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2
What Has Changed?
Presenters in this session, which was moderated by Gail Harrison, a
professor in the Department of Community Health Sciences at the Univer-
sity of California, Los Angeles School of Public Health, reviewed changes in
the WIC program and society that have occurred since the Loving Support
campaign was launched over a decade ago.
Georgia Galanoudis began by focusing on mothers, highlighting salient
characteristics about “Millennial Moms” (women born between 1977 and
1994), such as how they use technology, interact with peers and family
members, and perceive their own wants and needs. Kiran Saluja looked
at changes in the WIC program environment, drawing from an informal
survey of state and local WIC programs. She noted that the programs ex-
pressed strong support for breastfeeding, but she also commented on the
need to involve the whole community in order to have an impact, especially
in order to achieve exclusive breastfeeding. Joseph Robare summarized
recent and current studies that will provide data related to changes in WIC
participation, hospital practices, the WIC program, and other relevant
subjects. Marsha Walker highlighted programs, policies, and laws at the
federal and state levels that have created a more supportive environment for
breastfeeding than when the Loving Support campaign was first launched.
A question-and-answer period followed the panelists’ presentations.
15
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16 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
CHANGES IN COMMUNICATIONS PATTERNS:
COMMUNICATING WITH TODAY’S MOM
Presenter: Georgia Galanoudis
Georgia Galanoudis, executive director of the Meredith Corporation
Parents Custom Network Solutions Group, described the characteristics
of “millennial moms,” the 37 million women born in the United States
between 1977 and 1994. Except where noted, her findings are based on
the Moms & Media: Always On survey (The Meredith Parents Network
MomTrak®, 2011).
Changes in Demographics and Technology
More than 14 million of the U.S. women born between 1977 and 1994
are already mothers, and by 2030 more than 30 million of them will be
mothers, making them a large and powerful group. Fertility rates are the
highest that they have been in the last 15 years. In 2009 the millennial
moms gave birth to 63 percent of all babies born in the United States and
76 percent of first births, according to National Center for Health Statis-
tics figures (CDC/NCHS, 2010). They are also a more diverse group than
earlier generations. Two in five millennial moms belong to a racial or eth-
nic group other than non-Hispanic White, and one in nine, or 11 percent,
were born in the United States of an immigrant parent. Hispanic mothers
account for the largest percentage of the population boom (Pew Research
Center, 2010).
Galanoudis noted that these women grew up with home computers
and the Internet. A woman born in 1985 was in first grade when the In-
ternet came into widespread existence, and she considers a computer to be
a normal household item. These mothers are tech-savvy, Galanoudis said,
and they expect to find information online, especially because many do not
have their parents living nearby to help them with various issues. They turn
instead to their peers, to blogs, and to Web communities. As one mother
said, “It isn’t technology for the sake of technology. It’s about making con-
nections and staying connected.” WIC mothers’ use of technology is simi-
lar to that of others in their peer group. Virtually all (99 percent) of WIC
mothers use electronic resources, 89 percent of them use parenthood advice
and information websites, and 72 percent visit retailer websites. When an
e-newsletter was offered to expectant and new mothers, 54 percent of all
WIC mothers signed up, which was only slightly behind the percentage of
all mothers who signed up (63 percent) (The Meredith Parents Network
MomTrak®, 2011).
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WHAT HAS CHANGED?
Implications
The millennial moms place a high importance on feeling connected with
their peers, Galanoudis said. Eighty-two percent use social networks, such
as Facebook, leading Galanoudis to conclude that marketing to this group
will require using those networks to participate in the conversations millen-
nial moms are having with their peers, friends, and family members. They
look to friendships with other women for perspective and nonjudgmental
support, for adult interaction and socialization, and for advice and honest
assessments.
