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Participation in the Supplemental Nutrition Program for Women, Infants and Children (WIC) and Breastfeeding: National, Regional, and State Level Analyses

Abstract

This research builds on literature that suggests a negative association between participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) and breastfeeding. Variation in results at the national, regional, and state level has important policy implications for breastfeeding promotion through WIC. Using the 2007 National Immunization Survey dataset, Chi-square, ANOVA, and adjusted regression modeling techniques assess the relationship between WIC participation and breastfeeding initiation and duration. Adjusted regression models suggest a negative association between WIC participation and breastfeeding initiation rates (OR = 0.67, 95% CI: 0.61, 0.72). Of those who initiated breastfeeding, WIC participation was associated with a mean breastfeeding duration decrease of 0.63 months (95% CI: −0.86, −0.39). At the regional level, 3 of 7 regions showed a negative association between WIC participation and breastfeeding initiation. All of the regions indicated a negative association between WIC participation and breastfeeding duration. Out of 50 states, 13 had a statistically significant reduction in odds of initiation of breastfeeding and 10 had reduced duration of breastfeeding among participants of WIC when compared to non-participants. No state showed a positive association between WIC participation and breastfeeding. Regional and state differences in breastfeeding rates suggest that further research is needed to understand the role of national, regional, and state level policies which may undermine WIC’s breastfeeding promotion efforts. Although WIC revised the food packages to create a stronger incentive for breastfeeding, a disincentive for breastfeeding may exist given the higher market value of the formula packages.

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References

  1. 1.

    Scariati, P. D., Grummer-Strawn, L. M., & Fein, S. B. (1997). A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics, 99(6), E5.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Gdalevich, M., Mimouni, D., David, M., & Mimouni, M. (2001). Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. Journal of the American Academy of Dermatology, 45(4), 520–527.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Monterrosa, E. C., Frongillo, E. A., Vasquez-Garibay, E. M., Romero-Velarde, E., Casey, L. M., & Willows, N. D. (2008). Predominant breast-feeding from birth to six months is associated with fewer gastrointestinal infections and increased risk for iron deficiency among infants. Journal of Nutrition, 138(8), 1499–1504.

    PubMed  CAS  Google Scholar 

  4. 4.

    Banerji, A., Greenberg, D., White, L. F., Macdonald, W. A., Saxton, A., Thomas, E., et al. (2009). Risk factors and viruses associated with hospitalization due to lower respiratory tract infections in Canadian Inuit children : a case-control study. The Pediatric Infectious Disease Journal, 28(8), 697–701.

    PubMed  Article  Google Scholar 

  5. 5.

    Matson, A. P., Thrall, R. S., Rafti, E., & Puddington, L. (2009). Breastmilk from allergic mothers can protect offspring from allergic airway inflammation. Breastfeed Medicine, 4(3), 167–174.

    Article  Google Scholar 

  6. 6.

    Scholtens, S., Wijga, A. H., Brunekreef, B., Kerkhof, M., Hoekstra, M. O., Gerritsen, J., et al. (2009). Breast feeding, parental allergy and asthma in children followed for 8 years. The PIAMA birth cohort study. Thorax, 64(7), 604–609.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Flores-Lujano, J., Perez-Saldivar, M. L., Fuentes-Panana, E. M., Gorodezky, C., Bernaldez-Rios, R., Del Campo-Martinez, M. A., et al. (2009). Breastfeeding and early infection in the aetiology of childhood leukaemia in Down syndrome. British Journal of Cancer, 101(5), 860–864.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Bener, A., Hoffmann, G. F., Afify, Z., Rasul, K., & Tewfik, I. (2008). Does prolonged breastfeeding reduce the risk for childhood leukemia and lymphomas? Minerva pediatrica, 60(2), 155–161.

    PubMed  CAS  Google Scholar 

  9. 9.

    Metzger, M. W., McDade, T. W. (2009). Breastfeeding as obesity prevention in the United States: A sibling difference model. American Journal of Human Biology.

