014 at 12:07 pm #

            You can marry my placenta.

          • any mourse
            November 30, 2014 at 10:32 am #

            wouldn’t matter. Oxytocin is a rather large molecule. It wouldn’t be absorb able through the gut. Plus, it would totally be digested by stomach acid.

        • Sarah
          November 28, 2014 at 2:49 am #

          I do have a baby bottle for a mother. She morphed into one after too many SSRIs. AND I was breastfed!

        • yugaya
          November 28, 2014 at 5:09 am #

          “That means a higher probability of autism.”

          No it does not, except in minds of people who believe that it is a “fact” that chemtrails have the same effect.

          • guestS
            November 29, 2014 at 5:20 am #

            I love that autism is touted as, like, THE WORST POSSIBLE THING EVA. Sooner pertussis, measles and kidney failure than autism! lol.

          • KeeperOfTheBooks
            November 30, 2014 at 12:50 pm #

            This is something I’ve pointed out for a while now. What the hell is it telling an autistic person when a movement (ie, the anti-vaxxers) say “I’d rather see my child dead than end up like you!”

            Me, I’d rather have a live kid on the autism spectrum than one who asphyxiates from pertussis.

          • LibrarianSarah
            December 1, 2014 at 2:56 pm #

            It’s a disgusting message and it’s one we hear loud and clear. Unfortunately, most “mainstream” autism organizations (cough couch autism speaks) aren’t much better. There message is “we must find a way to fix you or prevent any more people like you from existing.”

          • KeeperOfTheBooks
            December 1, 2014 at 6:18 pm #

            Indeed. The mind boggles at the sheer arrogance. “We know what’s best for the human race, and what’s best is that we make you exactly like us and prevent more of your kind from coming into this world.” Eugenics, much?

        • demodocus' spouse
          November 28, 2014 at 9:42 am #

          How did you know I keep my mother’s ashes in a baby bottle?

      • Sarah
        November 28, 2014 at 2:58 am #

        Nah, it’s a substitute for chicken. I never make a roast dinner without a good squirt of Aptamil, these days. Because modern.

        • Mishimoo
          November 28, 2014 at 3:00 am #

          I do hope that’s Aptamil Toddler Gold, because DHA !

          • Sarah
            November 28, 2014 at 3:04 am #

            No way, you child abuser. How is it possible for a new mother to leave a modern kitchen without knowing why and how to avoid the harms of Toddler Gold?

          • Mishimoo
            November 28, 2014 at 3:05 am #

            Formula is love; formula is life.

    • Sarah
      November 28, 2014 at 2:47 am #

      Ladies and gentlemen, a quick look at rwinkel’s work both here and elsewhere suggests he/she/it is either a tinfoil hatter or a troll. And a grossly Americentric one at that. I humbly suggest that anyone wishing to engage tailors their replies accordingly.

      • Samantha06
        November 28, 2014 at 2:51 am #

        You’re right… it’s deja vu… Patricia.. but much, much nastier…

        • November 28, 2014 at 2:57 am #

          It’s not hard to see the defensiveness on this blog or where it comes from. You people illustrate why so many women are opting for home birth.

          • Sarah
            November 28, 2014 at 5:43 am #

            Whatever, I’m a homebirth midwife.

          • Amazed
            November 28, 2014 at 7:20 am #

            Can I hold the space for your practice?

          • Sarah
            November 28, 2014 at 8:08 am #

            You can even come along and help me do unmedicated hands off c-sections too, if you want. And knit. Provided you have no medical or nursing qualifications, obviously.

          • Amazed
            November 28, 2014 at 7:20 am #

            So many women… less than 1%.

            What does it say about you and your ilk than more than 99% of women choose hospital birth?

      • guestS
        November 28, 2014 at 7:17 am #

        I was going to reply when I saw that, that Rwinkel is even a rubbish troll in my experience of trolls. I think the idea is that you build up pointless and infuriating points slowly so that by the time people realise that you’re a troll they’ve already been driven half mad. In the case. because Rwinkel’s little life is so sad that s/he can’t even be successful at trolling, s/he has dropped in thrown everything they’ve got at it and been called out within ten responses. Ooops.

        Having said that this subject has the potential to hurt a lot of women’s feelings here and I would like to point out that, given the environment that we live in, breast or bottle doesn’t matter. You’re doing a great job, unlike Troll McShit here. 😀

    • Stacy48918
      November 28, 2014 at 7:37 am #

      “Where did I get the idea that formula was a substitute for breast milk?”
      Ummm…I don’t know, maybe from the fact that my (unmedicated vaginal birth) baby was losing weight while exclusively breast fed and would have died without formula? A baby that weighs less than 8 pounds at 4 months is not a real good advertisement for the wonderfulness of breastmilk.

  6. sdsures
    November 26, 2014 at 5:56 pm #

    My head –> desk. Repeat.

  7. Dr Sarah
    November 26, 2014 at 1:19 pm #

    Dr Amy, one correction and one clarification needed in your figures:

    The correction: the women were not given the £200 in a lump sum for any breastfeeding, but in £40 increments for reaching specific stages (2 days, 10 days, 6 – 8 weeks, 3 months and 6 months). The costs are therefore less than you’ve calculated.

    The clarification: the reason the best figures we have are for breastfeeding at the 6 – 8 week mark is because that was as far as the study (which was a pilot study for acceptability/feasibility, not the definitive study) has got at this point. It’s possible that it may also increase breastfeeding rates at the 3 – 6 month mark, making a difference to the potential benefits.

    Of course, it’s open to debate whether either of those factors is going to be enough to make this cost-effective, but inaccurate comments don’t help here either.

    • Amy Tuteur, MD
      November 26, 2014 at 1:30 pm #

      So the women had actually received £120 ($180) thus far, not £200?

      That would mean that the program has spent $6600, or $660/additional breastfeeding woman. That’s better, but hardly a successful outcome.

    • Young CC Prof
      November 26, 2014 at 1:39 pm #

      OK, good. I still ask, cost effective at what? Is increasing breastfeeding rates really worth money? If you want to do cash for behavior, why not do it for reading to children, or bringing them to dental appointments? Both of those are more clearly linked to good outcomes, and both are things that all parents should be able to do.

      • Elaine
        November 26, 2014 at 11:08 pm #

        A Medicaid HMO in my area is offering cash incentives for moms to attend prenatal appointments and to bring their kids to well-child visits. (I’ve heard bellyaching about how people will deliberately have more kids to get the incentive.)

        • Cobalt
          November 27, 2014 at 9:58 am #

          Because 20 bucks for schlepping the kids to a doctor’s appointment a few times a year is so lucrative, it’s totally worth having more kids.

      • Mishimoo
        November 27, 2014 at 5:03 pm #

        Over here, if you don’t take your child to their 4 year old check-up, you risk forfeiting a fair chunk of your Tax Benefit payment. I’m not sure if it’s changed yet, but there was talk about expanding that to include being up-to-date on vaccines as well.

      • Who?
        November 28, 2014 at 2:12 am #

        Or not smoking around them? I can’t help feeling that many of the enthusiasts for this would brisle at social engineering in other areas.

        • Sarah
          November 28, 2014 at 2:54 am #

          Yes, it does feel a touch exploitative in many ways doesn’t it? Taking poor women, those who inevitably have less agency in society because of their lack of income, and using their lack of economic power to persuade them to behave differently to how they otherwise might. Whereas a richer woman who wants to stop would be able to do so without having to think of whether the pound shop vouchers are going to pay for the rest of the family’s food for the week.

          • Who?
            November 29, 2014 at 6:17 am #

            Not so much exploitative as an attack on bodily autonomy. Given that nicotine is outrageously addictive, making pregnant women feel bad for wanting to do it-when it is perfectly legal, available everywhere and a massive source of government revenue-is a bad look.

            Tackling people who are likely to struggle to advocate for themselves isn’t generally a winner, but poor pregnant women are uniquely vulnerable and exposed to criticism from those who enjoy their version of the moral high ground.

        • Theoneandonly
          November 28, 2014 at 8:43 am #

          One of the District Health Boards in New Zealand has actually resorted to bribing women to give up smoking during pregnancy. They get given pharmacy vouchers instead of cash, but it’s still a bribe.

          • Who?
            November 29, 2014 at 6:10 am #

            Assuming you could enforce it, this could (I suppose) have measurable health benefits for existing children, mum and unborn baby, but it is not a good look if one assumes that a woman should have bodily autonomy.

            I have no problem with messing with the profits of cigarette companies, but would be fussier about how I did it. Our government is as hooked on cigarette tax revenue as any smoker is on nicotine, so fiddling around the edges and picking on the poor are predictable strategies.

  8. Dr Kitty
    November 26, 2014 at 9:19 am #

    There was a rather excellent bit on BBC Radio 4 Woman’s Hour this morning, I only caught the very end of it, unfortunately, but it was the main researcher and someone else, whose name I didn’t catch, but who seemed eminently sensible and who made all the same points as Dr T.

    The final question was “Which is best? Breast or bottle?”

    Head researcher said “breast is best”.
    The other speaker when asked said “In the UK, breast feeding may have marginal benefits, but breast may not be the best choice for each individual mother-baby combination”.

    If you have access to BBC podcasts, you might want to check it out.

    • The Bofa on the Sofa
      November 28, 2014 at 11:13 am #

      “All else equal, breast is best. But all else is never equal.”

    • JRH
      November 28, 2014 at 4:12 pm #

      The ’eminently sensible’ woman was paediatrician Dr Sasha Howard, co-author of ‘Guilt-Free Bottle Feeding: why your formula fed baby can be happy, healthy and smart’, an eminently sensible book.

