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COMMENTARY |
Department of Pediatrics, Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
Abbreviations: WIC, Supplemental Nutrition Program for Women, Infants, and Children
Ryan and his colleagues have contributed substantially to our knowledge and information about infant feeding trends for the past 50 years. The Ross Laboratories Mother's Survey has remained consistent in content while increasing the frequency of polling from every quarter to every month and increasing the sample size from 40000 to 117000 households per month. Sampling is adjusted to oversample low-responding groups. Mothers report on the current month's feeding practices and do not depend on long-term recall. Granted, the response rate is low, but results are consistent and the respondent population is representative of the general population. Results can be compared year by year and decade by decade.
In the report in this month's issue of Pediatrics by Ryan and Zhou1 on the breastfeeding rates of the Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants from 1978 to 2003, the authors found that breastfeeding rates have increased over time from 35% to 54% (initiation rate in hospital) and 10% to 21% (breastfeeding at 6 months). These rates are at least 20% lower than those of non-WIC women at all points. The authors state that this should not be taken as an evaluation of the effectiveness of WIC. However, it is certainly a call to action!
Although the WIC participant has to meet certain income restrictions, it is worth noting that women who qualify for WIC but have not enrolled have higher breastfeeding rates according to the authors than their WIC counterparts. The ethnic profile of those participating in WIC has changed from predominantly black to Hispanic and southeast Asian; women in both of these ethnic groups traditionally breastfeed.2 When participating in WIC, Hispanic and southeast Asian women do not breastfeed at such high rates. When all the demographic parameters are examined, it would suggest that being a WIC participant is the strongest determinant of lower breastfeeding initiation and duration.
A significant effort was made in the 1990s to enhance breastfeeding education and support of mothers in WIC with the initiation of the Best Start breastfeeding training program. This may well account for the transient elevation in rates, but the effort has not been sustained because of a lack of funding. The value of peer support in improving breastfeeding rates and duration has been demonstrated in all socioeconomic groups and educational levels including the WIC population. Peer-support programs in WIC have also suffered from budget cuts. Other support efforts that provide counseling and telephone support have also been shown to make a difference. The methodology for improvement has been identified, but it seems that it is all about money.
Ryan and Zhou report that the budget for WIC in fiscal-year 2005 was $5235 billion (cash rebates from infant formula contributed an additional $1.52 billion).3 Forty-eight percent of the infants born in 2005 in the United States participate in WIC. Although a breastfeeding-promotion incentive has been part of WIC for 30 years and federal legislation established national breastfeeding promotion in WIC in 1992 to include education, support, and equipment, the budget is small and the effort is feeble. Only $34 million (0.6%) of the total WIC budget is designated for breastfeeding initiatives.
The financial benefit to health care maintenance of breastfeeding has been estimated to be at least $400 per child in the first year of life, not including the lifelong benefits of a reduction in incidence of long-term obesity, allergy, diabetes, and other chronic disabilities and not to mention the benefits to the mother.4
The continued gap in breastfeeding initiation and duration of WIC participants is clearly demonstrated by Ryan and Zhou. WIC must begin to use the support mechanisms that are known to enhance breastfeeding.
The WIC budget must include a larger portion for breastfeeding initiatives. It is a fiscally and medically sound policy.
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FOOTNOTES |
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Address correspondence to Ruth A. Lawrence, MD, Department of Pediatrics, Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 777, Rochester, NY 14642. E-mail: ruth_lawrence{at}urmc.rochester.edu
The author has indicated she has no financial relationships relevant to this article to disclose.
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This article has been cited by other articles:
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  M. F. McCann, N. Baydar, and R. L. Williams Breastfeeding Attitudes and Reported Problems in a National Sample of WIC Participants J Hum Lact, November 1, 2007; 23(4): 314 - 324. [Abstract] [PDF]
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