Breastfeeding incentives: a pilot scheme with young parents

Jill Smith, Senior Project Officer at Small Steps Big Changes (SSBC), lifts the lid on a breast-feeding incentive programme currently running in Nottingham.

Breastfeeding in Nottingham

As part of its nutrition work, Small Steps Big Changes (SSBC) delivers several activities in Nottingham. These include the promotion of the Healthy Start Scheme, Family Mentor Cook and Play sessions, Small Steps at Home, a breastfeeding public heath campaign ‘Feed Your Way,’ and a breastfeeding incentive voucher scheme.

We know that a significant drop in breastfeeding takes place in the first six weeks of life. According to data from 2018/2019, breastfeeding rates at birth in Nottingham sit at 58.7%, which is lower than the England-wide average of 67.4%. In some of the more deprived areas of the city, the rates are even lower, with half of babies in the city not receiving any breastmilk at six to eight weeks of age.

Breastfeeding has a positive impact on both the short and long-term health and development outcomes of children and their mothers. A UNICEF report fund that increased breastfeeding rates would contribute to significant savings for the NHS as breast/chest feeding provides protective factors to babies and children (First Steps Nutrition 2023).

Incentivising breastfeeding

Previous research has shown that financial incentives in areas with low rates of breastfeeding can increase the number of babies being breastfed. The 2018 NOSH trial in neighbouring South Yorkshire and North Derbyshire showed that breastfeeding incentives had a significant effect on breastfeeding continuation rates at six to eight weeks.

Building on this evidence, we wanted to consider whether an incentive scheme could impact on breastfeeding rates in Nottingham. Using a ‘test and learn’ approach, the aim was to determine whether financial incentives would contribute to more children receiving breastmilk at birth and for longer, and to understand the impact of breast/chest feeding parents feeling valued for their efforts.

The pilot scheme has been delivered with the Family Nurse Partnership since March 2022. Family nurses support first time mums under the age of 19 with babies up to the age of 2 years with their transition to parenthood.

Young parents receiving the support of a Family Nurse were given a £20 digital voucher if they were providing any breastmilk to their baby, at any of the following points in time: two days, ten days, six to eight weeks, three months, six months and one year.

To date, the pilot has supported 60 families who have received 178 vouchers totalling £3,560. Vouchers can be used at several retailers including high street stores, online clothing retailers and supermarkets. Parents are encouraged to use them however they wish.

Unfortunately, the cohort was not large enough to offer any statistical analysis when comparing breast/chest feeding rates, but the qualitative evaluation has offered some powerful insights. Nottingham Trent University Centre for Children and Young People completed an evaluation of the pilot exploring the young mothers’ perceptions and experiences of the incentive scheme and what influenced their infant feeding decisions.

Outcomes

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

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

Family Nurses also mentioned how mothers had used the vouchers for breastfeeding equipment. For example, buying an electric breast pump or a comfy breastfeeding pillow which they wouldn't have brought otherwise as they ‘wouldn't have the spare money to spend on such a luxury item.’

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

References

First Steps Nutrition Trust 2023: INFANT MILK INFORMATION | Types of infant milks on the UK market

UNICEF, 2023: The benefits of breastfeeding - Baby Friendly Initiative (unicef.org.uk)

Family Hubs and Start for Life Programme Guide: (publishing.service.gov.uk)

Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial Clare Relton, PhD; Mark Strong, PhD; Kate J. Thomas, MA; Barbara Whelan, PhD; Stephen J. Walters, PhD; Julia Burrows, MA; Elaine Scott, MPhil; Petter Viksveen, PhD; Maxine Johnson, PhD; Helen Baston, PhD; Julia Fox-Rushby, PhD; Nana Anokye, PhD; Darren Umney, PhD; Mary J. Renfrew, PhD 2017

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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Visit the A Better Start website to find out more.