  9. Lion
    November 26, 2014 at 6:59 am #

    how does this differ from giving women formula samples to entice them into formula feeding? Seems like it is the same type of marketing plan really.

    • Cobalt
      November 26, 2014 at 8:04 am #

      The government isn’t paying moms to use formula. Formula companies are try to get people who buy (or might in the future buy) formula to buy their brand by giving away samples. Very different.

      The existence of formula doesn’t harm breastfeeding. Giving away baby food does not harm breastfeeding.

      • Lion
        November 27, 2014 at 6:58 am #

        It is still giving an incentive to induce a certain behaviour – that is the similarity I was referring to.

        • Cobalt
          November 27, 2014 at 10:07 am #

          Under that logic, the government should also give money to families that use cloth diapers, because some families get a few free disposables in the mail from diaper manufacturers.

          Cloth diapers: they’re so much cheaper! (Unless you use AIOs or any of the trendy styles) They’re more natural/environmentally friendly (uh..you still need to produce them, and all the water, detergent and energy use for washing adds up). They’re healthier (if your baby happens to be one with skin that doesn’t like disposables). They’re easier (just…no).

          • Lion
            December 1, 2014 at 2:04 pm #

            I must say that cloth diapers make me feel quite il
            . Washing and reusing things that have been pooped on. Yuck. But I do understand what you’re saying.

          • KeeperOfTheBooks
            December 1, 2014 at 6:31 pm #

            *chases down rabbit hole*
            Well, to be fair, I use cloth AIOs and they are still cheaper than disposables. I have a *very* high-efficiency washing machine; our water usage hasn’t gone up at all when I compare it to the same month of the previous year. DD is nine months old now, and those things have paid for themselves three times over. Detergent-wise, a half-load of laundry 3-4x a week just doesn’t cost very much. Also, the ones I got will last through 2-3 kids. Cost is the reason I decided to use them: we’re on a budget, and I’d rather use that cash on something fun than on diapers.

            I don’t know if they’re more environmentally friendly. On the one hand, less crap in landfills, but on the other, they do require energy/processing to make and wash.
            Healthier? As you say, it seems to depend. DD’s bum doesn’t seem to know the difference between disposables and cloth, but I’ve met moms whose kids reacted badly to one but not the other each way.
            Easier? BWHAHAHAHAHA! The *only* area in which I’d say they’re easier is that I never run out in the middle of the night, but that’s only because I wash faithfully every other day and am willing to do so. Other than that…I swear, some CDing moms must be on crack.

            That having been said, I don’t give a crap (whether contained by cloth or disposable) how anyone diapers their kid unless I’m the one doing the diapering. For me, I’m a SAHM, and laundry is one of the chores I don’t really mind doing. If using cloth diapers meant scrubbing the bathtub more often, DD would be in disposables permanently. :p As it is, I can free up the budget for a little more fun spending…yay!

          • Cobalt
            December 1, 2014 at 7:15 pm #

            I went with prefolds/flats (all cotton, easy to wash) and 2 size covers. My total cost (including detergent, but not electric or water) is about $400 over 2.5 years. I wash twice a week.

            I do it for the money.

    • guestS
      November 26, 2014 at 8:40 am #

      We don’t have that system in the UK anyway bright spark. ^^

      • Lion
        November 27, 2014 at 6:57 am #

        I’m not from the UK bright spark. We don’t have that system where I live either, but it doesn’t mean some other countries don’t. If you don’t understand the question, ask for clarity don’t be rude. It was a genuine question.

        • guestS
          November 27, 2014 at 7:22 am #

          You were commenting and told about it far further down on the thread. So you weren’t asking a genuine question you were trying to build a straw man.

          • Sarah
            November 27, 2014 at 11:05 am #

            Exactly. So you’re not from the UK Lion- fine. Ask, or google. It’s not news to anyone here that some countries do have the system you describe, it’s just completely irrelevant.

          • Lion
            December 1, 2014 at 2:02 pm #

            What? Are we even talking about the same thing? Shall I google marketing theory?

          • Sarah
            December 1, 2014 at 2:43 pm #

            If it’s going to tell us why marketing tactics used in some countries but banned in another are relevant to the discussion, by all means.

          • Lion
            December 1, 2014 at 2:01 pm #

            I asked the question before I read down the thread and asked something else. You were snarky first and then when I called you out then scrolled down. Why are you so rude?

  10. Anna T
    November 26, 2014 at 6:17 am #

    I must say the whole idea of giving out coupons, vouchers or gifts to breastfeeding women is incredibly stupid in my eyes, not to mention insulting and manipulative. We don’t need to be “bribed” to do things which are beneficial anyway. No one gives me financial or social boosts for cooking my children dinner or reading them a story. Breastfeeding in itself has many benefits, such as being convenient and FREE (I reject the claim that women stay home “in order to breastfeed” and thus breastfeeding causes women to stop working and lose their income. I don’t think that’s true. I would have stayed home with my babies regardless, even if they were adopted. The value of a mother at home is more than that of just serving as food source).

    If the natural good things about breastfeeding aren’t enough to prompt a woman to breastfeed, government vouchers won’t do it.

    • RKD314
      November 26, 2014 at 7:53 am #

      Breastfeeding is convenient and free FOR SOME PEOPLE. It is NOT convenient and free for all women, I would argue that it’s in fact not for most women. Even if the act itself comes easily to you and your baby, it is NOT convenient and NOT free if a woman works full-time, and must return to work relatively soon after her child is born. If you need a pump, if you need to take breaks from work to express milk, that is at best an inconvenience and at worst costs you money (at least in the US, in cases where your employer must allow you pumping breaks, it’s not required that they pay you during those breaks). I really wish that this “Breastfeeding is FREE!” idea would stop being propagated, as it’s simply FALSE.

      • Anna T
        November 26, 2014 at 8:04 am #

        RKD, breastfeeding is free unless you have to pay for special equipment to do it, such as a pump, etc. Of course there are people who’ll convince you you need all sorts of special equipment to breastfeed (nursing pillows, bras, pads, supplements to boost milk supply, etc) – it’s an industry too. But in its basics breastfeeding is free for women who choose to stay home with their babies anyway. It’s also free for women who choose to do it part-time, in their hours off work. Expressing milk is a hassle and I don’t know that I’d do it long-term, but don’t forget formula costs money too and each woman must make her cost/benefit considerations. Certainly a woman who breastfeeds before and after work and at night, *even without pumping*, still saves money even if her baby receives formula during the day, as opposed to a woman who just gives up breastfeeding entirely. Which is OK too – she’s within her right NOT to breastfeed for whatever reason. I just don’t get this dichotomy – either you breastfeed exclusively, or only give formula. Why not both?

        • RKD314
          November 26, 2014 at 8:10 am #

          What it seems you’re saying is that exclusive breastfeeding is free for women who have no problems requiring the need of nursing aids (nipple shields, supplements, a pump) and who are staying home anyway. I don’t disagree with that. I also don’t disagree with the statement that part-time nursing will save you money on formula. What I disagree with is the blanket statement you made in your previous comment, which was that breastfeeding is “convenient and FREE”. How many women really can afford to stay home? Even if you can afford it, it’s not a “free” choice–there is a tradeoff. Look, I’m not saying that breastfeeding is bad. But labeling it as “free” is in many cases just misleading (i.e. in the case of women who have full-time jobs and can’t make partial breastfeeding work…which is no small number).

          • Anna T
            November 26, 2014 at 8:34 am #

            Obviously breastfeeding isn’t free for those who *can’t* do it, or who can’t do it without significant and costly effort. However, it is free *when it works* (perhaps I should have been clearer on that account). Certainly not easy, free and convenient for everyone. But for many people, yes. Whether pumping at work is worthwhile is another question, I personally never tried it.

            Fact: I chose to stay home with my babies. I had (and still have) the privilege to do so. It was not “in order to breastfeed” but because I felt it’s best for us all.
            Fact: babies need to be fed. So it was either breastfeeding or formula.
            Fact: breast milk came out of my breasts, while formula would come from the store. Therefore, I would have to pay for formula, but I didn’t have to pay for breastfeeding.

            So, for women like me, who stay home and don’t have any problems breastfeeding, it’s indeed convenient and free. If it hadn’t been so I wouldn’t have done it for as long as I have.

          • Carolyn the Red
            November 26, 2014 at 9:22 am #

            Not really. I was on leave from my program (and not working) for other reasons when my daughter was born (and well into when she ate solids). But nursing still required pumping or supplementing if I wanted to have any time away from my daughter, particularly early on. So, I had to choose if I was happy abandoning all hobbies (a two hour band practice would almost certainly mean missing a feeding), all social contact sans baby, all exercise (I tried baby and mom classes, not really exercise), and even the chance to go buy pants that fit and get a haircut. I ended buying a good pump and some bottles, and keeping a small amount of formula around.

            You may have made the choice to be on call all day every day without thinking, but it’s still a cost, and even when I was contentedly at home full time with a baby. I needed a few hours, on occasion, where I wasn’t on call for intense touch and baby care.

          • Young CC Prof
            November 26, 2014 at 9:58 am #

            Especially with the modern version of breastfeeding on demand, which even my mother found absurd. She was part of the original NCB movement and breastfed two children, one of whom never took a bottle ever.

            She did NOT think it normal to breastfeed an older baby every couple of hours night and day, which some books now claim is the “right” way to do it. She remembers that at 6 months I was feeding only 5 times a day, which dropped to 4 once I got the hang of eating purees. She never deprived us, but she expected babies to need larger, less frequent feedings as they got bigger, and encouraged us to eat that way.

