Breastfeeding Promotion in WIC

Current Federal Requirements

Federal policy

By: USDA Food and Nutrition Service

Date: March 9, 2005

Source: Breastfeeding Promotion in WIC. USDA Food and Nutrition Service, March 9, 2005.

About the Author: The United States Department of Agriculture's Food and Nutrition Service provides access to food for children and low-income individuals and families in the United States. It administers the Women, Infants, and Children (WIC) supplemental nutrition program.

INTRODUCTION

At the beginning of the twentieth century, the United States experienced a sharp decline in breast-feeding rates for infants and toddlers. Until the invention of artificial baby milk, the only acceptable form of nutrition for young infants was breast milk, either from the biological mother or from a wet nurse. While some infants were able to survive on substitutes such as cow's milk or goat's milk, the human stomach is not designed to easily break down the proteins in the milk of other mammals, and such substitutes often led to illness or death.

The first artificial baby milk, now commonly known as "formula" in the United States, was invented in the 1860s in Germany. The Nestle corporation created a powdered version in the 1870s composed of malt, wheat flour, dry cow's milk, and sugar. By 1897, the Sears Roebuck catalog, the primary catalog for dry goods in the United States, advertised eight formula varieties; compared to cow's milk, the formulas were expensive. Breastfeeding was still the norm by the turn of the century.

By the 1910s and 1920s, physicians began to recommend a homemade version of formula: 13 ounces (0.4 liters) of evaporated, canned milk added to 19 ounces (0.6 liters) of boiled water, with two tablespoons of corn syrup or sugar added. Homemade and commercial formula gained in popularity as the scientific management movement of the early twentieth century promoted the idea that anything involving science was better; a formula designed in a laboratory, approved by experts and physicians and endorsed by professionals was viewed as superior to traditional breastfeeding and breast milk. In addition, as women moved into the industrial workforce in growing numbers, formula provided a socially acceptable nutritional substitute for the mother's milk.

Lower-income women breastfed in greater numbers than middle- and upper-income women at this time; when lower-income women used formula, it was more likely to be the homemade version, which over time paled in comparison to commercial brands that added fats, vitamins, and minerals to become a more complete form of nutrition for infants and toddlers. Breastfeeding rates in the 1910s were 70 percent, and gradually dropped to 22 percent in 1972, the lowest point in recorded history for breastfeeding in the United States. The rates gradually increased throughout the 1970s, 1980s, and 1990s to reach a rate of 66 percent in 2003.

Sparked by a trend among well-educated, middle-and upper-income white women, the overall breast-feeding rate includes all attempts at breastfeeding—even those infants breastfed for one day of their life. The breastfeeding rate among lower-income women, such as those women receiving nutritional assistance from the Women, Infants, and Children (WIC) supplemental program, has historically been lower than the national rates. Women and children enrolled in WIC receive vouchers for grocery products such as milk, cereal, juice, and eggs; mothers who choose not to breastfeed receive a full year's supply of infant formula. Critics of the WIC program pointed to the formula provision as a factor in discouraging breast-feeding. In response, WIC created the National WIC Breastfeeding Promotion Project.

PRIMARY SOURCE

The current federal WIC regulations contain provisions to encourage women to breastfeed and to provide appropriate nutritional support for breastfeeding participants.

246.2 Definitions.

Breastfeeding means the practice of feeding a mother's breast milk to her infant(s) on the average of at least once a day.

Breastfeeding womenmeans women up to one year postpartum who are breastfeeding their infants.

246.3(e)(4) State staffing standards.

Each State agency shall designate a breastfeeding promotion coordinator, to coordinate breastfeeding promotion efforts identified in the State plan in accordance with the requirement of 246.4(a)(9). The person to whom the State agency assigns this responsibility may perform other duties as well.

246.4(a)(9) State Plan.

The State Plan must include the State agency's nutrition education goals and action plans, including a description of the methods that will be used to promote breastfeeding.

246.7(e)(1)(iii)†Certification of Participants.

Breastfeeding Dyads. A breastfeeding mother and her infant shall be placed in the highest priority level for which either is qualified.

Nutritional risk priority system. Priority I: pregnant women, breastfeeding women and infants at nutritional risk as demonstrated by hematological or anthropometric measurements or other documented nutritionally related medical conditions which demonstrate the need for supplemental foods.

246.7(g)(1)(iii) Certification Periods.

Breastfeeding women shall be certified at intervals of approximately six months and ending with the breastfed infant's first birthday.

246.10(c)(7) Supplemental Foods.

Food Package VII—Breastfeeding Women (Enhanced) contains additional amounts of juice, cheese and legumes, plus carrots and canned tuna.

246.11(c) Nutrition Education.

