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A Quasi-Experimental Evaluation of a Breastfeeding Support Program for Low Income Women in Michigan

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Abstract

We examined the effectiveness of a peer counseling breastfeeding support program for low income women in Michigan who participate in WIC. Because there was more demand for services than could be met by the program, many women who requested services were not subsequently contacted by a peer counselor. We used a quasi-experimental methodology that utilized this excess demand for services to estimate the causal effect of the support program on several breastfeeding outcomes. We relied on data derived from administrative and survey-based sources. After providing affirmative evidence that our key assumption is consistent with the data, we estimated that the program caused the breastfeeding initiation to increase by about 27 percentage points and the mean duration of breastfeeding to increase by more than 3 weeks. The support program we evaluated was very effective at increasing breastfeeding among low income women who participate in WIC, a population that nationally breastfeeds at rates well below the national average and below what is recommended by public health professionals. Given the substantial evidence that breastfeeding is beneficial for both the child and mother, the peer counseling breastfeeding support program should be subjected to a cost/benefit analysis and evaluated at other locales.

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Acknowledgements

This study was funded by Michigan Department of Community Health and Michigan State University.

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Correspondence to Beth H. Olson.

Appendix

Appendix

 

Treatment

Control

N

Mean

N

Mean

BFI

County

336

 

654

 

    Lenawee

48

14.3%

176

26.9%

    Monroe

110

32.7%

108

16.5%

    Newaygo

17

5.1%

105

16.1%

    Sanilac

64

19.0%

23

3.5%

    Wayne

97

28.9%

242

37.0%

Previous breastfeeding experience

309

26.9%

139

31.7%

Medicaid

Mother’s race/ethnicity

336

 

654

 

    African American

83

24.7%

222

33.9%

    Hispanic

22

6.5%

36

5.5%

    White

229

68.2%

388

59.3%

Female infant

336

50.9%

654

50.2%

Vital records

Birth weight (g)

288

3291.7

611

3259.3

Pregnancy within 18 monthsa

276

22.8%

587

23.3%

Early prenatal careb

287

90.2%

596

89.4%

Adequate prenatal carec

282

77%

582

77.1%

Tobacco use in pregnancy

286

23.1%

607

24.9%

Prior pregnancies

288

49.7%

606

61.4%

Apgar score (1–10)

288

9.04

606

8.95

Mother’s education (years)

286

11.72

590

11.76

Mother’s age (years)

288

23.24

607

23.79

Drinks per week in pregnancy

288

0.066

607

0.068

Admitted to the NICU

288

3.8%

607

2.6%

WIC

Gestational age (weeks)

336

36.42

654

36.89

Head circumference (cm)

184

34.07

408

34.00

Household monthly income

282

14,952

578

14,196

  1. aThis variable takes on a value of 1 for those women who have had a prior pregnancy within 18 months, 0 if there was a prior pregnancy more than 18 months ago, and missing for everyone else
  2. bEarly prenatal care is an indicator variable for whether the woman sought care before the 5th month of pregnancy
  3. cAdequate prenatal care is an indicator variable for whether the amount of prenatal visits is deemed adequate or better as measured by the Kotelchuck index, which compares the actual prenatal visits to the expected prenatal visits from the start of pregnancy care

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Olson, B.H., Haider, S.J., Vangjel, L. et al. A Quasi-Experimental Evaluation of a Breastfeeding Support Program for Low Income Women in Michigan. Matern Child Health J 14, 86–93 (2010). https://doi.org/10.1007/s10995-008-0430-5

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  • DOI: https://doi.org/10.1007/s10995-008-0430-5

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