            Nowadays, when a 9-month-old’s mother is going crazy breastfeeding every two hours around the clock, her crunchy friends tell her this is NORMAL and she should keep it up! That in fact trying to reduce feeding frequency would be tantamount to abuse! It’s insane.

          • fiftyfifty1
            November 26, 2014 at 11:04 am #

            I agree that older babies have no biological need to be feeding every 2 hours round the clock. But that doesn’t mean that all women can decide to just breastfeed larger amounts less often. Breast storage capacity varies markedly from woman to woman. Some women can store 6 ounces in each breast and feed infrequently. Some women can only store a couple of ounces, and if their breasts are not emptied frequently, their production drops fast. This is the same difference between dairy cows and non-dairy cows. Both can easily support a calf. But to support a calf, beef-cows need to feed extremely frequently, whereas a dairy cow can be milked only twice a day and continue to produce copious amounts. My own mother says she had a terrific storage capacity. Her journals from that time show I was sleeping through the night by a month old. It was a combo of me being a good sleeper and her being able to get my stomach FULL right before bed.
            It is frustrating that lactivists don’t acknowledge these biological differences. So lactivist mothers who themselves had to feed frequently assume that it’s the way it has to be done and say so in their books. And lactivist moms who had large capacities can’t figure out why some moms say breastfeeding is so time consuming and chaining and why they say their milk keeps threatening to dry up…the latch must be “wrong” or they must be lying about how often they feed.

          • Cobalt
            November 26, 2014 at 11:28 am #

            I think mine is limited by the baby’s stomach size, or I’m just not effective in getting him to eat more at a go. At 3 months he’s still getting 8-10 feeds a day of about 9 minutes each. He’s going 7 then 3 or 4 hours regularly overnight, but we can’t seem to get off the every 2 hours daytime schedule. If I pump regularly I can get 3-4 ounces per side easily, but then I have to pump, and he only takes 3 oz when given the bottle.

            The older kids weren’t like this, but they were in daycare so the whole set up was different.

          • Young CC Prof
            November 26, 2014 at 11:42 am #

            Baby’s stomach size IS definitely a factor. My son was exclusively bottle fed after the first week (some pumped milk, some formula) and his stomach was kind of small. His appetite was huge, but if I fed him too much, he’d just bring all it right back up, as opposed to just spitting up a little. He was 2 months old before he could manage to go even 4 hours between meals at night, and 3 months before he could reliably sleep 7 hour stretches.

          • Anna T
            November 26, 2014 at 1:53 pm #

            Count yourself lucky. My second daughter didn’t sleep as much until she was 9 months old. And sometimes when she’d wake she wasn’t even hungry, she’d just fuss at the breast a little and go right back to sleep (I wish I could, too, instead of tossing and turning half the night). Some children are just fitful sleepers, well into toddlerhood. At 4 years old, she’ll often wake me 3 times at night for things like a bad dream, a glass of water, or because her blanket fell off. Her sister was never like that. Go figure.

          • Young CC Prof
            November 26, 2014 at 2:00 pm #

            Oh, he still wakes up sometimes. But there’s a world of difference between waking up for 5-10 minutes of cuddling and then going back to sleep versus an hour of feeding, diaper change etc.

          • Anna T
            November 26, 2014 at 2:03 pm #

            Don’t forget changing the sheets in the middle of the night because the baby spat up all over you, herself and your bed!!

            I really should emotionally prep myself for that kind of stuff, as I’m now 34 weeks along.

          • Cobalt
            November 26, 2014 at 2:46 pm #

            I was really hoping I was just doing it wrong. I can change my habits, but if it really is his stomach size then it’s just a waiting game. Anything over three ounces or 10 minutes and it just comes right back up, and then he’s hungry again in half an hour.

          • Young CC Prof
            November 26, 2014 at 1:25 pm #

            True, some women do need to feed that often. My issue is with lactivists who either don’t acknowledge that that’s a particularly difficult nursing relationship, OR, who tell new or expectant parents that there’s no way to even try to train a baby out of those sorts of habits without committing child abuse. (Expecting it to work rapidly and perfectly is unreasonable. Trying and expecting some improvement in night sleep over time is NOT unreasonable.)

          • Anna T
            November 26, 2014 at 1:46 pm #

            “Nowadays, when a 9-month-old’s mother is going crazy breastfeeding every two hours around the clock, her crunchy friends tell her this is NORMAL and she should keep it up!”

            Breastfeeding frequency is definitely supposed to *gradually* drop as the child grows older. It’s a no-brainer. A 1-year-old isn’t a newborn and shouldn’t be fed as such. Recently a new mom asked me, “how on earth could you nurse her for over 2 years? I’d go crazy!” – to which I responded that a nursing 2-year-old wasn’t like a nursing 3-month-old. She’d be breastfed morning and night and that’s it. Two times a day. I could leave her for a whole day with her grandparents and she’d be OK. I couldn’t bear being attached to a toddler like a limb.

            Someone below mentioned breast milk storage capacity, which is highly important. Mine was low and I had to feed often, at least when the babies were young. But with older babies/toddlers it didn’t matter very much anymore.

          • Lion
            November 27, 2014 at 7:01 am #

            Not all babies reduce the frequency of feeding, some reduce how long they feed for, so one baby might have been feeding for an hour at a time every 2 to 3 hours and as they grow older they will suck more efficiently and take in the same amount or more milk in about 5 – 10 mins and still feed every 2 to 3 hours, but it is far less intense on the mother. I’ve breastfed my toddlers, and from about a year I definitely stopped demand feeding, as they could understand waiting till it was more convenient (or at least I taught them to) and also they were eating a lot more solid food by then and drinking water so it wasn’t the main way they were getting nutrition.

          • Anna T
            November 26, 2014 at 1:41 pm #

            “You may have made the choice to be on call all day every day without thinking, but it’s still a cost”

            I wonder what you mean by “without thinking”.
            I do not see the choice I made as having a financial cost. It’s a choice depending on one’s personality and lifestyle. It worked for me without being a “sacrifice”. I’m a writer and an introvert, and don’t have any hobbies that require me to be away from home on a regular basis. And when babies are small, I personally find them easier to have with me at all places than older babies/toddlers who require constant attention. I could take the 2-months-old and carry her with me to the doctor’s, or when I wanted to grab a cup of coffee with a friend. I’d nurse her sometime in between and she’d usually be asleep in her pram soon after. A 2-year-old would be a lot more of a hassle.

          • ali
            November 26, 2014 at 7:53 pm #

            I agree it is so easy when they are small and you can bring them everywhere with you.Motherhood does have a cost, it is up to everywomen to decide the best way to manage it for themselves. Anna T your comment did sound a little denigrating.

          • ali
            November 26, 2014 at 7:49 pm #

            I agree for me once my milk supply was settled it was easy to not have to buy formula make bottles etc. I could feed my babies on the go or at home very easily

        • Sarah
          November 26, 2014 at 8:51 am #

          Breastfeeding is only free if you think the time of the person doing it is worthless.

          • Anna T
            November 26, 2014 at 1:34 pm #

            Well, I was staying home. It’s not like I would have saved time, or money, if I gave formula. On the contrary. I’d have to buy formula, whereas I didn’t have to buy breast milk. Therefore, for me (and for other Moms in the same boat) breastfeeding was indeed a money-saver.

            If I said, “I took four extra months off work in order to breastfeed”, then I guess you could argue about financial cost.

            I’m definitely not talking about other needs such as wanting to be away from the baby for a few hours, etc. That’s everyone’s personal business.

          • Sarah
            November 26, 2014 at 1:49 pm #

            Right, but the idea that a person’s time is free if it wouldn’t otherwise be spent earning money is really something that needs to be fought against. That’s a great way to undervalue the work of stay at home parents, unpaid carers and volunteers everywhere. If you want to say that breastfeeding was free for you because you wouldn’t otherwise have been earning money during that time, I suppose it’s not my business to correct you, but it really isn’t an idea I can get on board with and it needs to be made very clear that you’re only talking about yourself and nobody else. Time still has a value even for someone not engaged in paid work.

          • Anna T
            November 26, 2014 at 1:55 pm #

            OK, but a baby still needs to be fed if you’re caring for her, right? So how would I save time if I simply gave bottles instead of breastfeeding? At least I didn’t have to wash bottles… dishes would get stacked in the sink all day long anyway…

          • Sarah
            November 26, 2014 at 3:01 pm #

            Who said anything about you saving time? I don’t know whether you did or not.

          • Elaine
            November 26, 2014 at 11:16 pm #

            You said “Right, but the idea that a person’s time is free if it wouldn’t otherwise be spent earning money is really something that needs to be fought against.”

            Anna’s point was that she would be spending the same amount of time feeding the baby whether she breastfed or gave formula. So any argument saying that her time is or isn’t free would apply equally to whatever method of feeding she chose. When we’re discussing the economics of formula feeding, nobody includes the necessary time for the caregiver to give the bottle, so why is the time required for the mother to nurse the baby necessarily factored into the economics of breastfeeding? In some situations it bears discussing, but if she is a stay-at-home parent and would be doing most of the feedings anyway, and if nursing is a relatively smooth process that does not take longer than giving a bottle, the time investment is the same either way and so it doesn’t seem relevant.

          • Box of Salt
            November 27, 2014 at 12:04 am #

            Elaine “so why is the time required for the mother to nurse the baby necessarily factored into the economics of breastfeeding?”

            It’s the *required* part. If you are breastfeeding, you are required to be there, and put the time in.

            Do you value your time? It seems to me that Anna T does not value hers.

            If you believe your time has value, breastfeeding is not “free.”