  10. 10.

    Parikh, N. I., Hwang, S. J., Ingelsson, E., Benjamin, E. J., Fox, C. S., Vasan, R. S., et al. (2009). Breastfeeding in infancy and adult cardiovascular disease risk factors. American Journal of Medicine, 122(7), 656.e1–663.e1.

    Article  Google Scholar 

  11. 11.

    Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yucesan, K., Sauerland, C., et al. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics, 123(3), e406–e410.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment (Full Report), 153, 1–186.

    Google Scholar 

  13. 13.

    Healthy People 2010. Objectives 16–19. [cited 2009 Sept 17]. Available from: http://www.healthypeople.gov/Document/HTML/Volume2/16MICH.htm#_Toc494699668.

  14. 14.

    Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., et al. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.

    PubMed  Article  Google Scholar 

  15. 15.

    Health Resources and Services Administration. Maternal and child health measures. [cited 2009 Sept 17]. Available from: https://perfdata.hrsa.gov/mchb/mchreports/TVISReports/UI/Snapshot/snapshot.aspx?.

  16. 16.

    Centers for Disease Control. National immunization survey. [cited 2009 Apr 17]. Available from: http://www.cdc.gov/breastfeeding/data/NIS_data/2005/socio-demographic_any.htm.

  17. 17.

    McDowell, M. M., Wang, C. Y., & Kennedy-Stephenson, J. (2008). Breastfeeding in the United States: findings from the national health and nutrition examination surveys, 1999–2006. NCHS Data Brief, 5, 1–8.

    PubMed  Google Scholar 

  18. 18.

    Thulier, D., & Mercer, J. (2009). Variables associated with breastfeeding duration. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(3), 259–268.

    PubMed  Article  Google Scholar 

  19. 19.

    National Archives and Records Administration (2007). Federal register - 7 CFR Part 246 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC Food Packages; Interim Rule 72(234).

  20. 20.

    Prell, M. (2004). An Economic Model of WIC, the Infant Formula Rebate Program, and the Retail Price of Infant Formula. 39–42.

  21. 21.

    Welch, P., & Welch, G. (2009). Economics theory and practice. New Jersy: Wiley.

    Google Scholar 

  22. 22.

    USDA Food and Nutrition Service Office of Analysis, Nutrition, and Evaluation (2007). WIC food package costs and rebates summary: fiscal year 2005.

  23. 23.

    USDA Food and Nutrition Services. Legislative History of Breastfeeding Promotion. [cited 2009 Sept 20]. Available at: http://www.fns.usda.gov/wic/Breastfeeding/bflegishistory.HTM.

  24. 24.

    United States General Accounting Office (2001). WIC faces challenges in providing nutrition services. Report to Congressional Committees GAO-02-142.

  25. 25.

    Black, M. M., Hurley, K. M., Oberlander, S. E., Hager, E. R., McGill, A. E., White, N. T., et al. (2009). Participants’ comments on changes in the revised special supplemental nutrition program for women, infants, and children food packages: the Maryland food preference study. Journal of the American Dietetic Association, 109(1), 116–123.

    PubMed  Article  Google Scholar 

  26. 26.

    Holmes, A. V., Chin, N. P., Kaczorowski, J., & Howard, C. R. (2009). A barrier to exclusive breastfeeding for WIC enrollees: limited use of exclusive breastfeeding food package for mothers. Breastfeed Medicine, 4(1), 25–30.

    Article  Google Scholar 

  27. 27.

    Ryan, A. S., & Zhou, W. (2006). Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978–2003. Pediatrics, 117(4), 1136–1146.

    PubMed  Article  Google Scholar 

  28. 28.

    Herman, D. R., Harrison, G. G., & Jenks, E. (2006). Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. Journal of the American Dietetic Association, 106(5), 740–744.

    PubMed  Article  Google Scholar 

  29. 29.

