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Women’s preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment

Lookup NU author(s): Dr Frauke Becker, Professor Caroline Relton



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2018 Becker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Increasing breastfeeding rates have been associated with reductions in disease in babies and mothers as well as in related costs. ‘Nourishing Start for Health (NoSH)’, a financial incentive scheme has been proposed as a potentially effective way to increase both the number of mothers breastfeeding and duration of breastfeeding. Aims To establish women’s relative preferences for different aspects of a financial incentive scheme for breastfeeding and to identify importance of scheme characteristics on probability on participation in an incentive scheme. Methods A discrete choice experiment (DCE) obtained information on alternative specifications of the NoSH scheme designed to promote continued breastfeeding duration until at least 6 weeks after birth. Four attributes framed alternative scheme designs: value of the incentive; minimum breastfeeding duration required to receive incentive; method of verifying breastfeeding; type of incentive. Three versions of the DCE questionnaire, each containing 8 different choice sets, provided 24 choice sets for analysis. The questionnaire was mailed to 2,531 women in the South Yorkshire Cohort (SYC) aged 16–45 years in IMD quintiles 3–5. The analytic approach considered conditional and mixed effects logistic models to account for preference heterogeneity that may be associated with a variation in effects mediated by respondents’ characteristics. Results 564 women completed the questionnaire and a response rate of 22% was achieved. Most of the included attributes were found to affect utility and therefore the probability to participate in the incentive scheme. Higher rewards were preferred, although the type of incentive significantly affected women’s preferences on average. We found evidence for preference heterogeneity based on individual characteristics that mediated preferences for an incentive scheme.Conclusions Although participants’ opinion in our sample was mixed, financial incentives for breastfeeding may be an acceptable and effective instrument to change behaviour. However, individual characteristics could mediate the effect and should therefore be considered when developing and targeting future interventions.

Publication metadata

Author(s): Becker F, Anokye N, De Bekker-Grob EW, Higgins A, Relton C, Strong M, Fox-Rushby J

Publication type: Article

Publication status: Published

Journal: PLoS ONE

Year: 2018

Volume: 13

Issue: 4

Online publication date: 12/04/2018

Acceptance date: 14/02/2018

Date deposited: 14/06/2018

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0194231


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