Thank you! Dr. Lisa Gennetian Dr. Caroline Friedman Levy Dr. Hiro - - PowerPoint PPT Presentation

Promoting Breastfeeding

A Behaviorally-Informed Approach for Parents, Programs, and Policy Makers

Mackenzie D.M. Whipps, BSc, CLC New York University Email: mackenzie.whipps@nyu.edu Website: www.mackenziewhipps.com Twitter: @MacWhipps

Thank you!

• Dr. Lisa Gennetian
• Dr. Caroline Friedman Levy
• Dr. Hiro Yoshikawa
• Dr. Erin Godfrey

Michelle Spiegel and Alex Clothier

Childhood obesity is an epidemic in America.

Childhood obesity is an epidemic in America.

1971 2010 5% 10% 15% 20%

Source: CDC/NCHS, NHANES. https://www.cdc.gov/nchs/data/hestat/obesity_child_ 09_10/obesity_child_09_10.htm

Adult obesity rates by state, 2017

Source: Behavioral Risk Factor Surveillance Survey, 2017 https://stateofobesity.org/adult-obesity/

Percent of high school students who did NOT exercise at least 60 minutes on 1 out of the last 7 days, 2013

Source: Adapted from State Youth Risk Behavior Survey, 2013

Percent of infants who were exclusively breastfed through 6 months, 2012

Source: CDC Breastfeeding Report Card, 2012 https://www.scienceandsensibility.org/blog/breastfeeding-stats-2016

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth
• Infant feeding choices
• Infant book-sharing
• Multi-method basic science and

program evaluation

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth
• Infant feeding choices
• Infant book-sharing
• Multi-method basic science and

program evaluation

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth
• Infant feeding choices
• Infant book-sharing
• Multi-method basic science and

program evaluation

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth
• Infant feeding choices
• Infant book-sharing
• Multi-method basic science and

program evaluation

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth

² Infant feeding choices

• Infant book-sharing
• Multi-method basic science and

program evaluation

My background and experience

• 10+ years as birth & postpartum

doula

• Certified lactation counselor
• Applied Social / Community

Psychologist-in-training

• Parental decision-making in the

childbearing year

• Where and how to birth

² Infant feeding choices

• Infant book-sharing
• Multi-method basic science and

program evaluation

Today’s Webinar

• Conventional versus

behaviorally-informed approaches to breastfeeding promotion

• Science to practice
• Working with various

stakeholders

How do parents decide (and keep deciding) to exclusively breastfeed?

Perspective from Convention Economics

• Theory of Utility Maximization
• Compare costs with benefits
• Preferences are:
• Stable
• Static
• Well informed
• Self interested

Source: https://hbr.org/2009/07/the-end-of-rational-economics

Perspective from Social Psychology

• Preferences are malleable
• Myopic, impulsive
• Seek social cues

² The easy & quick way wins out over the rational way

Source: https://hbr.org/2009/07/the-end-of-rational-economics

Behavioral Economics is a theory of human decision making integrating concepts from cognitive science and social psychology with economic theory.

Conventional Economic Theory Social Psychological Insights

BE

Parents as the decision makers.

• Parenting is a series of small decisions, made every

hour of every day

• Obesity prevention programs presume that parents’

decisions optimize the use of valuable programs and services available

Parents as the decision makers.

• Parenting is a series of small decisions, made every

hour of every day

• Obesity prevention programs presume that parents’

decisions optimize the use of valuable programs and services available

• But, cognitive barriers can interfere with parents’

ability to think through decisions and follow through on intentions

Traditional intervention approaches are based on the utility maximization model. Conventional Economics says parents will...

• Weigh all costs and benefits
• Make decisions based on full

information, analysis of benefits

• Have stable preferences
• vertime

Behavioral Economics says parents will...

