Cash may get more mothers to breastfeed babies

Cash incentives may encourage new mothers to breastfeed until their infants are at least six months old, a small experiment suggests.

Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.

Mothers can benefit too, with longer periods of breastfeeding linked to lower risks of depression, bone deterioration and certain cancers.

For the current experiment, researchers randomly chose 18 low-income Puerto Rican mothers to receive monthly cash incentives totaling up to $270 to breastfeed infants, and compared their feeding habits to another 18 similar mothers who were not offered cash.

When the babies were six months old, 72 percent of the mothers eligible for cash rewards were breastfeeding but none of the other mothers were, researchers report in Pediatrics.

“It has been challenging to help mothers maintain breastfeeding especially among those who are socioeconomically disadvantaged and belong to racial or ethnic groups who do not commonly promote breastfeeding among their members,” said lead study author Dr. Yukiko Washio, of Christiana Care Health System and the University of Delaware in Newark.

“Although the study sample was very small, the study provides an insight on a potential way to motivate mothers to continue breastfeeding,” Washio said.

Women in the study received services through the Supplemental Nutrition Program for Women, Infants and Children, or WIC, a government program that gives healthcare and nutrition support to pregnant and breastfeeding women and their young kids.

After initial evaluations, researchers assessed whether women were still breastfeeding by watching mothers nurse babies during evaluations at one, three and six months postpartum. If mothers pumped milk for babies, staff observed this and watched mothers feed expressed milk to their babies.

All of the participants were paid $25 for each assessment, with the potential to earn up to $100 for completing the study.

Mothers in the cash incentive group could also earn $20 for the first month of breastfeeding, then payments increased by $10 each month after that.

At one month, 89 percent of women eligible for cash were still breastfeeding, compared with 44 percent of mothers who didn’t get payments. By three months, the same proportion of mothers in the cash group still breastfed their babies, but this declined to 17 percent of women who didn’t get payments.

Still, many women supplemented breast milk with formula, and there wasn’t a meaningful difference in the proportion of women who exclusively breastfed babies.

One limitation of the study is that it’s too small to detect factors in addition to cash incentives that might influence whether women continued with breastfeeding, the authors note.

One concern with payments is that they might coerce low-income women into breastfeeding when that isn’t the choice they want to make, Dr. Lydia Furman of Case Western Reserve University and Rainbow Babies and Children's Hospital in Cleveland, Ohio, writes in an accompanying editorial.

Women may also need additional support to succeed with breastfeeding, Furman said by email. Particularly when they return to work, women need support from home, Furman added.

In addition, the La Leche League, an international organization that helps women to breastfeed, notes on its website that working mothers may encounter resistance from their employers when requesting time and a private space for pumping.

Among other things, women may do better with expressing milk if they can call the caregiver during the day to speak to their baby or go down to the daycare and nurse the baby, Furman said. Nursing at night can also help.

“I personally believe that cash incentives paid to WIC recipients for breastfeeding can ‘level the playing field’ with respect to money spent by WIC on the mother-child couple and that they are ethically defensible and socially responsible,” Furman writes in the editorial.