Referring to findings from The Meredith Parents Network MomTrak®
survey (2011) as well as from the Pew Internet & American Life Project
(Horrigan, 2008), Galanoudis said that millennial mothers view mobile
technology as “a functional tool that they cannot live without.” Sixty-two
percent say that, of all forms of communication, their cell phones would
hardest to give up, more so than the Internet, television, landline tele-
phones, or e-mail. According to Galanoudis, 90 percent of WIC mothers
have a mobile device and 26 percent had a smart phone at the time of the
Meredith survey, but, Galanoudis noted, that figure is steadily rising.
Galanoudis described WIC mothers as “media omnivores.” Expect-
ant and new mothers reported that they get information from 11 different
sources each month—magazines, books, websites, and other resources—
with Hispanic mothers reporting that they use 17 different sources monthly.
They do not find this amount of information overwhelming; rather they
say that they optimize and filter the information to fit their own needs.
When asked about the information sources that influence their decisions to
purchase foods and beverages for their children, they ranked in-store prod-
uct displays first, followed by television, retailer/company websites, non-
parenthood websites, healthcare professionals, catalogues, health/medical
websites, and parenthood magazines.
People marketing to this group should, Galanoudis recommended, keep
five characteristics about them in mind:
1. Instant gratification: They are pressed for time, and convenience
is key. They grew up accustomed to the speed of the Internet, and
they demand quick access and immediate action. As noted earlier,
mobile technology plays an increasingly important role in their
lives, providing them with multifunctional information devices.
2. Personalization: Technology also provides the ability to customize
information, such as tailored Web page content. Many of these
mothers have custom Web pages, iPods tailored to their musical
tastes, and the ability to watch their favorite television shows on
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18 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
their own schedule. They expect messages to be personalized and
interactive in order to catch their attention.
3. Diversification: These women represent more cultures and eth-
nicities than ever before in U.S. history, and they are also quick to
embrace different cultures. Messages and images must reflect this
diversity.
4. Recognition as a multi-dimensional person: Millennial mothers
do not want to give up their “non-mom” identity. Connecting
with them means appealing to all aspects of their identities. As an
example, when postpartum women were asked what they would
choose to do if they had a “magic wand” that could magically fix
something for them, one common response was that they wanted
to lose their baby weight. Galanoudis suggested finding ways to use
that information to promote breastfeeding.
5. A voice: They do not want to be talked at but rather to be involved
in a two-way conversation. Start a dialogue with these women,
Galanoudis suggested. Get them involved.
Recognizing these characteristics, Galanoudis concluded, will lead to a
successful campaign.
CHANGES IN THE WIC PROGRAM ENVIRONMENT
Presenter: Kiran Saluja
Just as the WIC participants’ demographics and use of technology
have changed since 1997, so too have WIC and the environment in which
it operates, said Kiran Saluja, chair-elect of the executive committee of
the National WIC Association and deputy director of the Public Health
Foundation WIC Program, which serves more than 300,000 participants
in and around Los Angeles, California. She began her presentation with a
comment received on the agency’s website, in which a mother expressed
her appreciation for and willingness to publicly promote WIC breastfeeding
support. She noted that this comment, as well as many similar ones heard
throughout the Los Angeles area, reflects Galanoudis’s observations that
mothers today are using technology and want to be involved.
In what Saluja termed “the new WIC world,” breastfeeding is a cor-
nerstone activity. Breastfeeding is the most discussed topic in WIC and
is a part of everything that people involved with WIC do, from the food
package to training. Many changes have occurred since Loving Support
began in 1997. Some of these changes, Saluja said, are that many states
have enacted breastfeeding legislation; lactation accommodation was in-
cluded as part of health care reform (Patient Protection and Affordable
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WHAT HAS CHANGED?
