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Randomized Controlled Trial
. 2017 Mar;139(3):e20163119.
doi: 10.1542/peds.2016-3119. Epub 2017 Feb 6.

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Yukiko Washio  1 , Mara Humphreys  2 , Elisa Colchado  2 , Maria Sierra-Ortiz  3 , Zugui Zhang  4 , Bradley N Collins  5 , Linda M Kilby  6 , Donna J Chapman  7 , Stephan T Higgins  8 , Kimberly C Kirby  9   10
Affiliations
Randomized Controlled Trial

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

Yukiko Washio et al. Pediatrics. 2017 Mar.

Abstract

Background and objective: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers.

Methods: A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $20 to $70 for a total possible of $270.

Results: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits).

Conclusions: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Consolidated Standards of Reporting Trials (CONSORT) diagram.
FIGURE 2
FIGURE 2
Breastfeeding status during 6 months postpartum. ** P = .01; **** P < .0001.
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