Financial Incentives

Negative financial incentives are widely applied in taxes on harmful products (alcohol, tobacco). More recently positive financial incentives are being used to modify health-related behaviour. There is good evidence of the effectiveness of positive financial incentives in promoting smoking cessation in pregnancy (1) e.g. in Scotland women are paid grocery vouchers worth £12.50 for each week they abstain from tobacco up to a maximum of £650 for pregnant women, and currently in the Sheffield SOS Scheme, 490 women are being paid £140 to stop smoking during pregnancy. The largest national scheme (555,000 women and children) using positive financial incentives to influence health related behaviour is the statutory Healthy Start scheme. This scheme provides vouchers (worth £3.10 or £6.20 per week) for fruit and vegetables, formula, cow’s milk and vitamins to pregnant women and families with young children in receipt of benefits.

The advantage of financial incentives is their ability to attract and engage their target audience. The impact of financial incentives for women on breastfeeding is a relatively unexplored area. A US breastfeeding education program increased exclusive breastfeeding among urban low income participants (2). A USA quasi-RCT (3) reported that an incentive-based (free diapers) partner-supported educational program on breastfeeding at three months by lower income women improved breastfeeding rates. Discussion with topic experts identified a range of practices including an incentives to breastfeeding programme in Quebec (4) whereby women on benefits receive a monthly breastfeeding benefit of $55 until their baby is one year old and paid breastfeeding breaks for women in employment in France (5). In the UK there are several small scale unevaluated ongoing social marketing projects regarding (non financial) incentives to encourage teenage breastfeeding (6).

References

1. NICE (2010) How to stop smoking in pregnancy and following childbirth NICE Public Health Guidance 26/
2. Finch C, Daniel EL. Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the American Dietetic Association. 2002 July;102(7): 981–4.
3. Sciacca JP, Phipps BL, Dube DA, Ratliff MI. (1995). Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program. J Am Diet Assoc. Mar;95(3):323-8.
4. Emploi-Quebec: For a Healthy Baby and Mother!
5. Saurel-Cubizolles MJ. (1993), Description of maternity rights for working women in France, Italy and in the United Kingdom. European Journal of Public Health, 3 NR 1.
6. Tedstone, S (personal communication) Regional Healthy Early Years and Infant Feeding Lead
Department of Health South West, Bristol BSMC Teen Breastfeeding report & Bristol Teenage Pregnancy Social Marketing Interventions