          • Sarah
            November 27, 2014 at 2:15 am #

            Absolutely. This attempt to bring formula into it is a red herring, because that’s not free either. Even if you don’t have to pay for the formula itself.

          • Anna T
            November 27, 2014 at 5:32 am #

            “Do you value your time? It seems to me that Anna T does not value hers.”

            I value my time so much that I can’t think of a better investment of it than to care for my newborn children. Feeding them is part of the packet. Breastfeeding was the most convenient, easiest, cheapest way for us to do it. I’d still stay home if I couldn’t breastfeed, but then we’d have to shell money out of our pocket to buy formula. Ergo, all other circumstances being equal, breastfeeding was a money-saver. I really don’t see what’s so controversial about that.

            Trying to prove that breastfeeding has a “cost” even if I’m staying home anyway and everything is going smoothly seems a stretch to me.

          • Sarah
            November 27, 2014 at 11:02 am #

            Nobody is arguing with you saying breastfeeding saved you money, it may well have done. It is often cheaper than formula, sometimes much more so. They’re arguing with you saying it’s free. Not the same thing at all.

            You seem to actually acknowledge this yourself, when you talk about investing your time in your children. That suggests you do indeed think it has value, ie it isn’t free. I would agree.

          • Anna T
            November 27, 2014 at 2:44 pm #

            When I said free, I meant “not costing money”. As simple as that. Breastfeeding didn’t cost us anything (unless you factor in some extra helpings of dinner because I had such an enormous appetite and was losing my pregnancy weight so quickly).

            Time definitely has value, but I really don’t know how I’d measure it in terms of money. What is the financial value of a nature walk with my children? Of a bedtime story?.. I really don’t know. What I *do* know for sure is, that if I hadn’t breastfed, our weekly grocery list would have the addition of formula. Since I did breastfeed – and since I never had to buy any nursing equipment – I say it was free.

            I could apply the same argument to early potty training, perhaps. When our second daughter was 1 year old, she’d cry and scream while trying *not* to poop all over herself in the diaper, and I went along with that. It definitely required some investment of time on my part, but she very quickly and happily grasped the idea of holding it in for a minute so she could go into the potty. Of course I had to be “on call” until she had enough coordination to toddle over to the potty and take off her own pants. BUT we immediately saved a bundle on diapers (and my child was much happier, not to mention she stopped having those awful rashes).

            If I understand correctly, according to the logic of time = money, we didn’t really save anything because I was investing my time and effort in order to keep up with her potty habits. I can’t agree with that because, again, I was a stay-at-home mom and my schedule was flexible enough to factor potty training into it. My time wasn’t “worthless”, but I had enough of it to put my child on the potty whenever she needed to go.

            Now, if I had said, “this marvelous job opportunity came up at about that time, but I had to pass because no other caregiver would bother potty training a 1-year-old”, you could say I lost an income opportunity *specifically because of potty training*, and thus that potty training cost money.

            Same thing about breastfeeding, IMHO.

          • Sarah
            November 27, 2014 at 3:37 pm #

            Well first of all, if you ate more, breastfeeding did cost you something. It would only be ‘free’ as in not costing you any money if you could get the extra calories for nothing. So it wasn’t free in any sense of the term. If the extra calories cost less than formula would’ve, it was cheaper, but as we’ve established, that is not the same as free, even in the sense that you mean it.

            But the wider point is, your time doesn’t suddenly become ‘free’ because you’re not sure how you’d economically quantify it. If you say that breastfeeding is free, particularly when you don’t take care to confine this only to yourself, Box of Salt is right that you diminish the value of the time of the person doing it.

          • Anna T
            November 28, 2014 at 7:26 am #

            Bah. The extra food I consumed was negligble compared to what ends up in our trash can in the form of leftovers scraped off kids’ plates nowadays.

            Excuse me, but your whole argument seems nit-picky. It’s like I say, “we passed through the mall today and they were handing out free balloons to kids”, and then this someone jumps up:

            “No! The balloons weren’t really free! What about the money you spent on gas?”

            “We didn’t drive there. We walked.”

            “Well… then… but what about the time you spent walking? Is it worthless?!”

            “We just happened to be there. Only had to make a few extra steps to get those balloons.”

            “A few extra steps! Aha! And you probably had to wait in line too, because there must have been a crowd clamoring to get those balloons! So you DID spend time! I TOLD you it wasn’t free!”

            So… *eyeroll*… perhaps 0.00001 isn’t zero. It’s just very, very, very little.

            Perhaps breastfeeding wasn’t *free*. It was just very, very, very cheap.

            But in the jargon of ordinary humans – you know, people who see a square and say, “This is a square” without measuring each side first – yes, I maintain it was free.

          • Sarah
            November 28, 2014 at 8:06 am #

            Negligible or not, if you had to pay more for it then it wasn’t free even in the sense you mean it.

            The eyerolling is also unnecessary- it isn’t my fault you made a broad, sweeping statement indicating that the time of people who breastfeed is worthless when what you apparently meant was that for you, it was extremely cheap even though your time is of great value. I make no apologies for challenging the idea that time spent by a person who would not otherwise be using it to earn money is free. It’s a pernicious attitude that contributes to the systematic undervaluing of the work unpaid carers, usually women, do.

          • Box of Salt
            November 27, 2014 at 2:58 pm #

            Anna T “I value my time so much that I can’t think of a better investment of it than to care for my newborn children.”

            If you agree with me, stop promoting it as “free.”

            The “free” characterization diminishes the value both you and I see in it.

          • Anna T
            November 27, 2014 at 3:15 pm #

            See my comment below.

          • Sarah
            November 27, 2014 at 2:06 am #

            How does any of this mean it is correct to suggest that breastfeeding is free though? It doesn’t. Nothing in your post rebuts my point that time doesn’t somehow become valueless when a person wouldn’t be using it to earn money. If people were suggesting time spent formula feeding was also free, you and Anna might have a point. I certainly wasn’t, because the time I and other close family members spent formula feeding my child was no more free than the time I spent breastfeeding.

          • Anna T
            November 27, 2014 at 5:24 am #

            That’s exactly what I meant to say.

          • Cobalt
            November 26, 2014 at 3:29 pm #

            That’s where I am. The baby is with me just about all the time anyway (I work on our farm at home), I have to spend time and effort feeding him no matter what I feed him, and breastfeeding is winning right now. I don’t have to buy stuff, and I don’t have to wash stuff, so it’s free and easy. That could be different, and for many women it is different, but it’s true for me.

          • RKD314
            November 26, 2014 at 4:41 pm #

            Neither did I, I have a dishwasher.

          • t
            November 26, 2014 at 6:14 pm #

            It’s generally not more expensive, time-wise, than formula. The actual, physical, liquid is free. Getting into the baby can be anywhere from free to incredibly expensive.

          • Sarah
            November 27, 2014 at 2:12 am #

            It may or may not be more expensive, time-wise, than formula. As a general rule, it takes longer in the beginning, less time later on. The liquid may well be free if you’re not needing to consume extra calories to produce it. However, once again the time spent is only free if you think it is worthless.

        • LibrarianSarah
          November 26, 2014 at 10:22 am #

          Sigh, here we go again. There is no such thing as a free lunch. If you are not making money you are spending money. Just because no money exchanges hands doesn’t mean something is free. One of the things you have to factor in when determining the cost of something is time cost. The only way breastfeeding will be considered “free” is if your time is worth nothing.

          Also, just because your partner made enough money for you to stay home, and breastfeeding came relatively easy for you doesn’t mean that everyone has the same circumstances. For a lot of women, the financial sacrifices of exclusively breastfeeding would be economically devastating.

  11. Maya Manship
    November 25, 2014 at 11:31 pm #

    My free formula samples are a lifesaver right now. I am currently using my breast pump and also some formula. My baby girl is only a week old but I am having trouble getting her to latch properly so my nipples are incredibly sore and causing me a lot of pain when she latches. So it’s the breast pump and formula until I heal. I had some soreness with her older sister but not like this! Thanks to being able to use formula my baby is not hungry. I just hope I heal soon.

    • Adelaide
      November 26, 2014 at 12:46 am #

      You may want to get your baby checked for a tongue tie if she has not been checked. I had the exact same types of problems with my third until his tongue tie was snipped. I was shocked at the immediate difference it made in breastfeeding.

      Formula and/or pumping is a blessing for tired sore mamas and hungry babies. I am starting to think that limited use of formula during the first few weeks postpartum could actually improve breastfeeding stats. All or nothing does nothing, but discourage women. It would be so much better if breastfeeding mothers could be taught how to supplement while minimizing the risk of a loss of supply and nipple confusion. Unfortunately, information seems to be withheld thanks to someone else’s agenda.

      • SporkParade
        November 26, 2014 at 8:22 am #

        Agreed. I did actually nearly give up breastfeeding due to the lactation “promoting” policies of the hospital I gave birth in. It was an issue of my baby’s safety (his pee was bright orange and I was ready to fall asleep on top of him), and the nursery nurses were prohibited from having an honest discussion about supplementation with me. I feel very strongly that they were willing to play fast and loose with my baby’s health in order to “promote” breastfeeding.

      • Maya Manship
        November 26, 2014 at 9:41 pm #

        Both of my older sister’s children either have or had a tongue tie. I think it might have been corrected on one of them but I’m not sure. I’ll have the pediatrician check.

  12. Sue
    November 25, 2014 at 5:51 pm #

    This is typical of research that measures processes rather than outcomes.

    They may have made a difference to short-term BF rates, but how many infections did they prevent, and at what post per episode?