• Have limited cognitive

bandwidth to fully weigh costs and benefits

• Be influenced by what others

think

• Be distracted by things in her

daily life

Conventional Economic Theory ŸDon’t know benefits

• f breastfeeding

ŸLow motivation ŸNo place to pump Social Psychological Insights ŸStigma or fear of judgment ŸWanting to do what

• thers do

Ÿ“I turned out fine”

BE

ŸEducation ŸMotivational ads ŸWorkplace support programs ŸAffirm identity ŸSocial anchoring ŸChoice architecture

+

Barriers Levers

Source: https://www.health.ny.gov/prevention/nutrition/wic/the_new_look_of_wic.htm

Source: HHS Press Release, 4 June 2004, “Public Service Campaign to Promote Breastfeeding Awareness Launched”

Source: HHS Press Release, 4 June 2004, “Public Service Campaign to Promote Breastfeeding Awareness Launched”

Source: HHS Press Release, 4 June 2004, “Public Service Campaign to Promote Breastfeeding Awareness Launched”

Bias is always present in decision-making.

• Present Bias
• Loss Aversion
• Procrastination, or inaction inertia
• Lack of attention
• Lack of self control
• Social influences

Bias is always present in decision-making. ² Present Bias

• Loss Aversion
• Procrastination, or inaction inertia
• Lack of attention
• Lack of self control
• Social influences

Source: Bisin, A., & Hyndman, K. (2014) National Bureau of Economic Research.

Time is a precious resource for new parents.

First year of infant’s life Time needed for a feeding

Source: Whipps, Yoshikawa, & Godfrey (2018). Human Development.

Time is a precious resource for new parents.

First year of infant’s life Time needed for a feeding

Source: Whipps, Yoshikawa, & Godfrey (2018). Human Development.

Time is a precious resource for new parents.

First year of infant’s life Time needed for a feeding

Source: Whipps, Yoshikawa, & Godfrey (2018). Human Development.

Time is a precious resource for new parents.

First year of infant’s life Time needed for a feeding

Source: Whipps, Yoshikawa, & Godfrey (2018). Human Development.

Time is a precious resource for new parents.

First year of infant’s life Time needed for a feeding

Source: Whipps, Yoshikawa, & Godfrey (2018). Human Development.

Other costs and benefits to weigh…

• Appropriate infant weight gain
• Physical pain and pleasure
• Cost of breast pumps and lactation consultants
• Cost infant formula
• Healthcare costs
• Employment benefits and lost wages
• Social stigma and discrimination

Bias is always present in decision-making. ² Present Bias

• Loss Aversion
• Procrastination, or inaction inertia
• Lack of attention
• Lack of self control
• Social influences

Bias is always present in decision-making. ² Present Bias ² Loss Aversion

• Procrastination, or inaction inertia
• Lack of attention
• Lack of self control
• Social influences

Source Tom, Fox, Trepel, & Poldrack (2007). Science.

Framing your message to parents.

“I’ve gotten so much out of breastfeeding, including an amazing bond with my daughter.”

Framing your message to parents.

“I can’t believe I almost missed out on the precious moments I spend nursing my daughter.”

Framing your message to parents.

Source Gennetian, L. (2018) Private Communication.

Framing your message to parents.

R e d & G r e e n L e t t e r s

Source Gennetian, L. (2018) Private Communication.

Choice architecture is a lever for changing behavioral defaults.

• Opt-in vs. opt-out

strategies

• Active consent vs.

presumed consent

• Automatic enrollment

Organ donation by consent type.

Source: Johnson & Goldstein (2003) Science

“The lactation consultant says, ‘You have the best chance to provide your baby with the best possible start in life, through the special bond of

• breastfeeding. The wonderful advantages to you and your baby will last a

lifetime.’ And then the mother bottle feeds. Why?” “Best possible, ideal, optimal, perfect. Are you the best possible parent? Is your home life ideal? Do you provide optimal meals? Of course not. Those are admirable goals, not minimum standards. Let's rephrase. Is your parenting inadequate? Is your home life subnormal? Do you provide deficient meals? Now it hurts. You may not expect to be far above normal, but you certainly don't want to be below normal. When we talk about the advantages of breastfeeding – the ‘lower rates’ of cancer, the ‘reduced risk’ of allergies, the ‘enhanced’ bonding, the ‘stronger’ immune system -- we reinforce bottle feeding yet again as the accepted, acceptable norm.”

