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. 20% 15% 10% 5% 1971 2010 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 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 Social Economic Psychological BE Theory Insights

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 Behavioral Economics says parents will... says parents will... • Have limited cognitive • Weigh all costs and benefits bandwidth to fully weigh • Make decisions based on full costs and benefits information, analysis of • Be influenced by what others benefits think • Have stable preferences • Be distracted by things in her overtime daily life

Social Psychological Conventional Economic Insights Theory Stigma or fear of Don’t know benefits Barriers BE judgment of breastfeeding Wanting to do what Low motivation others do No place to pump “I turned out fine” Education Affirm identity Motivational ads Levers Social anchoring + Workplace support Choice architecture programs

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”

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