Evidence for incentive-based strategies to promote breastfeeding: a systematic literature review of randomised controlled trials

TL;DR

This review explores whether offering incentives can help increase breastfeeding rates, finding some evidence but noting limited and varied research.

Contribution

The paper systematically reviews randomized controlled trials on incentive-based strategies to promote breastfeeding, highlighting gaps in current evidence.

Findings

Some studies showed incentives improved breastfeeding intention, initiation, and duration.

Results were mixed and not consistently positive across all studies.

Most studies were small and focused on low-income populations.

Abstract

There is some evidence that incentive-based strategies effectively encourage smoking cessation in the perinatal period. Incentives could be part of policies aiming to increase breastfeeding rates. This systematic review aimed to summarise current evidence to guide researchers and policymakers towards potentially effective incentive-based strategies for increasing breastfeeding.

Searches of electronic literature databases were conducted (MEDLINE, Scopus, Embase, CINAHL, and PsycInfo) for evaluations of incentive-based strategies to promote breastfeeding published up to August 2024. Identified studies were screened against pre-specified inclusion criteria: studies focusing on promoting or sustaining breastfeeding; an incentive intervention given to mothers or households; a comparator of standard or usual care or an alternative non-incentive intervention; random allocation to treatment group; evaluation of at least one quantitative outcome measure related to breastfeeding. The following were excluded: literature reviews; conference abstracts; protocol papers; animal studies. Key study information was extracted from included records and they were critically appraised using a published checklist (CASP RCT). The results were presented and synthesised narratively. The review protocol was published on the PROSPERO literature review register.

Database searches identified 64 non-duplicate records, and 2 additional records were identified through citation searching of previously published reviews. There were 7 records (from 6 studies) included in the review. Four studies included a total of 260 participants, and the other two studies included a total of 3418 households. Most studies were either conducted in low-income countries (3 of 6) or with low-income mothers in the United States (2 of 6). Some studies reported positive effects of incentives on breastfeeding intention, initiation, prevalence, and duration of exclusive breastfeeding, although others reported neutral findings. Incentives and study designs were heterogeneous, the studies were generally small, and results may not be generalisable to other settings/population groups.

There is some evidence that incentives may improve breastfeeding outcomes, although the quantity and quality of current evidence are both low. Future studies should ensure that sample sizes are sufficiently large and that core breastfeeding outcomes are defined and collected.

The online version contains supplementary material available at 10.1186/s12884-025-08405-2.

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