TABLE 3

Summary of Included Studies for Incentives Provided to Encourage Breastfeeding

StudyCountryStudy DesignN Randomized/ RecruitedIncentive ValueIncentiveIncentive Contingent onPrimary OutcomeFollow-upMain Outcomes Reported
Breast pump incentives
 Dungy et al, 199221aUSRCT146$15Manual breast pump + gift items (breast pads, breast cream). Control group received formula discharge packBreastfeeding initiationBreastfeeding continuation rates2, 4, 6, 8 wkPrevalence of exclusive breastfeeding (weeks):
 Intervention: 2 wk 72.7% (32/44); 4 wk 54.5% (24/44); 6 wk 45.5% (20/44); 8 wk 36.4% (16/44)
 Control: 2 wk 53.5% (23/43); 4 wk 34.9% (15/43); 6 wk 30.2% (13/43); 8 wk 23.3% (10/43)
 Sciacca et al, 199528,29USRCT68NSBreast pump (type unspecified), vouchers (for haircut, lunch, clothing, infant carrier), gifts (baby powder, nappies, baby wipes, tickets to a football game), and raffle for both parents (prizes included trip to Grand Canyon, $100 grocery voucher, tool kit)Participation and continuation of breastfeedingExclusive and any breastfeeding rates at hospital discharge and continuation rates2, 6 wk, 3 moExclusive breastfeeding:
 At discharge: intervention 23/26 (88.5%); control 16/29 (55.2%)
 At 2 wk: intervention 21/26 (80.8%); control 10/29 (34.5%)
 At 6 wk: intervention 13/26 (50%); control 7/29 (24.1%)
 At 3 mo: intervention 11/26 (42.3%); control 5/29 (17.2%)
Any breastfeeding:
 At discharge: intervention 3/26 (11.5%); control 7/29 (24.1%)
 At 2weeks: intervention 4/26 (15.4%); control 6/29 (20.7%)
 At 6 wk: intervention 8/26 (30.8%); control 2/29 (6.9%)
 At 3 mo: intervention 5/26 (19.2.3%); control 2/29 (6.9%)
  Bliss et al, 199718bUSRCT1625NSManual breast pump and formula discharge pack (2 intervention arms). Control group received neither pump nor formulaBreastfeeding initiationBreastfeeding duration6 wk, 4 mo, 6 moMean duration (weeks) of any breastfeeding:
 Intervention (pump only): 16.0 wk
 Intervention (pump + formula): 15.7 wk
 Control: 15.7 wk
  Hayes et al, 200823USRCT280NSElectric or manual breast pump (given as loan)Participation in the studyBreastfeeding duration6, 12 moBreastfeeding for ≥6 mo:
 Electric: 72.3% (94/139)
 Manual: 76.8% (76/107)
Median duration (months) of any breastfeeding:
 Electric:12 mo (95% CI 8–12 mo)
 Manual: 11 mo (95% CI: 9–14)
  Rasmussen et al, 201126USRCT34NSElectric or manual breast pump (2 intervention arms). Electric pump given on loan for 10–14 dParticipation in the studyBreastfeeding continuation rates7, 30, 90 dMedian duration (weeks) of exclusive breastfeeding (IQR):
 Electric: 0.7 wk (0.1, 2.7)
 Manual: 2.3 wk (0.4, 4.4)
 Control: 4.4 wk (1.1, 9.4)
Median duration (weeks) of any breastfeeding (IQR):
 Electric: 4.0 wk (2.4, 8.4)
 Manual: 13.4 wk (2.1, 36.0)
 Control: 26.6 wk (9.4, 44.6)
 Chamberlain et al, 200619USHistorically controlled studyUnclear$175–$320Breast pump (type unspecified)Participation in the studyBreastfeeding initiation ratesInitiationBreastfeeding initiation:
 Intervention: general 74%; NICU 64%
 Control: general 16%; NICU 34.5%
 Cohen and Mrtek, 199420USCase series187$500 per employeeElectric breast pump + gift items (expressing kit)Breastfeeding initiationBreastfeeding duration and behaviorUnclearAverage duration (months) of any breastfeeding:
 8.1 mo. Since program inception (4-y period) 74% (n = 139) of mothers who returned to work breastfeeding continued to breast feed for a least 6 mo compared with a national average of 10%
Food package incentives