  13. mostlyclueless
    November 25, 2014 at 2:59 pm #

    Don’t be so down on them, Dr. Maybe if people breastfed longer in the UK, children would be smarter. They could produce a physicist who could explain a brief history of time, a biologist who could invent memetics, a molecular biologist who could help co-discover the structure of DNA. If only we could get those British women to breastfeed longer, the UK could produce a decent scientist or two. If only.

    • The Bofa on the Sofa
      November 25, 2014 at 5:16 pm #

      Then again, maybe they point to Prince Charles and say, “If only he were breastfed…”?

      • Sue
        November 25, 2014 at 5:52 pm #

        Prince Charles doesn’t need magic milk. He has magic water (aka homeopathy).

        • Sarah
          November 26, 2014 at 3:07 am #

          I think Prince Charles is beyond the help even of breastmilk.

          • SuperGDZ
            November 26, 2014 at 3:09 am #

            I have a horrible mental picture of Charles hiring a wetnurse. The worst part is that the idea doesn’t seem entirely implausible.

          • Sarah
            November 26, 2014 at 9:00 am #

            I’d upvote that, except urrrrrgh.

  14. southwarkbelle
    November 25, 2014 at 2:30 pm #

    Interesting post, I’ve not really thought about the costs of this and it’s possible that some of the vouchers were donated or subsidised by the companies as they will get these women into their shops. But even if that is the case I suspect the costs will be even higher than £200 per woman because of all the man hours involved. This also brings in a major flaw in the study.

    From the abstract and news articles it seems that the women had to see a “health professional” who had to confirm they were breastfeeding. It also sounds like they got a fair bit of support and encouragement thrown in with the vouchers. One reason many women in the UK struggle to breastfeed even if they want to is that there is a lack of consistent advice and support on the NHS. The women in this study weren’t just getting vouchers, they were getting help and that would surely make a difference, quite likely more of a difference than the vouchers, but we can’t tell as there was no control group who got the support but not the vouchers!

    Oh and interesting to note that the person in charge of this is a homeopath and most of her previous publications are in that field.!

  15. Dr Kitty
    November 25, 2014 at 1:27 pm #

    With a 1 week course of paediatric amoxicillin costing the NHS less than £2 and GPs paid a flat rate no matter how many times they see snotty kids, you’d have to prevent a heck of a lot of tummy bugs and ear infections for this scheme to actually save money…

    • Allie P
      November 25, 2014 at 3:07 pm #

      I think they might “save money” because formulas and bottles are subsidized by NHS (similar to WIC in US?) I’m not sure how the system works, but I do know formula is $$$ and a common argument for increasing breastfeeding rates among eligible mothers on WIC is that paying the extra for maternal food for nursing moms is cheaper than formula. (Unfortunately, many of the working moms who receive WIC have jobs that do not make nursing feasible, so the math doesn’t add up on their end.)

      • Dr Kitty
        November 25, 2014 at 3:19 pm #

        Normal formula and bottles are not subsidised in any way.
        Medical formula for allergies is free on prescription, but normal formula is not subsidised.

        Someone expecting their first child, or who is expecting multiples and who is in receipt of certain qualifying benefits, can get a Sure Start grant of £500, but she can spend it on whatever she wants.

        • Dr Kitty
          November 25, 2014 at 4:58 pm #

          In case you’re thinking “why only first and multiples?”
          The government expects you to recycle your pram, crib and car seat for subsequent children, but understands that you can’t stack twins.

        • 453
          November 26, 2014 at 11:47 am #

          Does “medical formula” include more expensive formulas that aren’t necessarily for allergies but are advised for babies who have trouble digesting normal formula? I’d expect that the older a baby is, the more likely he is to be able to tolerate normal formula. So encouraging mothers to breastfeed for as long as possible could save NHS money.

          That said, it doesn’t sound like it’s working very well. I think it would also be like rubbing salt in the wound of a mother who tried & failed to breastfeed.

          • Dr Kitty
            November 26, 2014 at 1:16 pm #

            The ACBS formulas available on prescription are the extensively hydrolysed ones for mild allergies like Nutramigen or Alimentum, the amino acid ones for severe allergies like Neocate and the ones for premature infants like Nutriprem.

            All our patients are told that they can choose to buy whichever off the shelf formula they like, because all are nutritionally complete and there is no evidence that any is superior. They are advised not to use casein-based formulas, low lactose formulas or soy formulas because there is no evidence of benefit from them.

            You can see the (very, very extensive) local guidance on maternal and child nutrition I try to follow here:


      • Sarah
        November 25, 2014 at 3:20 pm #

        Not quite. Bottles aren’t subsidised by the NHS and neither is formula. The poorest families get a voucher that can be used for formula, but it can also be spent on cows milk, fruit or vegetables, so it’s also useful for a woman who is breastfeeding as she can spend it on the extra food she needs. It doesn’t come from the NHS and you have to pay for the bottles yourself regardless- this would also be true if you use them for feeding expressed milk.

        The idea with breastfeeding saving the NHS money is that, as formula fed children are less healthy and therefore more expensive as a group, if they were breastfed they’d be less ill and more cheap. Of course, formula fed children are also poorer as a group too, and we all know poor people are expensive.

      • guestS
        November 26, 2014 at 9:16 am #

        it’s also the same amount of vouchers regardless of whether you’re breastfeeding or formula feeding or both. So there’s no saving there, the NHS don’t fund this scheme as far as I know. I *think* it’s more associated with tax credits and the DWP (department for work and pensions) than health.

  16. Ellen Mary
    November 25, 2014 at 12:47 pm #

    So how do you justify formula freebies? I am just wondering. I got cans unsolicited this time. I didn’t sign up for any mailing lists, yet cans appeared in my mailbox. I agree the money could be better spent but how about we only send formula to women who ASK for it. I’ve actually heard that straight asking results in free formula less often than us BF moms get it . . .

    • Ellen Mary
      November 25, 2014 at 12:51 pm #

      I am just saying that paying moms to BF only makes sense in a climate where FF is subsidized & also heavily & aggressively promoted with marketing dollars. No other product shows up unsolicited in the mailboxes of new mothers with such regularity and I didn’t even touch in hospital marketing. You can say it is only a brand that is marketed & not the whole practice but marketing any brand serves to market a practice. (Like you can’t advertise iPhones without advertising smart phones in general).

      • Sarah
        November 25, 2014 at 1:12 pm #

        So you’re saying paying mothers to breastfeed doesn’t work in the UK, then?

      • An Actual Expert
        November 25, 2014 at 2:32 pm #

        The statement “No other product shows up unsolicited in the mailboxes of new mothers
        with such regularity and I didn’t even touch in hospital marketing” must be some kind of joke. Clearly, Ellen Mary has absolutely no experience in marketing or knowledge of marketing practices in the U.S. because even the most beginner business student knows that new moms are the most sought-after demographic and are aggressively targeted.

        New moms are hugely attractive to marketers. The number of companies that target new moms and send them unsolicited product is ridiculous and includes companies I’m sure we would find in Ellen Mary’s house like Disney, P&G, J&J, Unilever etc. By no means is formula the only product showing up unsolicited in mailboxes of new mothers with such regularity. Based on data I’ve seen, I would actually guess that diapers are the most common.

        And for the personal anecdotes, the area I live in doesn’t even carry formula in the grocery store – based on average income, you can make a strong guess that people breastfeed more than the national average in my zip code. So I haven’t gotten a single free sample of formula in the mail or at the hospital. But, because I’m an attractive customer to lots of other brands, I’ve gotten tons and tons of other samples. Its possible that based on Ellen Mary’s zip, she’s in an area where companies aggressively market formula….or more likely, she’s simply repeating a trope echoed by the NCB advocates with no knowledge of how the real world operates.

        • Cobalt
          November 25, 2014 at 2:41 pm #

          Oddly enough, what I got most was pacifiers (but none of the kind the kid actually likes, dammit) and free portrait coupons.

        • Amy M
          November 25, 2014 at 2:46 pm #

          We got mostly coupons in the mail, but samples from the hospital: diaper rash cream, diapers, pacifiers, wipes, coupons for formula, the hospital gave us some formula since we were feeding it to the babies, diaper bags, a bottle or two, and coupons for various other baby products. I remember going through all of it, and using some because any money saved was good. A&D sent me some diaper rash cream AND Desitin did too—we used both!

          • staceyjw
            November 25, 2014 at 4:16 pm #

            I got breast pads free too! And a bunch of Medela ads!
            Mostly, I got coupons, but also got formula (requested), diapers, rash cream, baby shampoo, dishsoap, toothpaste, laundry detergent, fabric softener, and other random stuff.
            Women do the majority of household spending across the board, so they are targets, and moms with new babies and kids are even in more demand because they spend more.

            Breastfeeding has it’s own marketing, don’t be fooled.

        • Ellen Mary
          November 27, 2014 at 12:24 am #

          Hmmm 3 kids, nothing in the mail but formula. If you live in the US, I 1000% call BS that formula is not sold in your grocery store. Use my name all you want, your claims are as ridiculous as they are untrue. If you don’t see formula on your chain grocery shelves, it is somewhere else in the store.

          And just incidentally, I’ve never received a single diaper in the mail, you won’t find J&J, Unilever or DIsNEY anywhere near my mailbox.

      • dbistola
        November 25, 2014 at 6:34 pm #

        Although what you are saying seems to make sense at face value, I really don’t think the two can be compared. Sending freebies through the Mail is a time honored marketing technique. I have received a lot through the mail, especially since having kids, but even before. I don’t see how free samples of formula would result in the type of hair pulling, stomach twisting anxiety some mothers get after meeting with their intensely militant LC. Even the most devoted nurser could simply give them away or toss them, which would be regretful. To most people, freebies and goody bags from companies are just what they are, not aggressive brainwashing. I used a lot of the crap I got, and I nursed for quite a while.

