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Overview Every month the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides 9.2 million Americans with nutritious food, nutrition education, including breastfeeding support, and referrals to healthcare and social services. Among the services provided by WIC, breastfeeding support has been a priority of the program since it began in the 1970s. In 1997 the Food and Nutrition Service (FNS) of the U.S Department of Agriculture (USDA) launched a national breastfeeding promotion and support campaign called Loving Support Makes Breastfeeding Work. Fre- quently referred to as Loving Support, the campaign emphasizes that the support of family and friends, the health-care system, and the community are essential for a breastfeeding mother to be successful. Since its inception the campaign has offered social marketing research, a media campaign, a community organizer’s kit, a training conference, a breastfeeding resource guide, and continuing education and technical assistance (Best Start So- cial Marketing, 1996). Peer counseling was added later as an additional resource. WIC agencies across the country can use whichever pieces of the campaign fit their needs. FNS is planning to update the campaign to reflect changes in the WIC program and the environment in which it operates. As one of the first steps, the agency asked the Institute of Medicine (IOM) to conduct a one-day workshop. The objective of the workshop was to provide critical input from experts about the actions needed to build effectively on the successes of the existing campaign, using an evidence-based social marketing strategy to make the campaign relevant and effective. This publication summarizes 1

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2 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN the main points of the presentations and discussions at that workshop, held April 26, 2011, at the Keck Center of the National Academies. The full presentations of the speakers are available on the IOM website at http:// www.iom.edu/Activities/Nutrition/USDABreastfeeding/2011-APR-26.aspx. The IOM Food and Nutrition Board established a workshop planning committee of six people with diverse nutrition, social marketing, and public health expertise (see the front matter for committee membership and Ap- pendix B for biographical sketches). The committee fulfilled the workshop objective by setting up panels around three broad themes: what has changed since Loving Support began in 1997, lessons learned from other public health campaigns, and suggestions for where to take the campaign in the future (see Appendix A for the agenda). This summary is an accurate representation of the workshop pre- sentations and discussions which has been prepared from the workshop transcript and slides. Chapter 1 summarizes the opening remarks from the president of the National WIC Association, which represents WIC partici- pants and agencies, and a historical overview about Loving Support from Debra Whitford, director of the Special Supplemental Food Program Divi- sion of the FNS. Chapter 2 highlights presentations about what has changed since the Loving Support campaign was launched almost 15 years ago in terms of the characteristics of the mothers who use WIC, the WIC program environment, new and emerging research, and changes in laws and policies. The changes identified by the speakers included the appearance of interac- tive, democratized communication created by new technology; the growing importance of peer networks among today’s mothers; and strong support by WIC state programs to promote breastfeeding, including exclusive breast- feeding. A steadily more positive policy environment for breastfeeding has emerged over the years. Chapter 3 focuses on the second panel, in which presenters discussed lessons from other public health campaigns that may have resonance for the updated WIC effort. After an overview of social marketing was pre- sented, panel members discussed the VERB™ campaign to promote physi- cal activity among young people, the National Breastfeeding Awareness Campaign, four state-level programs, and, as an international example, the Brazilian Breastfeeding Promotion Program. A common theme throughout these presentations was the importance of truly understanding audience needs and perceptions before moving forward with campaign design or implementation. The discussions of the final panel of the workshop are covered in Chapter 4. Presenters on this panel offered a range of suggestions for mov- ing the social marketing campaign forward, including program components and messages, communication tools, implementation tools for state WIC programs, strategic community-based partnerships, the identification of

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3 OVERVIEW research gaps, and the evaluation of program success. The presenters built on many of the topics covered earlier in the day, such as research and evaluation, the importance of social media, and broad community-based partnerships. The presentations from each panel were followed by a general discus- sion and questions from the approximately 75 participants. Two respon- dents and the workshop chair also reflected on messages and suggestions that emerged from the panels; their comments are grouped together in Chapter 5. Additionally, a website was open for public comments before and after the workshop. These comments are excerpted in Appendix E. Appendix C provides a list of Workshop Attendees and Appendix D lists Abbreviations and Acronyms used in the report. The suggestions of individual presenters and participants for the future of the campaign and, more generally, for WIC’s efforts to promote breast- feeding are captured here, but, in keeping with the workshop guidelines of the IOM, their suggestions do not represent a group consensus. REFERENCE Best Start Social Marketing. 1996. Breastfeeding Promotion Project: Research Brief. Unpub- lished report prepared by Best Start Social Marketing for the Food and Consumer Service of the U.S. Department of Agriculture.

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