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.