British researchers try paying mothers to breast-feed

LONDON — When Vanessa Purdy spotted a poster inviting her to earn shopping vouchers for breast-feeding, she didn’t think twice about signing up.

“I thought, ‘If I can get money for breast-feeding, why not?’ ” the 31-year-old mother said on a recent afternoon as she was nursing her son, James. She spent the vouchers on groceries, vitamins and baby toys, but Purdy said the most valuable part of the scheme was that discussing breast-feeding helped make it “seem more natural.”

The United Kingdom has one of the world’s lowest breast-feeding rates, according to British researchers, with mothers up and down the country cradling babies with one hand and offering their little ones a bottle of milk with the other.

Countering the country’s bottle-feeding culture has been a head-scratcher for decades for those dubbed the “Breastapo Brigade” and for health professionals who argue that breast-feeding offers health benefits that could dramatically reduce health-care costs if women nursed longer.

Now, a group of researchers in Britain is testing the novel idea of paying women to breast-feed. Some 6,000 women living in low-income areas are being offered up to 200 pounds ($310) in shopping vouchers if they primarily feed their babies breast milk for six months.

The year-long study, set up by researchers at the University of Sheffield, the University of Dundee and Brunel University, runs until February. A health professional must sign a form to verify the mother is breast-feeding. The vouchers are redeemable at a range of stores.

Critics of the program say that women are being bribed to breast-feed, or that it’s patronizing and naive, or that it’s unfair to women for whom breast-feeding is not the best option because it is too painful, or impractical in the workplace, or — for breast-cancer survivors — impossible.

Others argue that the difference between breast-feeding and bottle feeding is marginal and that new moms should be encouraged to make informed choices on what is best for them.

The view of the British government is clear: It follows the World Health Organization in recommending breast-feeding an infant exclusively for six months. But only 1 percent of British moms meet this target, according to Britain’s Infant Feeding Survey, compared with 19 percent in the United States.

It is perhaps surprising that breast-feeding hasn’t caught on in Britain. Unlike the United States, which does not guarantee paid maternity leave, Britain gives women 39 weeks of paid leave. Britain also has a ban on advertising formula for babies under 6 months old.

The latest figures available show that 81 percent of women here begin breast-feeding. But the drop-off rates are high. At six months, 34 percent of new mothers in Britain are still nursing at least some of the time, compared with 49 percent in the United States, according to the latest figures from the U.S. Centers for Disease Control and Prevention. In Norway, it’s 71 percent.

Across the West, breast-feeding declined in the first half of the 20th century as more women joined the workforce, milk substitutes grew and bottle feeding became fashionable.

The pendulum has since swung back toward breast-feeding, most notably in Scandinavian countries, following a concerted effort to improve rates. Generous maternity leave policies, support from health professionals and mother-to-mother support groups have all helped to create a breast-feeding culture there.

Studies show that affluent and educated women are more likely to breast-feed, and so perhaps it is not surprising that breast-feeding was embraced by Scandinavian countries, where there is generally less extreme income inequality than in the United States or the United Kingdom.

In Britain, rates vary widely across socioeconomic groups. Stumble into a posh cafe in London favored by moms who have attended a National Childbirth Trust antenatal course, a popular class among professionals, and you would think that breast-feeding was a cultural norm.

Researchers have suggested a multitude of reasons for Britain’s low rates, including inadequate training of health professionals, patchy support and a culture that is apt to advocate for formula when women run into difficulties such as breast pain or unease about feeding in public.

Some argue that in British and other cultures, the reaction to bare breasts can seem contradictory or even hypocritical.

“You get a lot of exposure to women’s bodies in highly sexualized ways and, at the same time, intense prudery about exposure of breasts for feeding babies,” said Mary Renfrew, an infant-health expert at the University of Dundee.

In a high-profile case earlier this year, a woman was nursing her baby at Claridge’s, an elegant hotel in London, when a waiter handed her a large napkin and asked her to cover up.

The University of Sheffield’s Clare Relton, the lead researcher on the shopping-voucher study, said the idea has the potential to change the perception of nursing from “a taboo activity to a valued activity.”

Cathy Warwick, the general secretary of the Royal College of Midwives, said, “We’d be up for anything that helps.” But she also cautioned that “if we only focus on vouchers, it may be it has less impact than if we focus on a wider group of issues.” Warwick said that better education and extra support for mothers in hospital wards could make a significant difference.

Purdy, the mother who participated in the voucher program, said that while she would have tried nursing without the vouchers, the program helped keep her going during tough periods when she was in pain or exhausted. As a resident of Maltby, a onetime coal-mining city in central England where breast-feeding rates are low, she qualified to take part in a pilot program last year that researchers said showed encouraging results.

“When you get a letter that says, ‘Congratulations for breast-feeding,’ it makes you feel happy about doing it and encourages you to continue,” she said.

Purdy sometimes meets with other new moms during the day at a local pub — not an uncommon thing to do in Britain — and said when she first started nursing there she would sit shyly in the corner of the room. Now, more comfortable with breast-feeding, she feeds her son at whatever table she’s at.

She said the pub owner responded by placing a sign in the window. It reads, “Breast-feeding Friendly.”