Care Act, P.L. 111-148, Sec. 4207 [2010]); exclusive breastfeeding goals
were set forth in Healthy People 2020 (HHS/ODPHP, 2010), the Surgeon
General’s Call to Action to Support Breastfeeding (HHS, 2011); the number
of Baby-Friendly Hospitals nationwide has increased (Baby-Friendly USA,
2011); and the Centers for Disease Control and Prevention (CDC) collected
data on breastfeeding and maternity practices to produce the Breastfeeding
Report Card, which provides perspectives on state and national trends in
breastfeeding (CDC, 2011). In addition, the evidence base for the benefits
of exclusive breastfeeding—such as its protective effect against obesity—is
growing. In light of these changes, the WIC program has stepped up to
become the face of breastfeeding support in the community––active in coali-
tions and task forces, providing peer counseling and staff training, working
with the National WIC Association to develop a summit and strategic plan,
and making funds available to support breastfeeding.
Informal Survey Results
To assess where different states are in the continuum of change in pro-
viding breastfeeding promotion and support, Saluja sent an informal survey
to state breastfeeding coordinators via the National WIC Association. She
received more than 20 responses which came from all USDA regions of the
country.
All of the states that responded except for one Southeastern state
reported that they provide staff training on breastfeeding and provide
breast pumps to mothers. Those same states reported making mothers feel
welcome to breastfeed while at WIC clinics, and none reported displaying
images of formula feeding. All respondents indicated that they provide
prenatal breastfeeding education, with a range and variety of programs of-
fered. About two-thirds of the 20 respondents offer breastfeeding support
groups, and 14 states either had or would soon have International Board
Certified Lactation Consultants (IBCLCs) on staff. About two-thirds of
the respondents said they offer home visits to support breastfeeding, and
all have peer counselors. Two-thirds of the states do not routinely issue
formula in the first month, but some states do provide a can of formula at
that time. Saluja called the new food packages “manna from heaven” and
noted that all states promote them to encourage breastfeeding.
Moving Forward
Saluja’s general conclusion was that the trend of responses indicates a
WIC environment that has evolved over the last 14 years. Despite varying
levels of breastfeeding support reported by WIC sites, survey responses
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20 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
indicate that sites are committed to providing support and improving the
ways in which they approach breastfeeding.
She noted some people have suggested implementing breastfeeding ser-
vice standards similar to those set for nutrition services. A dilemma arises,
however, in that WIC strongly supports breastfeeding while simultaneously
providing free formula, which is a fierce competitor to breastfeeding be-
cause of its perceived monetary value, direct marketing, and other incen-
tives. The new food package, Saluja said, offers a more viable alternative
to the issuance of formula than existed previously.
While not suggesting that mothers who do not breastfeed should be
penalized, Saluja urged that increasing exclusive breastfeeding should be the
focus of future efforts. She highlighted the regional disparities that exist in
the numbers of infants being exclusively breastfed. That is, the percentage
of infants exclusively breastfed in the southeast region of the United States
is much lower than the percentage in the northwest region (see Figure 2-1).
As one state coordinator said in the survey, “It takes the efforts of the full
community of partners and agencies [for] breastfeeding promotion and sup-
port.” Saluja said that increasing the number of babies exclusively breastfed
FIGURE 2-1 Percentage of all U.S. children exclusively breastfed through six months
of age among children born in 2007. 2-1.eps
Fig
SOURCE: CDC, 2010a. Bitmap
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21
WHAT HAS CHANGED?
to 6 months of age will involve not just making sure that the mothers know
what to do but also teaching mothers how to accomplish this with the help
of everyone around them. Just as immunization and the use of car seats
have has become norms, so too should breastfeeding, Saluja urged.
FNS WIC BREASTFEEDING RESEARCH UPDATE
Presenter: Joseph Robare
Joseph Robare, an epidemiologist and research analyst in the FNS Spe-
cial Nutrition Evaluation Branch, presented data from recent studies and
described several ongoing studies that should contribute useful insights as
the Loving Support campaign is updated. Specifically, the studies he dis-
cussed were the WIC Participant and Program Characteristic Study from
2008 (the 2010 data had not been not published at the time of the work-
shop), the CDC National Immunization Survey data related to breastfeed-
ing, the WIC Birth Month Study, the WIC Breastfeeding Peer Counseling
Study, and the proposed WIC Infant and Toddler Feeding Practices Study II.
