Thursday, 20 November 2014
Paying Women To Breast Feed - Update And Early Results
I wrote last year about a new study that aimed to see if mothers in deprived areas could be encouraged to breastfeed by giving them shopping vouchers if they did. I promised to report back when the results emerged and a few are to be presented soon at a scientific meeting organised by the medical journal The Lancet. So here we go...
It's worth saying that presenting something at a meeting isn't the same as publishing it in a scientific journal. So none of this has yet gone through the process of peer review where other scientists in the field look at the work and check it's been done well.
Plus, I'm not that impressed.
Of the 108 women eligible to join the program 58 signed up and at the third check point, when their babies were 6-8 weeks old, 37 were still breastfeeding. This works out to 34% of those eligible, which is better than the 21-29% which is normal for area the women live in.
But - oh, there are a whole lot of buts in this story:
Firstly, women were considered to be breastfeeding if they and a medical professional signed a form to say they were. Presumably said professional didn't trail these women 24/7 so they can't be sure how much the baby is actually breastfed - exclusively? half the time? only when a health professional is in front of them with a form? How is the result actually defined? The Mum is of course incentivised to say she is breastfeeding and not only to get the voucher. She may not want to admit to having "failed" at breastfeeding or may even be concerned about letting the researchers down. Similarly, health professionals may be inclined to give a woman the benefit of the doubt so she doesn't miss out on the vouchers.
But the big question in my mind is - if breast feeding has increased - how do we know it's the vouchers that did it? One of the participants is quoted by the BBC news as saying she gained a lot of confidence and made friends by being part of the program. In the video interview in the piece the same participant talks about how encouraging it was to receive a letter, praising her for continuing to breastfeed. It seems reasonable to assume that the women in the study were getting time with health care professionals to talk about breast feeding and get help (as those professionals had to sign the forms for the vouchers). So in addition to some gift vouchers, the women were gaining encouragement, praise, friends, a support network and professional advice. I know how hard it can be to breastfeed and how damn near impossible it can be to get consistent professional help if there are problems. I also know the huge value of having friends with babies the same age and the peer pressure to continue breastfeeding that that can also bring. There doesn't appear to have been any kind of control to rule out these other factors in this study and to me it seems screamingly obvious that they would have an effect.
Perhaps the vouchers serve the purpose of drawing women into the scheme and the help and support it offers? But we can't tell that from the data in the published abstract as it could be that all the participants intended to breast feed anyway (the one interviewed by the BBC says she did). The standard feeding rate at 6-8 weeks in the area only tells us how many women managed it for that long, not how many wanted to but gave up through lack of support.
I have Two final issues with this, firstly what effect will this have on those mothers who want to breastfeed and don't manage it? It's something often associated with a lot of guilt and can worsen post natal depression, but it's utterly unnecessary for women to be made to feel that bad about it. The benefits of breastfeeding, if you have ready access to formula, clean water and a steriliser, aren't that big. Looking at the whole population could the added burden of guilt on those failing to get the vouchers do more harm than good? (I say this as someone who exclusively breastfed both kids for over a year btw, I have nothing against breastfeeding!).
But finally, assuming that there are some benefits to breast feeding and that most mothers are told about these ad nauseum during pregnancy, are we really suggesting that mums in deprived areas can only be convinced to do something that will benefit their baby if they are bribed into it? You don't have to be a middle class mum with an NCT group and an expensive pram* to want the best for your child surely?
No doubt I will be returning to this at some point, it's very early data and it will be much more informative to see what is happening at the 3 and 6 month time points. Presumably there will eventually be a proper paper which may answer some of my concerns over the methods. The aim now is to do a much larger study. Hopefully this one will have a few controls - the obvious one being a group of women who get every benefit of the scheme except for the vouchers. In the mean time I remain unconvinced.
*I say this as a middle class mum with an NCT group and an expensive pram btw, I have nothing against us either!