 Finch and Daniel, 200222USRCT60$75Food packages+ voucherInitiation, continuation, exclusivity of breastfeedingExclusive and partial breastfeeding initiation and continuation ratesInitiation, 8 wkBreastfeeding initiation:
 No significant difference between the 2 groups
Median duration (weeks) exclusive breastfeeding (min/max):
 Intervention 12 wk (7/12+) n = 9/19
 Control 12 wk (5/12+) n = 5/29
Median duration (weeks) partial breastfeeding (min/max):
 Intervention 5 wk (1/12+) n = 6/19
 Control 12 wk (1/12+) n = 15/29
Gift item incentives
 Zimmerman, 199933USHistorically controlled study737$8Gift items: nursing pads, t-shirt, refrigerator magnet, safety plug guardParticipation in the studyExclusive and partial breastfeeding ratesHospital discharge and 2 wkExclusive breastfeeding at discharge:
  Baseline, 67 (36%)
  Year 1, 74 (51%)
  Year 2, 222 (55%)
 At 2 wk:
  Baseline, 37 (20%)
  Year 1, 44 (24%)
  Year 2, 115 (30%)
Partial breastfeeding at discharge:
 Baseline 26 (14%)
 Year 1 14 (10%)
 Year 2, 47 (12%)
 At 2 wk:
  Baseline 28 (15%)
  Year 1, 35 (24%)
  Year 2, 105 (27%)
 Tuttle and Dewey, 199527USHistorically controlled study412NSVouchers + gift items: infant care products, certificate with infant photographParticipation, initiation, and continuation of breastfeedingBreastfeeding initiation rates and continuation ratesBy day 3 and at 3–6 wkBreastfeeding at initiation:
 Intervention: 24/63 (38.1%)
 Control: N/R
At 3–6 wk:
 Intervention: 11/63(17.5%)
 Control: 19/349 (5.4%)
 Volpe and Bear, 200031USHistorically controlled study91NSGift items: chocolate, safety plug guard, perfumeParticipation in the studyBreastfeeding initiation rates defined as at least once a day for at least 3 dInitiationBreastfeeding at initiation:
 Intervention 28/43 (65.1%)
 Control: 7/48 (14.6%)
 Thomson et al, 201230UKQualitative and historically controlled study266 in historic controlled arm£71.99Vouchers + gift items: picture frame, healthy treats, swimming vouchers, magazine, cakes/hot drinksInitiation and continuation of breastfeedingBreastfeeding at 6–8 wk in historic controlled arm6–8 wkAny breastfeeding at 6–8 wk:
 Intervention: 57/94 (60.6%)
 Control: 119/172 (69.2%)
Nonmaterial incentives
 Pugh and Milligan, 199825USRCT60NSNon-breastfeeding tasks, including housework or child careInitiation and continuation of breastfeedingBreastfeeding duration and breastfeeding continuation rateInitiation, 6 moMean breastfeeding duration (days):
 Intervention 136.3 d
 Control 88.3 d
Breastfeeding at 6 mo:
 Intervention 50%
 Control 27%
Cash incentives
 Wolfberg et al, 200432cUSRCT59 couples$25 for fathers and $25 for mothers (total per couple $50)CashParticipation in the studyBreastfeeding initiation rates and continuation ratesInitiation, 4, 6, 8 wkBreastfeeding initiation:
 Intervention 20/27 (74%)
 Control 13/32 (41%)
At week 4:
 Intervention 10/26 (38%)
 Control 11/31 (35%)
At weeks 6 and 8:
 Intervention 9/26 (35%)
 Control 6/31 (19%)
 Hill, 198724cUSRCT64$5CashParticipation in the studyBreastfeeding continuation rates≥6 wkBreastfeeding at ≥6 wk:
 Intervention 12/31 (39%)
 Control 10/33 (30%)
  • CI, confidence interval; IQR, interquartile range; NS, not stated.

  • a Control group received infant formula (a potential disincentive to breastfeed).

  • b Included a comparator group that received formula but control group received neither formula nor pumps.

  • c Both arms received cash incentives as part of multifaceted interventions.