One of the things people love to say about breastfeeding is that it’s totally and completely free. No bottles to buy, formula to mix, nipples to pack, sterilizers to worry about. Just good ol’ Mother Nature supplying everything a baby could possibly need, straight from the source.
Except every mom who has ever breastfed knows that’s a bunch of crap.
Breastfeeding might technically be “free,” but the cost of nursing a baby is still substantial. From the amount of time and energy it takes to exclusively breastfeed to the loss of wages from work environments that aren’t supportive, and the resources and support required to make breastfeeding happen, breastfeeding comes with a price. So sure, nursing is free, but it costs women and families a lot.
That high, hidden cost of breastfeeding may account for why overall breastfeeding rates across the globe are low. According to a 2017 World Health Organization (WHO) report, there is not a single country in the world that meets the recommended standards for breastfeeding.
And now, a new study in JAMA Pediatrics revealed a somewhat surprising way to boost breastfeeding rates: pay women to nurse their babies.
The study examined what would happen if mothers in areas where breastfeeding rates are low (less than 40 percent) were given financial incentives to nurse their babies. Over 10,000 mothers in England were offered shopping vouchers valued at $50 at various baby check-ups if they were still nursing at the time. The result? Paying women to breastfeed led to higher breastfeeding rates.
According to the study’s authors, breastfeeding rates are particularly low in low-income communities within high-income countries. What makes this fact so startling is that these countries have the resources to support women, but the babies who would benefit most aren’t able to access them. And financial incentives are already playing a role in how and if mothers choose to breastfeed.
For example, France offers nursing mothers paid breastfeeding breaks, while the United Kingdom offers weekly vouchers to women in low-income communities (where breastfeeding rates are low) that can be exchanged only for infant formula, with no breastfeeding equivalent.
The bottom line is that when formula feeding is prioritized, either directly through baby formula vouchers or indirectly through work or life restrictions that make breastfeeding impossible, women are going to choose the formula because it makes sense. Therefore, if we want breastfeeding rates to go up, why don’t we create incentives that support nursing?
Rafael Pérez-Escamilla, a professor at the Yale School of Public Health and part of Becoming Breastfeeding Friendly: A Guide to Global Scale-Up (BBF), believes providing financial incentives for nursing is “appropriate” and effective.
As an example, he cited another recent study conducted with mothers in Puerto Rico that showed the same results: providing cash incentives to women helped improve breastfeeding rates. The study, which appeared in Pediatrics in March 2017, found that giving breastfeeding mothers monthly cash “bonuses” for nursing significantly increased breastfeeding rates within the six month postpartum period.
Although Pérez-Escamilla sees paying women to breastfeed as a short-term solution to help improve breastfeeding rates, he also points out that it won’t get us anywhere in the long run, until we address the deeper issues of why breastfeeding rates are so low. Namely, that there are systematic problems at hand, such as inadequate paid maternity leave and support from health care professionals that require long-term policy changes.
“My three-decade long research program has clearly demonstrated that women need much more access to social and lactation management support to be able to be successful to breastfeed their babies as long as they are planning to,” he explains. “Currently the great majority of women don’t meet their breastfeeding goals because the environments surrounding them make it very difficult for them to be able to do so.”
One could argue that women who breastfeed are performing a sort of public service, as it’s long been documented that breastfed babies have fewer doctor visits and long-term chronic health problems that could tax the medical system or taxpayer insurance programs. The WHO’s Nurturing the Health and Wealth of Nations: The Investment Case for Breastfeeding report found that higher breastfeeding rates could save 520,000 children’s lives, and generate $300 billion dollars in economic gains over 10 years as a direct result of lower illness rates and health care costs.
But of course, there are two sides to every argument — especially when it comes to what women should and shouldn’t do with their bodies. As one article pointed out, the JAMA study did not increase the number of women who started breastfeeding or exclusively breastfed, but only found more increased rates of women who reported that they were still breastfeeding at six to eight weeks postpartum. And there was no real way to verify whether participants were telling the truth.
Any type of similar voucher or financial incentive program that is meant to encourage breastfeeding would encounter the same issue. There is no real way to validate whether mothers were actually breastfeeding. Further, there would be potential drawbacks for women physically unable to breastfeed.
Could paying moms to continue breastfeeding help improve the U.S.’s current rate of less than 25 percent exclusive breastfeeding at six months? Maybe, but I doubt it will happen anytime soon; America still has a long way to go in supporting breastfeeding.
But if we do start paying women to nurse, I’m in full support of retroactive payment. I’ve got hours upon hours logged into the breastfeeding bank that I definitely wouldn’t mind cashing in.