A BIG question was answered this week. If you offer to pay women to breastfeed their babies, then more women will breastfeed.

The Nourishing Start for Health (NOSH – don’t you love clinical trial acronyms?) trial found a six per cent increase in breastfeeding rates in areas where women were paid.

This trial included 10,010 mothers and babies in 92 areas in South Yorkshire. New mothers were offered £40 of shopping vouchers if they were breastfeeding at two days, ten days, six to eight weeks, three months and six months after birth. That £200 covers 1,800 of the nappies. Mothers also saved the £286 that they would have spent on six months supply of formula milk.

As well as saving families some money, breastfeeding is good for health and wellbeing. It reduces babies’ long term risks of diabetes and obesity, and protects them against common childhood illnesses, like the dreaded chicken pox.

There’s this incredible feedback loop between a baby’s mouth and mum’s breasts which means that when a baby has a cold, mum’s breasts make the antibodies to fight it.

Breastfeeding helps babies and mums to feel calm and loved. Mums have lower breast cancer risks, and are less likely to develop postnatal depression.

Also, we shouldn’t underestimate a mum’s pride of watching a baby grow and knowing that it’s all down to the liquid gold being made by her breasts.

“Hurrah for NOSH! Let’s roll it out across the UK and get everyone breastfeeding”, I hear you thinking. Well, hold your horses. What if I told you that 81 per cent of UK mums start breastfeeding without any offer of payment?

And, that the NOSH trial didn’t show a significant increase in the numbers of women starting breastfeeding? What if I also told you that about 90 per cent of UK mums who had stopped breastfeeding by the time their baby was six weeks old, hadn’t wanted to? They wanted to keep breastfeeding. Women want to breastfeed their babies, and they want to keep breastfeeding their babies. So why don’t more mums breastfeed?

Here’s the thing. Breastfeeding is hard. It’s awesome when it works, but it’s hard to get it to work. We don’t see breastfeeding in our ordinary lives. It’s done inside the home because many women feel unable to breastfeed in public. Women aren’t familiar with their breasts before childbirth. Nothing prepares you for the physicality of feeding a baby. Your breasts have suddenly got a life of their own and you’re touching them all the time. You feel them fill up with milk, and leak when you’re least expecting it, and spend the rest of the day sporting milk stains.

Then there’s the actual sucking. Babies are like little vacuum cleaners. If you’ve never experienced breastfeeding, try putting the hoover nozzle on your nipple – actually don’t, you could do yourself some damage. But you get the idea. Yes, it’s amazing, but it’s hard work. It’s especially hard work when you’re exhausted from labour, have no idea how to look after the baby you’ve spent ninth months carrying, your hormones are yo-yoing, and you’re sleep deprived.

Payments are about motivating mums to keep going. But for most women motivation is not a problem. Women stop breastfeeding because they can’t get help when they need it. They can’t get it at 4am when they’ve got breasts like bowling balls and they can’t latch on the screaming newborn because they weren’t in hospital long enough for anyone to show them how to deal with engorged breasts. They get told over and over that “the latch looks fine” while the baby gets readmitted to hospital after losing too much weight.

Evidently the latch wasn’t fine, and now that mum’s breastfeeding journey is probably over unless she has skilled lactation support. Offering to pay these women to breastfeed would be cruel. They already feel like they failed.

Actually, they didn’t fail. They were failed by the system. Breastfeeding support is a postcode lottery. We’re lucky in Brighton and Hove to have an excellent breastfeeding support framework, and the best breastfeeding rates in the country.

Not everyone has that chance. So, no. I don’t think we should start paying every mum to breastfeed her baby. I think it will harm women who already want to breastfeed, but are let down by a system that doesn’t support them to do so.

There might be a place for payments to incentivise breastfeeding in the groups that have the lowest rates of starting breastfeeding. But it must be coupled with a real improvement in breastfeeding support nationwide so that women are informed and prepared for the experience and can access support when they need it. Anything less is cruel.

  • Dr Ruth Stirton is a lecturer in healthcare law at the University of Sussex