Source: Wiessinger, D. (1996) Journal of Human Lactation

Framing your message to parents.

R e d & G r e e n L e t t e r s

Source Gennetian, L. (2018) Private Communication.

Framing your message to parents.

R e d & G r e e n L e t t e r s Formula as Default

Source Gennetian, L. (2018) Private Communication.

Context matters, too!

Economic, Historical, Cultural, + Political Context Family + Social Network Resources Parental Life Course Events Parental Decisions

Source: Adapted from Whipps, Yoshikawa, & Godfrey (2018). Human Development.

How can Behavioral Economics inform obesity prevention programming?

Employers as the decision makers. ² Workplace actors make decisions that impact lactation support

• Cognitive biases
• Stressors of scarcity
• Procrastination, limited attention
• Present bias

Possible levers of action!

• Loss aversion

“You’re missing out on the best talent!”

• Social norming / Anchoring

“75% of employers like you in your community have committed to joining our program.”

• Automatic enrollment
• Personalized reminders

A reminder to consider the ethics. Responsible use of behavioral insights…

• Preserves freedom of choice
• Does not coerce or manipulate
• Is easily reversible

Organ donation by consent type.

Source: Johnson & Goldstein (2003) Science

What happened?

• Highly public change in policy
• May have been seen as coercion by the government
• Used opting-out as a signal to lawmakers

“People sometimes, but not always, act as social sensemakers when confronted with a decision.”

Source: Krijnen, J. (2018). http://behavioralscientist.org/choice-architecture-2-0-how-people-interpret-and-make-sense-of- nudges/

Choice Architecture 2.0

• Social Sensemaking “Audit”
• People are more likely to be sensemakers when:
• Uncertain about choice
• Distrustful of the architect (institution or person)
• Noticing a change in the choices offered

Source: Krijnen, J. (2018). http://behavioralscientist.org/choice-architecture-2-0-how-people-interpret-and-make-sense-of- nudges/

• Behavioral economics bridges social psychological

insights and conventional economic theory

• Decision-makers – including parents, policy makers,

and program implementers – are influenced by cognitive biases and contextual constraints

• We can leverage this understanding to promote healthy

choices and healthy communities

• Deep dives & light touches are necessary

• Behavioral economics bridges social psychological

insights and conventional economic theory

• Decision-makers – including parents, policy makers,

and program implementers – are influenced by cognitive biases and contextual constraints

• We can leverage this understanding to promote healthy

choices and healthy communities

• Deep dives & light touches are necessary

• Behavioral economics bridges social psychological

insights and conventional economic theory

• Decision-makers – including parents, policy makers,

and program implementers – are influenced by cognitive biases and contextual constraints

• We can leverage this understanding to promote healthy

choices and healthy communities

• Deep dives & light touches are necessary

Where to find out more about applying behavioral insights to breastfeeding promotion.

Source: https://steinhardt.nyu.edu/site/ihdscblog/2018/04/26/leveraging-behavioral-insights-new-directions-in-breastfeeding- intervention/

Where to find out more about breastfeeding in the maternal life course.

Source: https://www.karger.com/Article/PDF/487977?casa_token=565TjN0I- pYAAAAA:rgOFudedyThmitL8E7OilGkMmf2OpZRU541LhO_jgVeYBrJzmh1vwJPibHSG0EAMVmFWKbZRog

Where to find out more about beELL’s pioneering work in applying behavioral economic approaches.

Source: http://beell.org/

Thank you!

Mackenzie D.M. Whipps, BSc, CLC New York University Email: mackenzie.whipps@nyu.edu Website: www.mackenziewhipps.com Twitter: @MacWhipps