I would like to suggest we stop thinking about this as an issue of
incentives but one of recognition.  For some of these mothers the
items/photos etc may be the only recognition they receive that what they are
doing is important and valuable. Obviously the items/photos must be socially
and culturally pertinent.  What may work in one community may be perceived
as an insult or worthless in another.  The earlier comments from J Panchula
are an excellent example.
        In my social context I did not need physical rewards for
breastfeeding.  I was part of a social group (inside and outside LLL) which
supported breastfeeding and I received a lot of recognition from them.  BUT
most pregnancy outreach programs deal with mothers who are not part of a
similar social structure.  It may not be enough to hear a worker
congratulate them, getting a tangible reward might be helpful.  I can
imagine someone looking at the item whatever it was and being reminded that
SOMEONE considered breastfeeding important.  Certainly not all mothers would
respond but who cares?  You are trying to reach ALL mothers and if some of
them need recognition to continue then why not give it to them?  I would
hate to see philosophy get in the way of achieving increased breastfeeding
rates.  It is not unethical, it may work, so go for it, and after a period
of time evaluate the program's effect.
         Let's keep our eye on the goal, and recognize that mothers may take
vastly different routes to get there. We need to be flexible enough to
assist them on those varied pathways and not waste our time trying to fit
them into the one that we preferred.
--"Without interest and passion nothing great has ever happened in history.
Hegel"
               Rhoda Taylor, B.A., IBCLC   Duncan, B.C., Canada--