WIC Participant and Program Characteristics, 2008
The WIC Participant and Program Characteristic Study, published in
January 2010, is a huge dataset (9.5 million records) that offers a broad
view of WIC and its participants over a 10-year period. Robare shared
some of the findings and pointed participants to the final report (http://
www.fns.usda/ora).
Of note, the percentage of non-Hispanic White and African American
infants in the WIC program has declined since 1998, while Hispanic in-
fants and those from other ethnic groups have increased in proportion (see
Figure 2-2). Therefore, Robare noted, as it redevelops the Loving Support
campaign, FNS should take a look at the ethnic distribution of both the
infants and mothers and make the appropriate changes where necessary.
CDC National Immunization Study
The CDC National Immunization Study includes information about
breastfeeding. Robare shared data from that study concerning exclusive
breastfeeding of infants at 3 and 6 months of age and noted that WIC
mothers lag behind national averages. At 3 months of age, about 33 per-
cent of mothers overall breastfeed their infants, compared with about 25.5
percent of WIC mothers. Both percentages drop at 6 months of age, and,
again, WIC mothers lag. At 6 months of age, 13.3 percent of mothers
overall exclusively breastfeed their infants, compared to only 9.2 percent
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22 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
50 Black (non-Hispanic)
Hispanic
White (non-Hispanic)
45
Other
40
Percentage of Total WIC Infants Enrolled
35
30
25
20
15
10
5
0
1998 2000 2002 2004 2006 2008
FIGURE 2-2 Racial and ethnic distribution for WIC infants, 1998–2008.
Fig 2-2.eps
SOURCE: Adapted from USDA/FNS, 2010.
of WIC mothers (Figure 2-3). However, Robare offered two caveats about
the data: The study was done without taking into account the new food
package, since it only included data through 2007, and it does not represent
data coming out in the WIC Birth Month Study (see below).
WIC Birth Month Study
The design of the WIC Birth Month Study was based on a recom-
mendation in the IOM report, WIC Food Packages: Time for a Change
(IOM, 2006). The study, which was conducted by Abt Associates, examined
the impact that the interim rule on food packages had on breastfeeding
initiation, duration, and intensity in the month after birth. Intensity is a
dichotomous variable that measures exclusive breastfeeding and partial
breastfeeding rates. The study also analyzed how site characteristics af-
fected the food package choices before and after the interim rule. Methods
included interviews with WIC staff and recipients and data collection at
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WHAT HAS CHANGED?
50
National Data
45
WIC Recipients
40
35
Percentage of Breastfed Infants
30
25
20
14.1
15 13.3
12.3
12.1
10
9.9
9.3 9.2
8.8
5
0
2004 2005 2006 2007
FIGURE 2-3 Percentages of infants exclusively breastfeeding at 6 months of age:
Fig 2-3.eps
National figures compared to WIC recipients.
SOURCE: Adapted from data from CDC, 2010b.
17 local WIC agencies in 10 states with about 1,600 individuals. The final
report is scheduled for release in September 2011.
WIC Breastfeeding Peer Counseling Study
The WIC Breastfeeding Peer Counseling Study, Phase I, which was
also conducted by Abt Associates and is scheduled to be released shortly,
provides a comprehensive and systematic picture of the implementation of
the Loving Support peer-counseling program. Phase II will examine specific
variations in how implementing peer counseling affects the exclusivity and
intensity of breastfeeding. Between the two phases, Congress appropriated
$80 million to support peer counseling. Although the main goals of Phase
II will remain the same, the study is being reexamined to determine if, given
that expansion of peer counseling, changes in the study are warranted. The
study will be carried out at about eight of the largest local WIC agencies
involving more than 1,000 expectant mothers in total. At the time of the
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24 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
workshop, FNS was close to submitting its data collection package to
the Office of Management and Budget for clearance.
