Breastfeeding Initiation, Duration, and Exclusivity Among WIC‐Eligible Populations

Abstract

The benefits of breastfeeding are known to impact infant and maternal health outcomes. Healthy People 2020 designates several evidence‐based objectives for breastfeeding initiation, duration, and exclusivity. Despite these recommendations, rates of breastfeeding behaviors in the United States (U.S) fall short. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is required to promote and support breastfeeding practices, yet evidence of breastfeeding outcomes among WIC participants are mixed. This study uses nationally representative data to examine the association between breastfeeding initiation, duration, and exclusivity and family WIC participation status.We analyzed data using the combined 2016‐2018 National Survey of Children’s Health, administered by HRSA’s MCHB. Outcome measures included breastfeeding initiation, any breastfeeding at 6 months, and exclusive breastfeeding through 6 months. We conducted weighted bivariate analyses to examine prevalence of breastfeeding practices based on family WIC participation and sociodemographic characteristics, and multivariable logistic regression analyses to assess the association between WIC participation and breastfeeding outcomes. Adjusted analyses controlled for several sociodemographic and health status characteristics.The combined 2016‐2018 dataset contains completed questionnaires from 19,030 children ages 0‐3 years living in the United States. A total of 6,532 were considered to be WIC‐eligible, and 3,174 were from families reported to have participated in WIC within the past 12 months.Rates of breastfeeding outcomes among WIC participants were lower than national rates observed among the general U.S. population—72.8% of children were ever breastfed and 50.3% of children were breastfed ≥ 6 months (versus 83% and 58% nationally, respectively). When examining differences in breastfeeding outcomes between WIC‐eligible participants and non‐participants, we found that participants were less likely to report any breastfeeding ≥ 6 months than WIC‐eligible nonparticipants (Average Marginal Effect (AME) = ‐9.2, P < .05), after adjusting for covariates. When examining breastfeeding outcomes among WIC‐eligible participants while adjusting for covariates, families from predominantly non‐English‐speaking households were more likely to have ever breastfed (AME = 10.7, P < .01), more likely to report any breastfeeding ≥ 6 months (AME = 27.8, P < .001), and more likely to be exclusively breastfeeding ≥ 6 months (AME = 23.3, P < .01), compared with respondents from English‐speaking households. In addition, several sociodemographic characteristics were associated with a lower likelihood of breastfeeding outcomes among children, including Hispanic race/ethnicity, having a single mother, and lower household education.WIC participation was significantly associated with a lower likelihood of breastfeeding duration (any breastfeeding at 6 months), yet had no effect on the likelihood of breastfeeding initiation or exclusivity. Our results on subpopulations of WIC participants with lower rates of breastfeeding outcomes are noteworthy and highlight persistent disparities.Our findings inform potential target areas for interventions to improve breastfeeding outcomes among WIC participants. While anticipatory guidance and education are provided to new mothers through WIC to encourage breastfeeding initiation, additional support and outreach (appropriately timed during the postpartum period) may help overcome barriers that mothers face in maintaining breastfeeding duration. Such initiatives, incorporated with existing WIC programming, may contribute to improvements in breastfeeding rates for WIC populations to more closely align with Healthy People 2020 goals.