Bribing mothers to breastfeed

Nurse Bríd Hehir says let women decide how they feed their babies

A controversial pilot NOSH (Nourishing Start for Health) that will financially reward new breastfeeding mothers is being launched in deprived areas of South Yorkshire and Derbyshire where breastfeeding rates are low.

There has been a lot of discussion about this initiative, some of it critical - suggesting that it discriminates against women who physically can’t breastfeed or that encouragement should take a less ‘consumerist’ form. But there’s been too little questioning of the supposed benefits of breastfeeding being used to justify the scheme. And surely it undermine women’s choice around infant feeding methods?

The scheme is a collaborative effort between the government and the medical research council, led by Dr Clare Relton, a public health researcher at Sheffield University. In the selected areas for the pilot, just 25% of mothers are reported to be breastfeeding at six - to eight-weeks only compared with a national average of 55%. The aim is to improve the breastfeeding rate because it helps prevent problems like upset stomachs and chest infections, impacts on health inequalities and leads to better educational attainment.

In order to qualify for the vouchers, a mother has to confirm to a midwife or health visitor that she’s breastfeeding. She’ll then be entitled to £120 at six weeks and the full £200 at six months. The vouchers can be used in supermarkets and high street shops.

But for me this initiative seems to ignore recent studies questioning the benefits of breast over formula feeding yet the authorities continue to promote the ‘breast is best’ mantra. Joan Wolf, Professor of Gender Studies at Texas A&M University, researched the topic extensively for her book Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. She concluded that the health benefits conferred by breastfeeding are far less certain than proponents contend. She argues that in the association between breastfeeding and reduced risk to infant health, breastfeeding is not necessarily the causal factor. She even suggests that the difference between breastfeeding and bottle-feeding has little impact on the overwhelming majority of infants in the developed world. That is powerful evidence that needs to be discussed more broadly.

Does the NOSH initiative in Yorkshire take account of women’s choice? Surely a mother has the right to decide for herself how she should feed her baby? To me this is a staggering attack on a woman’s autonomy, but somehow this seems to count for little in the blinkered world of public health. Many involved in this sector have come to believe they have a moral right to bully people round to their way of thinking, as though only they can be right.

If I was a mother in the parts of Sheffield and Chesterfield where the scheme is being piloted, I know what I’d do. I’d lie to my midwife or health visitor to collect the vouchers. Why? Because it’s become normal for people to feel judged and undermined when questioned about aspects of their lives deemed to be the business of health professionals. So tell them what they want to hear to escape their judgement. Ultimately how a mother feeds her baby is her choice and no business of health professional’s or society.

NOSH (Nourishing Start for Health) is an MRC-funded study exploring the potential of offering women financial support in order to improve breastfeeding rates in low uptake neighbourhoods.

Brid HehirAbout the author

Bríd Hehir is a fundraising manager for Do Good Charity which sponsors nurse training and education in Africa. She worked in the NHS until 2011, as a nurse, midwife and specialist heath visitor and latterly a senior manager. She is a regular contributor to spiked and is a Battle of Ideas Committee member.