WIC Infant and Toddler Feeding Practices Study II
The final study that Robare highlighted, the WIC Infant and Toddler
Feeding Practices Study II, is contained in the fiscal year 2010 Research
and Evaluation Plan. As an update to the Infant and Childhood Feeding
Practices Study, the upcoming study will be longitudinal in design in order
to provide updated information on the feeding patterns of WIC infants,
with expanded information on infant and toddler feeding behaviors. It will
review nutrition education and breastfeeding promotion and support by
WIC and other sources to determine the relative effectiveness of different
approaches. One objective will be to identify aspects of WIC nutrition edu-
cation that could influence feeding practices in order to address the problem
of high body weight among young children in WIC.
Robare closed by thanking the WIC division and the IOM planning
committee, and he invited participants to contact FNS with questions or to
alert his office to other relevant studies.
CHANGES IN FEDERAL AND STATE
PROGRAMS, LAWS, AND POLICIES
Presenter: Marsha Walker
Marsha Walker, executive director of the National Alliance for Breast-
feeding Advocacy: Research, Education and Legal Branch, presented a
timeline of significant breastfeeding actions since 1996. An unprecedented
number of changes have occurred, she said, and she identified what she
saw as high points.
Chronology, 1996–2011
1996
Walker began by highlighting a piece of legislation that was enacted
shortly before the Loving Support campaign began: the 1996 Personal Re-
sponsibility and Work Opportunity Reconciliation Act. According to one
study (Haider et al., 2003), this act coincided with a decline in breastfeed-
ing by 22 percent in WIC mothers, so, as Walker phrased it, “We almost
started from behind the eight ball when Loving Support began.” In 1996
the Loving Support campaign was designed (officially launched in 1997),
and the country’s first Baby-Friendly Hospital was designated in Washing-
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WHAT HAS CHANGED?
ton. (There are currently 107 Baby-Friendly Hospitals nationwide and an
additional 256 in various stages of becoming designated as Baby-Friendly.)
Walker said that a supportive hospital environment is critical not only to
initiate but to continue breastfeeding.
1997
A key event in 1997 was the release by the American Academy of Pe-
diatrics (AAP) of its influential policy statement “Breastfeeding and the Use
of Human Milk.” Walker said that this statement, since updated, is almost
always cited in breastfeeding research articles. It underscores the value of
not only initiation, she said, but also duration and exclusivity.
1998
In 1998 the U.S. Breastfeeding Committee (USBC) was formed with
financial support from the CDC, the Department of Health and Human
Services’ Maternal and Child Health Bureau (HHS/MCHB), the HHS Office
on Women’s Health, and the USDA. The USBC assists the state breastfeed-
ing coalitions that now exist in every state, and many WIC state breast-
feeding programs belong to these coalitions. Much of the grassroots effort
that is needed to change legislation and policy comes through the state
breastfeeding coalitions.
1999
Walker highlighted a piece of legislation passed in 1999, the Right
to Breastfeed Act (H.R. 1848), which was spearheaded by Rep. Carolyn
Maloney (D-NY). It ensures a woman’s right to breastfeed on all federal
property. By the time the federal legislation passed, 16 states had already
enacted their own breastfeeding laws, but, to Walker’s knowledge, the Right
to Breastfeed Act was the first piece of federal legislation specifically related
to breastfeeding.
2000
In 2000 Healthy People 2010 was released. It included various breast-
feeding objectives, and of particular significance, Walker said, was its 2005
midcourse review that added exclusive breastfeeding targets. In that same
year HHS issued the Blueprint for Action on Breastfeeding, which posi-
tioned breastfeeding as a public health issue, not just a positive individual
choice.
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26 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
2003
The National Breastfeeding Awareness Campaign was launched in
2003, aimed at promoting breastfeeding among all first-time parents. (See
the next chapter of this report for a summary of a presentation on this
campaign.)
