Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers.
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.
Christiana Care Health System/University of Delaware, Newark, Delaware; ywashio@udel.edu.
Yukiko
Y
Washio
College of Education and.
Mara
M
Humphreys
College of Education and.
Elisa
E
Colchado
Temple University Hospital, Philadelphia, Pennsylvania.
Maria
M
Sierra-Ortiz
Christiana Care Health System/University of Delaware, Newark, Delaware.
Zugui
Z
Zhang
Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania.
Bradley N
BN
Collins
N.O.R.T.H., Inc-Philadelphia WIC program, Philadelphia, Pennsylvania.
Linda M
LM
Kilby
Springfield College, Springfield, Massachusetts.
Donna J
DJ
Chapman
Department of Psychiatry, University of Vermont, Burlington, Vermont.
Stephan T
ST
Higgins
Department of Psychology, Rowan University, Glassboro, New Jersey; and.|Treatment Research Institute, Philadelphia, Pennsylvania.
Kimberly C
KC
Kirby
D000328:Adult; D001942:Breast Feeding / Q000191:economics*; D005260:Female; D063105:Food Assistance; D006293:Health Promotion / Q000191:economics*; D006630:Hispanic or Latino; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers; D009042:Motivation; D015143:Philadelphia / Q000453:epidemiology; D011203:Poverty; D011647:Puerto Rico / Q000208:ethnology; D055815:Young Adult