      • demodocus' spouse
        November 25, 2014 at 6:56 pm #

        I got more tea samples than formula samples over my baby’s first year.

      • fiftyfifty1
        November 25, 2014 at 7:32 pm #

        I actually never received a single formula sample in the mail. Here are some freebies I did get in the mail:

        disposable diapers
        a baby spoon
        diaper rash cream
        baby sun screen
        baby shampoo
        baby clothes detergent
        lanolin nipple ointment
        breastmilk freezer bags

        If you think that formula samples should be banned, don’t you think all of these products need to be banned?

        • Bombshellrisa
          November 25, 2014 at 8:02 pm #

          I am jealous-I didn’t get any of that stuff. I got formula samples and coupons. I did use everything I did get, except for the coupons for the photography stuff.

    • Ash
      November 25, 2014 at 12:55 pm #

      That’s a private company using data mining techniques to figure out that you were a person that is highly likely to have an infant. If we were able to figure out how to biologically synthesize breastmilk, I’m sure you’d get that in the mail too.

    • Amy M
      November 25, 2014 at 12:58 pm #

      I could agree that only sending sample to women who ask for them would be best. What did you do with the samples that you didn’t want?

      • fiftyfifty1
        November 25, 2014 at 7:25 pm #

        Why she GRUMBLED about them and let everyone know that she DID NOT NEED THEM!!!!!!!!!

    • KarenJJ
      November 25, 2014 at 12:59 pm #

      Does the UK allow formula freebies? You can’t get them at all in Australia. A real nuisance for those of us that plan to formula feed.

      • Sarah
        November 25, 2014 at 1:15 pm #


      • southwarkbelle
        November 25, 2014 at 2:12 pm #

        I’ve never had any freebies (2 babies in UK) suspect it’s illegal here, advertising formula is banned except “follow on milk” for toddlers

      • Christina Maxwell
        November 25, 2014 at 4:14 pm #

        Not only are there no freebies, coupons or vouchers you also cannot get points in supermarkets (Tesco Clubcard/Boots Advantage card etc) and supermarkets cannot discount formula. There are no generic formulas either.

        • Lion
          November 26, 2014 at 7:09 am #

          Here in South Africa it is the same. No vouchers or freebie samples, no discounts and no loyalty points for formula. Nobody pays us to breastfeed either. Our government doesn’t give free formula except to HIV positive mothers who elect not to breastfeed (in this country your child is more likely to die from diarrhea from unsterilised water or unsterilised bottles and teats than they are to get HIV from breastfeeding) and the HIV positive mothers are given Nevirapene if they’re breastfeeding. There is no lactation support in government hospitals or private hospitals, just volunteers like me who help people get baby latched if mom wants help and answer questions.

      • Steve
        November 25, 2014 at 4:56 pm #

        I actually got some formula on the NHS – but only 2 weeks’ supply for use immediately after he was discharged from NICU. I only got it as a freebie instead of being expected to buy my own because he needed special formula for premature babies which you can only get on prescription (apparently because if it were available in shops then parents of full term babies would be stupid enough to feed the preemie-formula to their babies to make them gain weight quicker or something and this would be potentially dangerous). Once he’d ‘graduated’ to the stuff that’s available in shops, I had to buy my own.

        • Young CC Prof
          November 25, 2014 at 9:31 pm #

          Here in the USA, you can buy preemie high-calorie on the regular grocery shelf, at least here close to the inner-city. Perhaps it’s because we have so many preemies that it becomes economically feasible. 🙁

      • Joy
        November 26, 2014 at 10:35 pm #

        I got some free at the hospital when my then 3 month old had to be admitted for a high fever. I was combo feeding, so we got some ready to feed of our brand, but only a few bottles.

    • Sarah
      November 25, 2014 at 1:11 pm #

      In the UK, we don’t. So the formula samples issue is irrelevant to this discussion because they don’t exist.

    • MLE
      November 25, 2014 at 1:22 pm #

      The two topics (free formula provided by a PRIVATE COMPANY vs. the government paying to increase breast feeding rates) are completely unrelated.

      • Ellen Mary
        November 25, 2014 at 1:37 pm #

        Formula companies are only private in the sense that Haliburton is. The largest single purchaser of formula in the US is WIC . . . So they are, in a sense, a public/private hybrid.

        But yes, now that I have been shown that formula is not provided unsolicited in the UK, than the program does not make sense, I just thought it could make sense to meet a bribe of free products with a bribe of some other benefit for BF.

        • MLE
          November 25, 2014 at 5:58 pm #

          Formula companies are not government contractors if that’s the analogy you’re trying to make. They would exist independent of government orders. The fact that people in need get formula through WIC does not make formula companies a public private hybrid at all. It’s laughable.

          • Guest
            November 26, 2014 at 10:13 am #

            And nice attempt to demonize formula companies by comparing them to, of all corporations, Halliburton. Yeah, I see what you did there.

          • Jessica Nye
            November 26, 2014 at 12:07 pm #


        • Jessica Nye
          November 26, 2014 at 10:14 am #

          Nice attempt to demonize formula companies by comparing them to, of all corporations, Halliburton. Yeah, I see what you did there.

        • LibrarianSarah
          November 26, 2014 at 10:33 am #

          That would mean that every college in the United States is a public school because most students take out federal loans and scholars get federal grants. In other words, the words “public” and “private” have just become meaningless.

          • Ellen Mary
            November 27, 2014 at 12:16 am #

            Most Universities in the US do rely to some extent on public grants, monies, etc. If they take federal money, they usually have extra regulations to abide by because of this.

          • LibrarianSarah
            November 27, 2014 at 12:37 am #

            Yes that was the whole point of my comment Ellen Mary. All colleges take federal money either by grants or loans but that does not make all colleges in America “public.” If you identify every organization the he federal government gives money too as “public” the word becomes meaningless. You have a habit of missing the point of people’s comments. You should really work on that.

    • Ottawa Alison
      November 25, 2014 at 2:03 pm #

      I have gotten my freebies which I think is it (as in no more freebies after that) and my kid isn’t born yet, but I asked the company to send me them so I don’t worry about it…
      I do think it’s wasteful to send it unsolicited but the thing is, that’s neither here or there when it comes to government sponsored healthcare.

    • Cobalt
      November 25, 2014 at 2:16 pm #

      I would not complain about good free food. Private companies giving away formula is only a problem if you see the existence of formula as damaging to breastfeeding (it’s not). There’s also a lot of privilege that goes into fighting against giving away free baby food.

      There are practical uses for those formula samples even if you breastfeed. I carry a sample of ready-to-feed formula and a bottle when out with the baby. Emergencies happen, if I suddenly become unavailable, I don’t want the baby to miss a meal because of it.

      • Ellen Mary
        November 25, 2014 at 3:05 pm #

        They do not send it for altruism & it is actually harder to get when you ask for it. Painting a marketing program as altruism is ridiculous, no matter whether it is BF or FF.

        • staceyjw
          November 25, 2014 at 4:08 pm #

          Of course it’s not altruistic! But it is irrelevant. Free is free and we live in a nation where 1 in every 4-5 kids is hungry.
          I would love to dismantle industrial capitalism entirely, but until then, I’m gonna use what I can.

        • Cobalt
          November 25, 2014 at 5:08 pm #

          They send it to build brand loyalty. If you know your baby does well on Brand A, you’re less likely to try Brand B and risk upsetting the baby. The formula companies are competing with each other, not your breasts.

        • moto_librarian
          November 26, 2014 at 12:15 pm #

          Donate it to a food bank and get over yourself.

    • Allie P
      November 25, 2014 at 3:08 pm #

      Or you could just take the unopened cans to your local food bank. “Problem” solved.

    • carr528
      November 25, 2014 at 3:45 pm #

      I got formula samples, and yet I still BF. It was very nice to have a can on hand for my husband to use if he needed it. Or for us to use if we were somewhere where it wasn’t very feasible to BF. But, I’ve always been pretty laid back about BFing and was more than willing to supplement if I needed (or wanted) to.

      BTW, I got a sample can a year ago, just in time for my youngest’s second birthday. I tried not to be offended, and the local food bank was grateful for the donation. 🙂

      • Sue
        November 25, 2014 at 5:55 pm #

        It would be interesting to know whether the security of knowing that you have a back-up way of feeding takes any stress out of the BF experience, leading to an overall better BF experience or duration.

        • Cobalt
          November 25, 2014 at 7:03 pm #

          I always feel better with a back up. It’s food. Good, easily stored food.

          • Bombshellrisa
            November 25, 2014 at 7:57 pm #

            There is always much talk about having emergency supplies for natural disasters. Putting aside a sample can and a gallon of water in your car and in your emergency go kit and you are all set. I got a really nice bottle as a sample when I bought something at Motherhood Maternity. It sells for $7. I figured it was nice and I would pass it along or pack it in my emergency kit, but since I ended up having to bottle feed, it really came in handy when my son needed a bottle and now Its now part of my emergency car kit.

          • Sarah
            November 26, 2014 at 3:13 am #

            I feel like natural disasters are more of an issue in the US than the UK, too. Been a good long while since we had any kind of earthquake or tornado worth mentioning.

          • Amy M
            November 26, 2014 at 7:58 am #

            Yeah, those poor people in Buffalo last week though–stuck in their homes or cars for hours or days. There was a baby born in a fire station because the parents couldn’t get to a hospital. All was well there, but yeah, having extra supplies in the car can’t hurt.