2007
In 2007 the CDC conducted the Maternity Practices in Infant Nutrition
and Care (mPINC) study, which highlighted hospital practices related to
breastfeeding. Walker said that the findings demonstrated to hospitals how
poorly they were supporting breastfeeding mothers and that they have led
many hospitals to improve their practices (Bartick et al., 2010; CDC, 2008;
Edwards and Philipp, 2010).
2008
With the publication in 2008 of the information package, Business
Case for Breastfeeding (HHS/Office of Women’s Health, 2010), MCHB
and the Health Resources and Services Administration involved employers
by providing a series of materials designed to create breastfeeding-friendly
work environments. Throughout the workshop Walker and others pointed
out that lack of employer support often makes breastfeeding difficult for
WIC mothers who return to work, and this publication laid out the eco-
nomic case for workplace accommodations.
2010
Walker described four significant events that took place in 2010. First,
the Joint Commission Perinatal Core Measure Set was established, which
measures (among other things) the number of infants exclusively fed breast
milk at hospital discharge. As with the mPINC mentioned above, this mea-
sure shines a light on hospital practices (Joint Commission, 2011).
The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148,
Sec. 4207 [2010]) introduced specific worksite protections for many breast-
feeding mothers. In addition, a presidential memorandum ordered the cre-
ation of appropriate workplace accommodations for nursing mothers who
are federal civilian employees (White House, 2010). The Healthy People
2020 objectives, announced by HHS in 2010, set three breastfeeding-related
objectives: (1) increase the proportion of employers that have worksite lac-
tation support programs, (2) reduce the proportion of breastfed newborns
who receive formula supplementation within the first two days of life, and
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WHAT HAS CHANGED?
(3) increase the proportion of live births that occur in facilities that provide
recommended care for lactating mothers and their babies (HHS/ODPHP,
2010).
The Healthy, Hunger-Free Kids Act, described earlier in the morning by
Debra Whitford, contains provisions to recognize exemplary breastfeeding
practices at local agencies. In addition, the act provides bonuses to states
to reward various breastfeeding accomplishments, and it appropriates $80
million for peer-counseling programs.
2011
In 2011 several important policy-related events have already taken
place, such as the Surgeon General’s issuance of a Call to Action to Sup-
port Breastfeeding. In addition, as an example of how broader policies can
be used to support breastfeeding, the Internal Revenue Service began to
allow breastfeeding equipment to be reimbursed by flexible health spend-
ing accounts.
Other Policy Changes
The past few years have also seen an increase in the number of states
with laws protecting breastfeeding in public. Forty-four states now have
laws protecting the right to breastfeed in public, and 28 specifically exempt
breastfeeding from public indecency laws. Twenty-four states have laws
related to worksite protection for breastfeeding mothers; only West Virginia
has no breastfeeding laws on its books.
The number of International Board Certified Lactation Consultants
(ICBLCs) has doubled from 5,513 in 1999 to 11,064 in 2010, although
many mothers still lack convenient access to the level of care they need.
Walker also pointed to an explosion of articles (some 30,000) related to
breastfeeding on PubMed.
The federal government supports breastfeeding through other agencies
and programs, such as the USDA Child and Adult Care Feeding Program,
the CDC Communities Putting Prevention to Work grants, and the White
House’s Let’s Move campaign.
Mothers, advocates, and health professionals are now much more vocal
and politically savvy regarding breastfeeding and a woman’s right to feed
her child in a public place. In the past, women would not have been vocal
about breastfeeding, Walker observed, and now they are holding “nurse-
ins” to advocate for their rights. In addition, more than 400 hospitals have
eliminated formula discharge bags. Breastfeeding coalitions provide moth-
ers with printed cards that spell out their right to breastfeed in public if they
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28 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
are challenged. Applications on mobile phones also help women manage
their breastfeeding.
