I wasn't going to write about this as so very much has already been said about it in the media and on other blogs. But a couple of people have asked me what I think and I haven't seen much coverage of the science behind it all, so I'm going to bash out a quick post - forgive me if it's not a great read!
If you've missed it, (HOW???) A study is being launched to look at offering financial incentives to women to get them to breast feed. The idea is that in some poor areas breastfeeding is taboo. No one does it, no one sees anyone else do it and it's thought of as a weird. So the study want to see if they can encourage women to breastfeed by offering them vouchers if they do.
Cue twitter storm and massive outrage in the media.
I agree with a lot of what has been said TBH. I find the hypothesis that poor people won't breastfeed because it's good for their baby, but can be bribed into it, deeply unpleasant. I think that breastfeeding is often incredibly, unimaginably difficult, and that the best way to increase it is to ensure there is adequate and consistent help available. I also worry that those on the trial who "fail" to breastfeed will then have the added guilt of not getting the vouchers for their family. But lots of people have written all that already. What I'm wondering about is the science behind it.
Firstly lets look at breastfeeding itself: There are definite benefits to it but they are often overstated. For example, it does reduce the mother's risk of breast cancer, but if you had two children you would have to feed them for far more than the recommended six months in order to get that benefit. Evidence for many of the benefits to the baby is often a bit weak too, a lot more research is needed to confirm it all. As breastfeeding is more common among more affluent and educated groups it's often hard to separate the effects of feeding from other social and economic influences. Ultimately, while not breastfeeding may be one cause of the shameful health gap between rich and poor in this country, there are bigger fish to fry. Stopping poor kids taking up smoking for example would have a much bigger effect.
Now the study. What I can't tell from the reports is how this will actually be conducted. There are issues about finding out if the women really are breast feeding and exactly how you define that. More importantly what controls will be in place? If they are enrolling women onto the scheme and then comparing breastfeeding rates to the norm for the area, how can we be sure that it is the vouchers making the difference? As I said above the biggest barrier to many women is the lack of good advice and support. If the women in the study are regularly seeing midwives or health visitors to prove that they are breast feeding then it's possible that they will be receiving more help and attention than most of their peers. If the voucher scheme were to be rolled out nationally we'd need to know if it was really the vouchers or that additional help, making the difference.
Finally, I have concerns over the person running this study. Dr Claire Relton is a Homeopath. Something she makes quite clear on her university page. Now, I really REALLY don't want to start a homeopathy debate here. It's been done a million times and we are not going to suddenly reach a consensus in one blog post. But whatever side you are on we can probably agree that homeopathy isn't accepted by conventional, mainstream science and medicine. A major reason for this is that there are few if any well designed trials that show homeopathy has an effect beyond placebo. There are plenty of trials with more questionable methods though. A large proportion of Dr Relton's previous publications are in the field of homeopthy and alternative medicine. Which leaves me feeling a little uneasy. If Dr Relton has mostly produced the kind of publications that are generally seen as poorly designed by most mainstream scientists, how can we be sure that this study will be well run? Surely something this important and this likely to be controversial needs to be whiter than white and run by someone a proven tack record of high quality study design? It's also worth noting that this is all being funded by the government, via the MRC.
I've not had a lot of time for this post so I've not been able to find and read the protocol for the trial, it could actually be perfectly good and I don't think that any of the concerns here or raised by others are a reason not to do it. It is possible that it could be beneficial so it's worth a look. But when we do get published results and no doubt a million more media stories about them, I for one will be looking very, very closely at them before I make my mind up.
PS Sorry for the lack of references in this post, I just don't have time to dig them all up - if you're really bothered contact me or, you know, google it.