UK pilot study looks at rewarding mothers for breastfeeding

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The media is picking up on reports of a pilot study in Yorkshire and Derbyshire that will reward mothers with shopping vouchers if they breastfeed their children. According to The Guardian report: "Women will be offered vouchers worth £40 if they are breastfeeding when the baby is two days old and then further £40 vouchers at 10 days and at six weeks. The last two vouchers are spaced further apart – at three months and at six months."

Although not directly related to this approach, maternity support is one of the strategies for improving breastfeeding rates in IBFAN's Scaling up Breastfeeding proposals. Globally, according to the World Health Organisation, "About 800,000 lives of children under five years of age can be saved each year if all children 0-23 months are optimally breastfed."

Today is World Penumonia Day and WHO, UNICEF and the GAVI Alliance are again highlighting breastfeeding as a key intervention to prevent this illness and resulting deaths - click here for press release.

In the UK, UNICEF has calculated that the National Health Service would save £40 million per year if breastfeeding rates increased modestly, so reducing hospital admissions for the five diseases most prevalent amongst babies fed on formula.

A Department of Health survey in 2004 found that a third of mothers believe the 'myth' that infant formula is the same or almost the same as breastfeeding. The situation is unlikely to have changed as companies continue to promote their formulas as based on 'breastmilk research' and relaunch brands as more 'advanced' (as with the current Danone Aptamil Pronutra campaign), relying on mothers to think that makes them similar to breastfeeding, rather than questioning why the company gave exactly the same impression about the version it now claims was missing ingredients or not based so closely on breastmilk.

Anyone needing a quote can draw from the following from Mike Brady, Campaigns and Networking Coordinator at Baby Milk Action:

Certainly the coalition government should be investing in breastfeeding - regrettably when it came to power it scrapped the infant feeding coordinator posts at the Department of Health in 2010 in the cutbacks.

Danone Facebook advertisement

Formula companies spend a fortune trying to persuade pregnant women and mothers to buy their products, including offering vouchers and gifts when they sign up to formula-branded mother and baby clubs (as in Danone's Facebook advertisement shown left). It will be interesting to see what impact following a similar approach in this pilot study may have on breastfeeding rates.

I understand that the researchers are partly wanting to see whether associating money with breastfeeding will cause it to be valued more, particularly in communities where breastfeeding rates are very low.

The money itself may not persuade individuals, but the message that the chance of higher breastfeeding rates and reduced illness and treatment costs are worth the health authorities paying out £200 per breastfed baby may bring home breastfeeding's worth to babies, their families and society as a whole. It will be interesting to see what happens in practice. There are many other ways the money could be used to improve breastfeeding support - after all, most mothers who stop breastfeeding in the early weeks say they wanted to breastfeed for longer.

We think of breastfeeding as being free, whereas formula costs and so some might see it as more valuable. Anecdotally we hear some mothers and even health workers naming the most expensive formulas as 'the best', without justification, showing how expense is equated with quality.

In the past, we have asked the Advertising Standards Authority to investigate company advertising claiming Aptamil formula (click here) and SMA formula (click here) are 'the best' and the companies could not substantiate their claims and were warned not to repeat them.

Formula is an over-priced product to pay for all the company promotion - which breaks marketing standards. If these standards were enforced in the UK, formula would be cheaper, the information for mothers would be independent and breastfeeding rates would likely increase as well.

Examples of current company marketing practices are documented at

Nestlé entered the UK market with the takeover of Pfizer Nutrition/Wyeth and the SMA brand of formula in December 2012. It is now actively targeting health workers with events at hotel venues in an attempt to circumvent the restrictions many health facilities have in place to stop company representatives targeting staff. In these health facilities, companies can only provide information on their products to a designated expert staff member (or a multidisciplinary committee in some regions), who will assess the accuracy and only pass on what is necessary.

In some cases, the events are on issues such as vitamin D, iron and colic. Nestlé uses misleading claims on these issues to push its products. In other cases guest speakers will speak on other child care topics to entice health workers to the event. Nestlé is shortly to launch SMA HA formula in the UK - despite the fact its "hypoallergenic" claim has been prohibited in the United States following legal action after babies suffered anaphylactic shock. When Nestlé tried to introduce NAN HA into the UK a decade ago, it had to apply warning labels to tins after concerns were raised by the Department of Health - see the archive.

Nestlé is currently competing with the NHS and mother support groups in trying to persuade pregnant women to contact it for information on infant care. They are directed to a website promoting SMA formula. Click here for analysis.

Nestle SMA promotion

Danone, the second largest baby milk company, competes with Nestlé around the world and has stepped up promotion in the UK, including with advertising for Aaptamil formula over four pages of The Observer Magazine cover on 27 October 2013. Click here for analysis.

Observer cover

Enforcing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly in the UK would prohibit such practices. Some aspects of these campaigns are already prohibited under the Infant Formula and Follow-on Formula Regulations (2007) and associated Guidance Notes, but these are poorly enforced.

Stopping promotion can have a significant impact as the following graph from Save the Children's Superfood for Babies report demonstrates. India has implemented the International Code and Resolutions and sales of baby milk have remained fairly static. China has poor regulations and Nestlé, Danone and other companies are engaged in fierce competition. Formula sales are growing exponentially. Click here for examples of how Nestlé promotes its formula around the world with claims on labels such as it "protects" and is the "natural start".