GROUP DISCUSSION
Moderator: Gail Harrison
In keeping with the format of the workshop, moderator Gail Harrison
took written questions from the audience that she then directed to the
speakers. The topics included the following:
• Reaching women with special needs (such as those who are home-
less, in detention, or have medical conditions): Whitford said WIC
provides breastfeeding education to all women participants, unless
contraindicated. On the local level, Saluja said, the initial assess-
ment with a mother is very thorough to determine what issues the
mother may be experiencing that discourage breastfeeding her in-
fant. This enables the WIC staff to provide appropriate support for
the mother to continue breastfeeding. This support could involve
putting pumps in schools, referrals to other agencies, or providing
translators to understand the nutrition education materials.
• Existence of data about ongoing breastfeeding mothers versus
discontinuers: Robare offered to check to see if the data exist.
Harrison suggested that, if not, this might indicate the need for a
new line of research for FNS going forward.
• Broadening the campaign to reach all mothers: In answer to a
question about whether USDA is considering a program analogous
to the National School Lunch Program, which targets all children,
Whitford said that posters and other media will be visible to all,
not just WIC participants.
• Knowledge gaps at the local level that prevent implementation:
Saluja said that although she could not speak for the 3,200 local
agencies nationwide, she could identify one gap as a more general
one—how to provide effective counseling, such as asking open-
ended questions and listening to participants closely, given the time
constraints. Galanoudis noted that information about breastfeed-
ing is abundant but that how the information is packaged or how
accessible it is on the local level can affect its usefulness. Whitford
said that WIC has various resources and training materials avail-
able; one way they are available is online through WIC Works Re-
sources. The material has to be kept fresh for the more experienced
staff members, but it also needs to contain basic information for
new staff members coming in.
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WHAT HAS CHANGED?
• Percentage of eligible women who are WIC participants: This in-
formation was not readily available, but Robare said he would ob-
tain it. Saluja queried whether some eligible women who breastfeed
choose not to participate in WIC because of their perception that
women only participate in WIC to get formula, and she suggested
this as a potential area of formative research.
• Use of social media: The panel agreed that using social media to
promote breastfeeding is a must. However, there was not support
among the panel members for WIC getting involved in nurse-ins
or other actions organized through social media. Galanoudis sug-
gested utilizing lactation consultants to get more involved in social
media, since many are already very savvy about using Facebook
and other social media and, with the right tools, would be great
advocates. Saluja warned that, even though there is rapidly increas-
ing usage of social media, not all mothers have access to these
tools. She reported that data from her agency show that only 45
percent of English speakers and 17 percent of Spanish speakers use
social media (PHFE WIC Program, 2011 Survey of Los Angeles
County WIC Parents, unpublished data, March 2011). Those who
have access use social media extensively, but Saluja said that they
represent only a small percentage of overall WIC participants, at
least in Los Angeles. She went on to say social media has a niche,
but she would not advise using it in WIC.
• Food sharing: WIC does not employ “food police,” Whitford said,
but the intention of the food package is to improve the nursing
mother’s nutritional health to assist her and her infant. The foods
in the package are designed to meet specific nutritional needs, and
women are counseled about these issues.
• Barriers to breastfeeding today: Panelists noted that the barriers
identified prior to the 1997 launch—embarrassment, time, social
constraints, and social support—persist today. Galanoudis said al-
though the barriers cannot be eliminated, coping mechanisms can
help women overcome them—by, for example, empowering moth-
ers to make sure they know their rights and are aware of support
mechanisms. Saluja said that having more Baby-Friendly hospitals
would provide support to more mothers in the crucial first 48
hours. Walker said that mothers need support so they continue
breastfeeding successfully, beyond initiation. Peer counselors need
to be able to refer more complex cases, such as diabetic mothers
or a late pre-term baby, to a lactation consultant or other expert.
Robare noted that Phase II of the Peer Counseling study will look
at what works in peer counseling in order to inform planning for
the future.
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REFERENCES
Baby-Friendly USA. 2011. Baby-Friendly Hospitals and Birth Centers. http://www.babyfriendly
usa.org/eng/03.html (accessed August 16, 2011).