          • Life Tip
            November 26, 2014 at 10:03 am #

            We had a major hurricane a few weeks after my son was born. We had every neighbor on the block stopping by to make sure we had enough bottled water and supplies for baby. Fortunately breastfeeding was working out ok, but I was really thankful to have the pre-mixed bottles of formula on hand that they gave us at the hospital. They definitely helped with my peace of mind during a time when I could not have accessed formula if I needed it.

    • staceyjw
      November 25, 2014 at 4:05 pm #

      Formula samples cost the makeers of formula, not the state, not the hospital, not the HCPs.

      That formula is valuable, be happy they sent it and go drop it off at a DV shelter or food bank. WIC only covers 1/2 of a months formula and only for the lowest of incomes. You could do additional good by signing up with all the companies and donating all you get! If you dont want to bother taking it somewhere, just post on Craigslist and someone will get it.

      We get so little free, I just dont get the complaints about this.

      • Bombshellrisa
        November 25, 2014 at 4:40 pm #

        It’s about that tempting formula being in the house! Don’t you know every woman is capable of breastfeeding until there is a formula sample in the house! /snark
        I was going to breastfeed my son and figured I wouldn’t need those samples I had received and didn’t ask for. Turns out I used all of them, he couldn’t nurse and formula feeding was easier for us all around. Glad I didn’t wait to ask, the coupons and samples came in handy.

      • Sarah
        November 26, 2014 at 3:12 am #

        I would have loved free formula, or even just to be able to get loyalty card points on what I bought. Of course, you can get loyalty card points on breastfeeding paraphernalia- pads, nipple cream etc- so those formula feeding women who only have access to shops with loyalty card schemes, which is a lot, not only didn’t get any points themselves but were effectively forced into subsidising women buying breastfeeding accessories.

      • Somewhereinthemiddle
        November 26, 2014 at 3:08 pm #

        This isn’t specifically just addressed to you stacyjw, but I didn’t want to start a whole new thread so picked this one as being somewhat related to the question. But how do the formula companies obtain your personal information in order to send the sampes? I’m not all up in arms about marketing samples being sent unsolicited, but find it a bit puzzling that they obtained my info and the fact that I was having a baby from unknown source. From a retailer? Insurance company? For my most recent baby, I didn’t register anywhere or sign up for any lists, but recieved about 5 cans of formula from a few different companies.

    • fiftyfifty1
      November 25, 2014 at 7:16 pm #

      Ah yes, the cousin of the humble brag, the grumble brag:

      They sent me FORMULA SAMPLES (grumble grumble), don’t they realize I am an 100% exclusive BREASTfeeding mother? (grumble) How inconvenient (grumble)! There should be a law (grumble)!

    • Anna T
      November 26, 2014 at 6:21 am #

      Formula freebies are an advertising strategy of companies who want you to use their specific brand. I got some full-size cans too. They sat on our shelf for months unopened and forgotten until we donated them to someone. Luckily powdered formula can be stored for a long time so they were still good. Since I was breastfeeding successfully I was in no way “tempted” to use them. Implying that a can of formula lying around would have impacted my breastfeeding is an insult to women’s intelligence.

      • Ellen Mary
        November 27, 2014 at 12:11 am #

        They send them for a reason. If they were ineffective, they could never justify the waste. If the primary result of the campaign was occupying space in the cabinets of BF mothers, the program would stop tomorrow.

        • Box of Salt
          November 27, 2014 at 1:02 am #

          Ellen Mary, “They send them for a reason. If they were ineffective, they could never justify the waste.”

          I take it you’ve never watched the ads during the Superbowl. Companies waste money on marketing all the time.

        • Sarah
          November 27, 2014 at 2:20 am #


    • anh
      November 26, 2014 at 6:54 am #

      sigh. there is no “We”, here. Neither the US nor the UK gov have a policy of sending of formula freebies to new mothers. There is no policy you can affect. There is no government money being spent sending free formula samples to women. You cannot impact a private company’s marketing process.

  17. Cobalt
    November 25, 2014 at 12:05 pm #

    Maybe the well-off women should be offering to wet-nurse instead. They get the health benefits, the baby gets the magic milk, the poor mom gets some help with the baby, everyone wins. And since breastfeeding is so easy, and free, it’s not like it would be hard for them to do.

  18. November 25, 2014 at 12:04 pm #

    Call me cynical, but I’d sign anything that was wanted, grab the money, and bottle feed behind a closed door. How can it really be verified that a woman is breast-feeding, anyway? Force her to express milk in front of witnesses to show that she is lactating? Or a scenario like this:

    Health visitor: “What’s that bottle you’re giving the baby?”
    Mother: “Expressed breast milk; I have flat/sore/inverted nipples” and the Health Visitor demands a sample for analysis.

    Schemes like this make me think “there’s a sucker [no pun] born every minute”

    My experience in Cambridge was that nearly every mother [often pressured to do it] breastfed in hospital, but within a week at home most had gone over to the bottle but often tried to deny it to the district midwife or home visitor.

    • Joy
      November 26, 2014 at 10:39 pm #

      According to my LC, Cambridge has a particular problem because of the high Traveller population nearby. I would say most women bf in my baby group, but then I mainly know middle class women who were able to take the full year off.

      • November 27, 2014 at 12:54 am #

        During my time there, admittedly a VERY long time ago now [mid-70s], Travellers were not the problem. Women just liked the convenience of the bottle, and it was regarded as the “modern” way to go. It also meant that other family members could help out with the feeds, which, in a largely agricultural area, was a considerable benefit. Whatever the laws, farming families, depending on season, need every hand available, so many women got very little “maternity leave” in reality. And of course the student population still had classes to attend.

  19. Mel
    November 25, 2014 at 11:57 am #

    Dude…breast milk is NOT a magic elixir.

    I had a discussion about the usefulness of Head Start (a free pre-school and infant enrichment program for low socioeconomic status kids) with my fiscally conservative mom-in-law. She pointed out that Head Start kids were falling behind by third grade. I pointed out that Head Start alone couldn’t be expected to single-handedly undo the effects of endemic poverty and systematic racism in 1-2 years of part-time interaction with the kids.

    She got my point.

    I’m willing to bet that if the authors followed up with the children in the study in 3 or 5 or 10 years there would be little or no difference between the BF group and the non-breastfeeding group because one intervention (especially one without any strong demonstrated benefits) cannot undo the effects of poverty.

    • The Bofa on the Sofa
      November 25, 2014 at 12:57 pm #

      She pointed out that Head Start kids were falling behind by third grade.

      Not until 3rd grade? That’s pretty darn helpful. Because, you know, without Head Start, they were behind before they even started kindergarten.

      That they are, on the whole, not falling behind until third grade means that there are actually a lot more who haven’t fallen behind by third grade than without head start. And 6th grade. And 8th grade.

      • Mac Sherbert
        November 25, 2014 at 1:40 pm #

        Really not helpful at all. I see where you are going, but it’s really a poor outcome for all the effort put into it. They need to address why the kids are failing behind by 3rd grade. If headstart does not increase their outcomes in terms of graduation rates, going to college, etc…It’s not really doing them good long term, which is the goal. We really need to address why the benefits do not last beyond 3rd grade. I haven’t looked at the stats in long time, but I think they did show that “most” of the kids were falling behind by third…maybe someone with more time can look at the study.

        • Renee Martin
          November 25, 2014 at 4:33 pm #

          Head Start has many other benefits, so even if there was zero improvement in school (? If there is), there would still be good reason to do it.
          These include: free, educationally appropriate, childcare in a regulated setting (good for all moms), kids learn to interact with each other in a positive way at a time they are sponges, kids get 2 healthy meals per day and are taught nutrition, transportation is provided, families get home visits for extra one on one help with parenting and educational activities for their kids, families also get an advocate to help them access other social services and programs from DV shelter info to housing assistence, food and clothing are provided when needed, and one most overlook- they provide a safety net for abuse for some of the most at risk kids.

          I never realized what amazing wraparound services Head Start provided, until my son started last month. Last year he went to a private preschool and none of this was available. The kids there just didn’t need it. But for those that qualify, it’s a great program and makes a world of difference. I cannot imagine where some of those kids would be otherwise. Many are homeless.

          We do so little for families and kids, this is one thing we do well. It ought to be expanded.

          • The Bofa on the Sofa
            November 25, 2014 at 5:14 pm #

            We do so little for families and kids, this is one thing we do well. It ought to be expanded.

            Yep. I was thinking about the comment about how the students fall behind by third grade. What that tells me is not that head start is a failure, but we need to add more programs to continue the success.

            Great, focus on getting kids to be successful past grade 3. But you don’t do that by killing the program that gets them successfully into kindergarten. Without head start, you don’t have anyone to hold on to, because they never even get started.

          • Sue
            November 25, 2014 at 6:00 pm #

            Well said, Bofa. It may well be that the ”falling behind” is not only delayed but also of a lesser magnitude than without the program.

            One intervention can’t be expected to reverse all the disadvantages that impoverished families have.

          • fiftyfifty1
            November 25, 2014 at 7:49 pm #

            There is an ongoing study from Minnesota that shows that results last long term when the intervention is more intense. Low income families were given “scholarship” vouchers for their children to attend commercial daycare. Parents could choose the daycare as long as it met certain criteria (had to be rated 4 star). Because parents could now pay for high quality daycare, this encouraged high quality programs to open up in bad neighborhoods and for lesser performing daycares to improve practices in order to make the grade. Since these were full day programs rather than just 3 hour preschools, the gains were larger and are persisting. In addition, it frees the parents to pursue full time work. Half day preschool programs are so short that you can’t even work part time.

