The impact of WIC enrollment on breastfeeding rates: A comprehensive study | Image Credit: © Seventyfour - © Seventyfour - stock.adobe.com.
The Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) may impact breastfeeding decision-making, according to a recent study published in the American Journal of Obstetrics & Gynecology.
- The study suggests that the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) may influence breastfeeding decisions among new mothers in the United States.
- Lower rates of breastfeeding are observed in women facing economic challenges, with lower education levels, or from racial or ethnic minority groups. Early formula introduction during hospital stays also significantly affects breastfeeding duration.
- While WIC provides educational services and formula support, the study indicates that the provision of free formula may lead to reduced rates of exclusive breastfeeding among WIC-enrolled mothers.
- The retrospective cohort study, based on survey data from 46 US states and Puerto Rico, focuses on primiparous mothers with a singleton pregnancy and at-term delivery, revealing disparities in breastfeeding rates between WIC-enrolled and non-enrolled participants.
- The analysis of survey data indicates that, among low-income mothers with an annual household income below $35,000, those enrolled in WIC showed reduced rates of exclusive breastfeeding after 1 week postpartum compared to non-enrolled mothers.
Exclusive breastfeeding is recommended in the first 6 months of an infant’s life, with health benefits including decreased risk of maternal comorbidities and improved infant immunity. However, only approximately 25% of new mothers in the United States are exclusively breastfeeding at 6 months postpartum.
Lower rates of breastfeeding are observed in women in poverty, with a lower education level, or of a racial or ethnic minority group. Breastfeeding duration is also significantly impacted by early formula introduction while still in the hospital.
The WIC is a federal grant program that provides educational services, formula for women who are formula feeding, and supplemental food packages for women who are breast feeding. While WIC can support new mothers, free formula may reduce exclusive breastfeeding rates.
Investigators conducted a retrospective cohort study to evaluate feeding trends among US women enrolled in WIC vs those not enrolled. Survey data was obtained from the Pregnancy Risk Assessment Monitoring System, which included 46 US States and Puerto Rico.
Surveys collected from 2009 to 2018 were examined, with most participants having given birth within 2 to 6 months prior to questionnaire administration. Participants included primiparous mothers with a singleton pregnancy and at-term delivery.
Exclusion criteria included known fetal anomalies, delivery before 37 weeks’ gestation, surrogate mothers, and known maternal contraindications to breastfeeding. Survey questions evaluated breastfeeding initiation, breastfeeding duration, and introduction of other liquids, including specification if these factors occurred for less than 1 week postpartum.
Only women with an annual household income below $35,000 were included, with participants categorized based on whether they used WIC resources or were not enrolled.
Exclusive breastfeeding after 1 week postpartum was measured as the primary outcome of the analysis.Secondary outcomes included ever breastfeeding, breastfeeding after 1 week postpartum, and liquid introduction within 1 week postpartum.
There were 42,778 patients included in the final analysis. 68% of which received WIC resources while 32% were not enrolled. Patients enrolled in WIC were more often older, White, had private insurance, had a normal body mass index, and reported a higher education level.
Exclusive breastfeeding after 1 week postpartum was reported in 37.9% of patients enrolled in WIC vs 38.7% of patients not enrolled. Rates of ever breastfeeding were 84.3% and 92.2% in these groups respectively, indicating decreased rates of ever breastfeeding from WIC enrollment.
Rates of any breastfeeding after 1 week postpartum were also decreased in patients enrolled in WIC, at 74.4% compared to 86.5% in patients not enrolled. The introduction of other liquids was more common in enrolled patients vs patients not enrolled, at 23.4% and 21.1% respectively. When adjusting for age, WIC patients were also less likely to exclusively breastfeed after 1 week postpartum.
These results indicated reduced rates of breastfeeding among low-income patients enrolled in WIC. Investigators recommended further large-scale studies to aid the development of focused initiatives for improving breastfeeding frequency.
Abbate AM, Saucedo AM, Pike J, et al. Impact of household income and Special Supplemental Nutritional Program for Women, Infants, and Children on feeding decisions for infants in the United States. Am J Obstet Gynecol. 2023;229:551.e1-6. doi:10.1016/j.ajog.2023.06.013