Bartick M., R. A. Edwards, M. Walker, and L. Jenkins. 2010. The Massachusetts Baby-
Friendly collaborative: Lessons learned from an innovation to foster implementation of
best practices. Journal of Human Lactation 26(4):405–411.
CDC (Centers for Disease Control and Prevention). 2008. Breastfeeding-related maternity
practices at hospitals and birth centers––United States, 2007. Morbidity and Mortal-
ity Weekly Report 57(23):621–625. http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5723a1.htm (accessed August 9, 2011).
CDC. 2010a. Map 5: Percent of Children Exclusively Breastfed Through 6 Months of Age
among Children Born in 2007 (provisional). http://www.cdc.gov/breastfeeding/data/
NIS_data/2007/map_5.htm (accessed June 14, 2011)
CDC. 2010b. Breastfeeding Among U.S. Children Born 1999–2007, CDC National Immu-
nization Survey. http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm (accessed
June 27, 2011).
CDC. 2011. Breastfeeding Report Card—United States, 2011. http://www.cdc.gov/
breastfeeding/data/reportcard.htm (accessed August 10, 2011).
CDC/NCHS (National Center for Health Statistics). 2010. Births: Preliminary Data for 2009.
National Vital Statistics Reports 59(3):1–19. http://www.cdc.gov/nchs/data/nvsr/nvsr59/
nvsr59_03.pdf (accessed August 30, 2011).
Edwards R. A., and B. L. Philipp. 2010. Using Maternity Practices in Infant Nutrition and
Care (mPINC) survey results as a catalyst for change. Journal of Human Lactation
26(4):399–404.
Haider, S. J., A. Jacknowitz, and R. F. Schoeni. 2003. Welfare work requirements and child
well-being: Evidence from the effects on breast-feeding. Demography 40(3):479–497.
HHS (U.S. Department of Health and Human Services). 2011. The Surgeon General’s Call
to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and
Human Services, Office of the Surgeon General.
HHS/ODPHP (Office of Disease Prevention and Health Promotion). 2010. Healthy Peo-
ple 2020. Washington, DC. http://www.healthypeople.gov/2020/topicsobjectives2020/
objectiveslist.aspx?topicId=26 (accessed August 10, 2011).
HHS/Office of Women’s Health. 2010. Business Case for Breastfeeding. http://www.womens
health.gov/breastfeeding/government-in-action/business-case-for-breastfeeding/index.cfm
(accessed July 18, 2011).
Horrigan, J. 2008. Mobile Access to Data and Information: Pew Internet & American Life
Project. http://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Mobile.Data.Ac -
cess.pdf.pdf (accessed June 27, 2011).
IOM (Institute of Medicine). 2006. WIC Food Packages: Time for a Change. Washington,
DC: The National Academies Press.
Joint Commission. 2011. Perinatal Care. http://www.jointcommission.org/perinatal_care/ (ac-
cessed August 18, 2011).
The Meredith Parents Network MomTrak®. 2011. MomTrak®, Moms & Media: Always
On, January 2011.
Pew Research Center. 2010. Millenials: A Portrait of Generation Next. Washington, DC:
Pew Research Center. http://pewsocialtrends.org/files/2010/10/millennials-confident-
connected-open-to-change.pdf (accessed July 18, 2011).
USDA/FNS (U.S. Department of Agriculture/Food and Nutrition Service). 2010. WIC Partici-
pant and Program Characteristics 2008. Alexandria, VA: USDA/FNS. http://www.fns.
usda.gov/ora/menu/published/wic/FILES/pc2008.pdf (accessed June 14, 2011).
OCR for page 31
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White House. 2010. Presidential Memorandum—Delegation of Certain Functions and Au-
thorities. http://www.whitehouse.gov/the-press-office/2010/12/20/presidential-memoran-
dum-delegation-certain-functions-and-authorities (accessed August 18, 2011).
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