          • Mac Sherbert
            November 25, 2014 at 5:19 pm #

            I’m not saying they don’t do good work and they do make a difference in the early childhood, but it disappears after 3rd grade and actually there’s a study that suggests is disappears after 1st grade. That’s a huge problem! In education 3rd grade is kind of like the do or die grade. Children that do not do well by third are not likely to make up the difference later, especially in reading. Children that fail at reading in the early grades are at risk for failure in all subjects later, which of course means that will struggle as adults. My first grader reads at a third grade so he’s currently far above most the other kids in his class. However, research shows that by third grade that difference will be gone as the majority of average kids and most strugglers catch up to him. A study that shows these kids are not catching up, but falling behind by 3rd is…well disappointing and I find it startling. My background is in special ed and I firmly believe in early intervention. So, to my mind Headstart should make a very pronounced difference in the outcomes for these kids yet it doesn’t. I think there’s needs to be something done to help any gains made by Headstart in preparing these kids for K is not lost…Education is about long term outcomes.

    • Jessica
      November 25, 2014 at 4:40 pm #

      I went to Head Start. The year before I started my father was laid off and spent most of the year unemployed, so I qualified, even though by the time he finished he made too much money for me to qualify for the program. As best as I have been able to determine, I am the only one of my Head Start classmates to get a college degree, let alone a post-graduate degree. Most graduated from high school, though.

      My mother sort of resented the mandatory home visits with the Head Start educators, because a lot of the advice were things she already did. She did remark once that one of the educators who came for a home visit noted that ours was the only house she’d ever seen that had artwork on the walls.

  20. Ash
    November 25, 2014 at 11:57 am #

    Dr Amy, I’ve always appreciated the boldness of your blog. We obsess over c-sections and breastfeeding because it’s much easier to look at than poverty and lack of resources.

    The USA and the UK need to allocate more funding to training OBGYNs so we can increase our supply of well-trained practitioners rather than focused on the nebulous goal of making women “good mothers”

    • Amy M
      November 25, 2014 at 1:07 pm #

      I agree, with your post in general, and have been thinking about the first part. Poverty is at the root of many problems in the US, and I imagine the UK as well, and I think poverty itself is just so huge and hard to deal with, that people tend to focus on smaller issues, like you said. Now that could work, if the smaller issues were actually relevant to solving/helping the poverty problem, for example, various charities that fund education for kids who would never get it otherwise. Those charities aren’t solving poverty, but at least they are helping some people who are affected by it.

      But breastfeeding is such an insignificant issue, its kind of insulting that these people waste so many resources on it. That money could get formula for poor families where the mother works and therefore couldn’t breastfeed anyway, ensuring that there is enough formula and it isn’t being unsafely diluted. Or in America, it could help a poor family get healthcare they wouldn’t otherwise get, and maybe, someday that embarrassing infant mortality rate will drop. But these people want to make sure that a few more women breastfeed and that women who don’t breastfeed know, loud and clear, that they are terrible mothers. Excellent use of resources, ladies.

      • Sarah
        November 25, 2014 at 1:25 pm #

        Poor women being unable to breastfeed because they’re working isn’t really an issue in the UK. Very few go back to work before 6 months, by which point it’s generally possible to combine bf with being in the workplace if you want. Additionally, women who bf are more likely to return to the workplace after having their children anyway, because they’re more likely to be educated professionals who can earn enough to make it worthwhile.

        We certainly have plenty of unsafe formula dilution by poorer parents, though. You can get vouchers for £6.20 a week that can be used towards formula if you’re very low income, but that doesn’t quite cover the whole cost. The true scale of this dilution is being hidden from healthcare professionals, because naturally women are not too keen to report it to their health visitors. This will be at least part of the reason why formula fed babies do worse generally, and of course is going to disproportionately be a problem for the poorest ff babies. For economic reasons, there’s also something of a culture of moving babies off formula and onto cows milk before 1 year- the NHS recommends either formula or breastmilk should be the main drink before 12 months. But of course, cows milk is a lot cheaper. You can use the vouchers for that, and they’ll cover the whole cost. Again, this is associated with poorer outcomes.

        • Amy M
          November 25, 2014 at 2:40 pm #

          I live in the US, so I was looking at it through an American lens. There are a lot of single mothers in the US, so they must go back to work and aren’t really likely to be breastfeeding as a result. I was guessing there might be similar cases in the UK, but didn’t remember that your maternity leave there applies to everyone, not just those who can afford it, like here.

          Still, it seems there are similar class differences in the UK like the US, and of course the poorest tend to have the most problems (worst health, lowest education levels, highest crime, highest infant mortality, etc). Surely there are other way this funding could have been used that might have made a small dent, or difference to a few people, instead of this silly breastfeeding campaign. I mean, sure, spend some money on making sure that women who WANT to breastfeed get the support they need, but overall, who cares if the breastfeeding rate goes up? More important would be the number of hungry children going down.

          • Cobalt
            November 25, 2014 at 2:42 pm #

            “who cares if the breastfeeding rate goes up? More important would be the number of hungry children going down.”


          • Sarah
            November 25, 2014 at 3:15 pm #

            I forgot to add that also poorer women are more likely to have to engage in other unsafe formula practices such as leaving a bottle out for hours until it is drunk, because they can’t afford to waste it. Again, something people tend to keep quiet about, but potentially a big source of stomach complaints.

        • Joy
          November 26, 2014 at 10:45 pm #

          I used to work a minimum wage job in the UK. I now work in an office. A lot of the women I worked with in the shop went back before six months because they needed the money. Mat leave only covers 90% for the first six weeks and they just couldn’t afford to stay on SMP for very long after the first rate of pay dropped.

          • Sarah
            November 27, 2014 at 2:02 am #

            It does, but statistically it’s unusual for women to return before 6 months now. Not unknown, especially when self employed, but still not common. Obviously I don’t know what time period you’re talking about, it did used to be more common than it is now.

          • Joy
            November 28, 2014 at 9:59 pm #

            My baby is 12 months old, so within the last few years. Of all the women in my NCT class, I am the only one who took the full year.

          • Sarah
            November 29, 2014 at 5:07 am #

            Yeah I have a feeling about 9-10 months is average now? People usually want to take the whole paid period plus any holidays etc, but unpaid is much more of a challenge. I actually took less than 9 but I’m the only person I know who went back so soon.

  21. Sarah
    November 25, 2014 at 11:24 am #

    What is particularly offensive here is the claim that not breastfeeding is a cause of inequality. Rayner made that shit up. There are so very few women in the poorest groups in the UK who ebf that of necessity, we can make educated guesses at best when it comes to controlling for class. We don’t even know yet how inequality, as opposed to poverty, impacts on health, and the UK is one of the most unequal societies in Europe. But hey, much easier to poor blame, hector working class women and put all the onus on them to solve the widening inequality gap than to do something that might require actual concerted action from those in power.

  22. Allie P
    November 25, 2014 at 11:14 am #

    Where do I sign up for that free $300 because I happen to be breastfeeding? Asking for a friend.

    Seriously, BFing rates go up when women get lengthy maternity leaves. I can tell you that for free.

    • Sarah
      November 25, 2014 at 11:19 am #

      We actually have pretty long paid ML in the UK, so it’s not that. Hardly anyone goes back before 6 months, and breastfeeding is a minority concern long before that. Some of this is due to poor support, as there are definitely women who wanted to bf for longer than they did and got no support. Some of it is because of the elephant in the room, which is that even if we take the claimed benefits of bf at their very highest, ie we assume it’s actually possible to fully control for social class, while the effects across society are significant they are invisible on an individual level. Whereas there are very real disadvantages for lots of women, tangible ones. So why bother unless you want to anyway?

    • Joy
      November 26, 2014 at 10:55 pm #

      The US actually has better long term bfing rates than the UK. So having longer maternity leave doesn’t always mean better long term breastfeeding rates. http://apps.who.int/gho/data/view.main.NUT1730?lang=en

  23. Young CC Prof
    November 25, 2014 at 10:47 am #

    The entire scheme is based around lactivism’s Big Lie: That, even in the developed world, breastfeeding is an important goal in its own right with major public health implications. And I just cannot get on board with any plan that begins with the Big Lie.

    I don’t care if it increased breastfeeding rates or not. There’s no reason to believe this plan will improve the outcomes of infants born to low-income women.

  24. The Computer Ate My Nym
    November 25, 2014 at 10:42 am #

    How much did it cost? At £200 ($300) per participant, it cost $11,100.

    That’s just the cost in direct handouts. The total cost was presumably a good deal more since it also had to pay for the people who approach the women about the program, the people who provide the money to them, the people who keep track of the outcomes, etc. I’d guess that the total cost was as much as an order of magnitude higher, though some of those costs are relatively fixed and wouldn’t increase with increased participation.

    OTOH, giving women who are presumably poor (since breast feeding is inversely correlated with income) cash is probably a good thing overal. Maybe the kids will do better because their mothers can use that money to buy them clothes or toys or to make a downpayment to a good daycare, etc.

    • guestS
      November 25, 2014 at 12:20 pm #

      I think they’re vouchers for supermarkets and poundland (a cheap shop where everything is a £1).

      • Sarah
        November 25, 2014 at 1:14 pm #

        They are indeed, which is also very offensive in itself. Naturally, the povs would only wish to go to the pound shops. We can’t have them getting above their stations.

      • southwarkbelle
        November 25, 2014 at 2:16 pm #

        yep supermarkets and poundland! Plus they only get the full £200 if they continue to breast feed for 6 months and it comes in stages so not exactly a life altering amount of money, wouldn’t even touch on childcare costs here.

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