Offsetting the costs
But what if the women who experience the highest breastfeeding costs – women on low incomes – were actually compensated for these costs? What if these mothers received extra time, cash, products or services, or a mixture of all four when they breastfed? This is not a new idea, but it is the subject of some recent controversy – just take a look at the reactions to Courtney Jung’s Lactivism and a University of Sheffield trial in the UK that paid women on very low incomes to breastfeed exclusively.
Controversies aside, incentivizing the women who face the highest costs to breastfeeding but whose children also stand to gain the greatest benefits is good public policy. These are the women who should be first in line for paid maternity leave so they can breastfeed at home, and if they choose instead to return to work after baby is born, they should be first in line for paid work breaks to breastfeed if baby is in care nearby or to pump. They should have preferential access to quality, affordable breast pumps and to other breastfeeding supportive technologies.
We also know from decades of experimentation that conditional cash and non-cash incentives provided directly to women, especially those living in low- and middle-income countries, do influence healthier behaviors. Why not experiment further and at large scale with paying women who breastfeed where the costs of not doing so are very high and fall disproportionately on the most vulnerable babies? And if cash is not the solution, why not try non-cash rewards such as products (e.g., nutritious food vouchers for the family) and/or services (e.g., free family health care).
Each year an estimated 140 million women will face the decision whether to breastfeed or not. If rewards can increase breastfeeding rates among the populations of babies most exposed to the health risks associated with sub-optimal breastfeeding and do not penalize mothers on low-incomes who cannot breastfeed, they deserve to be a standard part of breastfeeding policies and programs, especially in countries struggling with high rates of child deaths. It is highly likely that the costs of funding rewards like these would be more than fully offset by savings to the health system and returns to society from healthier babies. And as every additional dollar given to mothers benefits the health and education of their families, cash and in-kind rewards for breastfeeding may actually end up delivering a double benefit that goes well beyond the immediate health gains for the breastfed baby.
The Sustainable Development Goal deadline of 2000 is fast approaching. A new target of 70% exclusive breastfeeding by 2030 has been proposed by the Global Breastfeeding Collective. So let’s start experimenting with different approaches that compensate breastfeeding mothers for the service they are providing to their families, to their communities and ultimately, to the world, and let’s make sure the mothers who face the highest breastfeeding costs and forfeit the greatest benefits are first in line for extra support.
Updated January 2024