Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial

Area of Science:

• Public Health
• Health Economics
• Maternal and Child Health

Background:

• Breastfeeding offers significant health benefits to infants, yet prevalence remains low in many communities.
• The impact of financial incentives on breastfeeding rates is not well understood.

Purpose of the Study:

• To evaluate the effectiveness of an area-level financial incentive program aimed at increasing breastfeeding prevalence at 6 to 8 weeks postpartum.

Main Methods:

• A cluster randomized trial (Nourishing Start for Health [NOSH] trial) involving 92 electoral wards in England with baseline breastfeeding prevalence below 40%.
• Intervention group received usual care plus financial incentives (shopping vouchers) conditional on breastfeeding, while the control group received usual care only.
• Data were collected from 10,010 mother-infant dyads, with the primary outcome being area-level breastfeeding prevalence at 6 to 8 weeks postpartum.

Main Results:

• The intervention group showed a statistically significant increase in mean breastfeeding prevalence at 6 to 8 weeks (37.9% vs. 31.7%), a difference of 5.7 percentage points (P < .001).
• No significant differences were observed in breastfeeding initiation rates or exclusive breastfeeding rates at 6 to 8 weeks between the groups.

Conclusions:

• Financial incentives can be an effective strategy to improve breastfeeding rates in areas with low baseline prevalence.
• The study demonstrated a modest but significant increase in overall breastfeeding prevalence at 6 to 8 weeks postpartum.