    Ertem, I. O., Votto, N., & Leventhal, J. M. (2001). The timing and predictors of the early termination of breastfeeding. Pediatrics, 107(3), 543–548.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Heinig, M. J., Ishii, K. D., Banuelos, J. L., Campbell, E., O’Loughlin, C., & Vera Becerra, L. E. (2009). Sources and acceptance of infant-feeding advice among low-income women. Journal of Human Lactation, 25(2), 163–172.

    PubMed  Article  Google Scholar 

  31. 31.

    Hurley, K. M., Black, M. M., Papas, M. A., & Quigg, A. M. (2008). Variation in breastfeeding behaviours, perceptions, and experiences by race/ethnicity among a low-income statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in the United States. Maternal & Child Nutrition, 4(2), 95–105.

    Article  Google Scholar 

  32. 32.

    McCann, M. F., Baydar, N., & Williams, R. L. (2007). Breastfeeding attitudes and reported problems in a national sample of WIC participants. Journal of Human Lactation, 23(4), 314–324.

    PubMed  Article  Google Scholar 

  33. 33.

    Mitra, A. K., Khoury, A. J., Hinton, A. W., & Carothers, C. (2004). Predictors of breastfeeding intention among low-income women. Maternal and Child Health Journal, 8(2), 65–70.

    PubMed  Article  Google Scholar 

  34. 34.

    Racine, E. F., Frick, K., Guthrie, J. F., & Strobino, D. (2009). Individual net-benefit maximization: a model for understanding breastfeeding cessation among low-income women. Maternal and Child Health Journal, 13(2), 241–249.

    PubMed  Article  Google Scholar 

  35. 35.

    Bunik, M., Krebs, N. F., Beaty, B., McClatchey, M., & Olds, D. L. (2009). Breastfeeding and WIC enrollment in the Nurse Family Partnership Program. Breastfeed Medicine, 4(3), 145–149.

    Article  Google Scholar 

  36. 36.

    Jacknowitz, A., Novillo, D., & Tiehen, L. (2007). Special Supplemental Nutrition Program for Women, Infants, and Children and infant feeding practices. Pediatrics, 119(2), 281–289.

    PubMed  Article  Google Scholar 

  37. 37.

    US Department of Health and Human Services (DHHS) (2008). National Center for Health Statistics. The 2007 National Immunization Survey. Hyattsville, MD: Centers for Disease Control and Prevention.

  38. 38.

    Centers for Disease Control. National immunization survey data user’s guide; 2008 [cited 2011 Mar 9] Available from: http://www.cdc.gov/nchs/nis/data_files.htm.

  39. 39.

    US Census Bureau. State and county quick facts. US Census Bureau; 2008 [cited 2009 Oct 30]. Available from: http://quickfacts.census.gov/qfd/state.

  40. 40.

    Guttmacher Institute. National and state trends in teen pregnancy statistics. Guttmacher Institute; 2006 [cited 2009 Oct 30]. Available from: http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf.

  41. 41.

    US Department of Agriculture Food and Nutrition Services.WIC regional offices; 2009 [cited 2009 Dec 4]. Available from: http://www.fns.usda.gov/wic/contacts/fnsoffices.HTM.

  42. 42.

    Jensen, E., Labbok, M. (2010). Unintended consequences of the WIC formula rebate program on infant feeding outcomes: Will the new food packages be enough? Breastfeed Medicine.

  43. 43.

    Oliveira, V., Davis, D. E. (2006). Recent trends and economic issues in the WIC infant formula rebate program 6657.

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Correspondence to Elizabeth Jensen.

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Jensen, E. Participation in the Supplemental Nutrition Program for Women, Infants and Children (WIC) and Breastfeeding: National, Regional, and State Level Analyses. Matern Child Health J 16, 624–631 (2012). https://doi.org/10.1007/s10995-011-0796-7

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Keywords

  • Breastfeeding
  • WIC
  • Infant feeding
  • MCH policy
  • Nutritional programs