A ladder logic model to inform the design of incentive interventions for breastfeeding

Breastfeeding is a socially patterned behaviour, which has consequences for health inequalities. Breastfeeding prevalence in the UK has not changed over the last 15 years. As a result many are advocating new approaches rather than more of the same. One such approach is to offer women incentives. Systematic review evidence on the effectiveness of incentives for improving breastfeeding outcomes is inconclusive (Morgan et al.2015). General public acceptability of financial incentives is mixed, a free breast pump worth £40 was more acceptable than shopping vouchers (Hoddinott et al.2014) and unintended consequences may occur for relationships (Thomson et al. 2014). One aim of our study was to improve understanding of the mechanisms of action of financial incentives for breastfeeding in pregnancy, with a focus on health inequalities.