State agencies shall perform the following activities in carrying out nutrition education responsibilities:

246.11(c)(2) Provide training on the promotion and management of breastfeeding to staff at local agencies who will provide information and assistance on this subject to participants.

246.11(c)(3) Identify or develop resources and educational materials for use in local agencies, including breast-feeding promotion and instruction materials; taking reasonable steps to include materials in languages other than English in areas where a significant number of or proportion of the populations needs the information in a language other than English.

246.11(c)(7) Establish standards for breastfeeding promotion and support which include, at a minimum, the following:

1. A policy that creates a positive clinic environment which endorses breastfeeding as the preferred method of infant feeding;
2. A requirement that each local agency designate a staff person to coordinate breastfeeding promotion and support activities;
3. A requirement that each local agency incorporate task-appropriate breastfeeding promotion and support training into orientation programs for new staff involved in direct contact with WIC clients; and
4. A plan to ensure that women have access to breastfeeding promotion and support activities during the prenatal and postpartum periods.

Participant Contacts.

All pregnant participants shall be encouraged to breast-feed unless contraindicated for health reasons.

246.14(b)(1)(iii) Program Costs.

The State agency may use food funds to purchase or rent breast pumps.

246.14(c)(1) Specified allowable nutrition services and administration (NSA) costs. Each fiscal year, each state agency must spend, for nutrition education activities and breastfeeding promotion and support activities, an aggregate amount that is not less than the sum of one-sixth of the amount expended by the State agency for costs of NSA and an amount equal to its proportionate share of the national minimum expenditure for breastfeeding promotion and support activities. The national minimum expenditure for breastfeeding promotion and support activities shall be equal to $21 multiplied by the number of pregnant and breastfeeding women in the Program, based on the average of the last three months for which USDA has final data. On October 1, 1996 and each October 1 thereafter, the $21 will be adjusted annually using the same inflation percentage used to determine the national administrative grant per person.

246.14(c)(10) Costs of breastfeeding aids which directly support the initiation and continuation of breastfeeding are allowable.

SIGNIFICANCE

The new guidelines offered women an incentive to breastfeed in the form of additional tuna, cheese, juice, carrots, and legumes. In addition, some states offer electric or manual breast pumps for mothers who work out of the home or attend school to use to express breast milk for later consumption by their child; the breast pump program helps mothers to maintain milk supply while reducing the need for infant formula. A 1997 research study published in the Journal of the American Dietetic Association, shortly before WIC began the breastfeeding promotion program, showed that the cost benefits to government agencies for WIC participants who breastfeed exclusively for the infant's first three months of life are substantial; $478 per infant is saved over the course of the infant's first six months. The $21 per woman enrolled in WIC allocated to breastfeeding promotion combined with funds for breast pumps and additional food is part of a cost/benefit analysis that drives social change as well.

Throughout the 1990s, organizations such as La Leche League, a breastfeeding advocacy group started by mothers in the 1950s, helped to sponsor laws that guarantee women and infants the right to breastfeed in public. Employment law in many states now includes provisions for pumping breaks for breastfeeding mothers, and corporations and government agencies such as Kaiser Permanente, Mattel, Inc., and NASA have lactation rooms on site for nursing mothers as part of a family-friendly approach.

The WIC breastfeeding promotion campaign showed success in follow-up studies. In Iowa, the initial breastfeeding rate for WIC enrollees went from 57.8 to 65.1 percent, and the rate at which mothers were still breastfeeding after six months increased from 20.4 to 32.2 percent. As a result of the success of the program, WIC continued to promote breastfeeding as part of the agency's overall mission.

Public health officials point to breastfeeding as an important factor in fighting against obesity, asthma, and childhood illnesses. WIC's counselors and fellow and former breastfeeding mothers are trained to assist mothers with supply-and-demand issues, latch questions, growth spurts, and breast pump questions. As breastfeeding increases in the United States across all income levels and races, the WIC campaign combines social change, public health, and cost savings to taxpayers with a single program that harkens back to the nineteenth century with twenty-first-century acumen.

FURTHER RESOURCES

Books

Baumslag, Naomi M. D. and Dia L. Michels. Milk, Money and Madness: The Culture and Politics of Breastfeeding. Westport, Conn.: Bergin & Garvey Trade, 1995.

La Leche League International. The Womanly Art of Breast-feeding. New York: Plume, 2004.

Periodicals

Montgomery, D. L., and P. L. Splett. "Economic Benefit of Breast-feeding Infants Enrolled in WIC." Journal of the American Dietetic Association97 (April 1997): 385.

Web sites

National Conference of State Legislatures. "50 State Summary of Breastfeeding Laws." <http://www.ncsl.org/programs/ health/breast50.htm> (accessed June 15, 2006).