UK project extends trial of offering gift vouchers to boost breastfeeding

21 November 2014

A UK project aimed at boosting breastfeeding rates by offering gift vouchers in areas with persistently low rates will move to a large-scale trial in Staffordshire and Yorkshire.

The Nourishing Start for Health (NOSH) scheme offers women £120 of shopping vouchers if they breastfeed their baby for up to six weeks and a further £80 if they continue breastfeeding to six months.

Breastfeeding rates in the UK are among the lowest in the world with 6-8 week breastfeeding levels as low as 12% in some areas. The wide-scale trial run by researchers from the Universities of Sheffield, Dundee and Brunel builds on the success of the initial feasibility phase, launched in November 2013. This had around 100 women living in three areas with low breastfeeding rates in Derbyshire and South Yorkshire. The scheme was designed by researchers and local healthcare professionals to complement existing breastfeeding support.

Over half of all eligible mothers signed up for the scheme, of whom almost two thirds claimed vouchers for breastfeeding their baby at six to eight weeks. Mothers in the study reported that they felt acknowledged for their effort, with one mother describing her experience of the NOSH scheme as, “Getting something good for doing something good.”

In the feasibility phase more than 50 midwives and health visitors helped women sign up to the scheme. Midwives and health visitors co-signed the forms used by breast-feeding mothers to claim the shopping vouchers. A Sheffield midwife said: “I don’t think it’s difficult to tell if a woman is breastfeeding as you are talking to them about breastfeeding anyway.”

Mothers taking part in the project reported spending the vouchers on groceries as well as nappies, baby clothes and toys. Some women used the scheme to set personal goals, and saw the vouchers as a reward for breastfeeding to two days, 10 days, six weeks, three months and six months.

One mother in the feasibility study said: “Sometimes you think ‘should I just move on to the bottle now?’ and then I think ‘oh but then I won’t get the money to be able to treat them’, so it does help”.

Principal investigator Dr Clare Relton from the University of Sheffield’s School of Health and Related Research (ScHARR), said: “For several decades now the majority of babies in the UK have not been getting enough breast milk, and despite many efforts, this situation has not improved. Now we need to conduct the full trial to find out if offering vouchers for breastfeeding can significantly increase our stubbornly low breastfeeding rates and be a cost effective use of UK public funds.

“Last year, there was a lot of controversy about the scheme and we didn’t know if it would be acceptable, so we have been delighted to see how enthusiastic local mothers and healthcare professionals have been.”

Mary Renfrew, Professor of Mother and Infant Health at the University of Dundee said: “In areas where most babies are bottle fed women need support to breastfeed. This scheme could make a difference. It’s great to be able to test it properly in a large trial.”

The forthcoming trial will now offer the NOSH Scheme to more than 4,000 mothers in Yorkshire and Derbyshire.

Video: Dr Clare Relton from the University of Sheffield’s School of Health and Related Research (ScHARR), discusses the project.



Relton C, et al. Are financial incentives for breastfeeding feasible in the UK? A mixed methods field study. The Lancet, Volume 384, Page S5, 19 November 2014. doi:10.1016/S0140-6736(14)62131-0

Further information

The Nourishing Start for Health (NOSH) research costs are funded by the National Prevention Research Initiative (NPRI).The vouchers are supported by Public Health England (PHE).

The study seeks to determine whether it is possible to boost breastfeeding through financial incentives in areas where six-eight week breastfeeding rates are less than 40%.

The components of the scheme were determined through work with local midwives, health visitors and mums. Participants do not get the full payments straight away and payments will not affect welfare payments.


National Prevention Research Initiative
The National Prevention Research Initiative (NPRI) is a national initiative made up of government departments, research councils and major medical charities that are working together to encourage and support research into chronic disease prevention.

The initiative is co-ordinated by the Medical Research Council and the award for this study was supported by the following organisations:

  • Alzheimer's Research Trust;
  • Alzheimer's Society;
  • Biotechnology and Biological Sciences Research Council;
  • British Heart Foundation;
  • Cancer Research UK;
  • Chief Scientist Office, Scottish Government Health Directorate;
  •  Department of Health; Diabetes UK;
  • Economic and Social Research Council;
  • Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division);
  • Medical Research Council;
  • The Stroke Association;
  • Wellcome Trust;
  • Welsh Assembly Government; and
  • World Cancer Research Fund.


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