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Fisher E, Wouk K, Patel P, Tang C, Zhang Q. Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study. Nutrients 2023; 15:nu15030527. [PMID: 36771234 PMCID: PMC9920282 DOI: 10.3390/nu15030527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.
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Affiliation(s)
- Emily Fisher
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Kathryn Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC 27514, USA
| | - Priyanka Patel
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Chuanyi Tang
- Department of Marketing, Strome College of Business, Old Dominion University, Norfolk, VA 23529, USA
| | - Qi Zhang
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
- Correspondence: ; Tel.: +1-757-683-6890
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Bertmann F, Dunn CG, Racine EF, Fleischhacker S. The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations. J Acad Nutr Diet 2021; 122:697-708. [PMID: 34016563 DOI: 10.1016/j.jand.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
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Zhang Q, Chen C, Xue H, Park K, Wang Y. Revisiting the Relationship between WIC Participation and Breastfeeding among Low-Income Children in the U.S. after the 2009 WIC Food Package Revision. FOOD POLICY 2021; 101:102089. [PMID: 34054198 PMCID: PMC8151795 DOI: 10.1016/j.foodpol.2021.102089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides breastfeeding support and free formula to low-income participating infants in the U.S. Literature has consistently documented worse breastfeeding outcomes in WIC infants and children than in non-participants, although self-selection bias poses a challenge in examining the relationship between WIC participation and breastfeeding in low-income mother-child dyads. The WIC program adopted a comprehensive food package revision in 2009, the first one in four decades. Since that time, few national studies have examined the relationship between WIC participation and breastfeeding while controlling for the endogeneity of WIC participation with the propensity score method. This paper applied an instrumental variable (IV) approach on a large, nationally representative survey sample of children, the National Immunization Surveys (NIS), to examine the relationship between WIC participation and breastfeeding among children born between 2005 and 2014. We identified state Supplemental Nutrition Assistance Program (SNAP) enrollment rates and SNAP Policy Indices as valid IVs to address WIC participation endogeneity. Without the IVs, WIC participation had a significantly negative relationship with breastfeeding. After addressing endogeneity using the IVs, the relationship became insignificant in the whole sample and in the subpopulations across race/ethnicity and child gender. The neutrality of WIC participation on breastfeeding is important for policy makers to understand in seeking to improve breastfeeding among WIC participants.
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Affiliation(s)
- Qi Zhang
- School of Community and Environmental Health, Old Dominion
University, Norfolk, Virginia, USA
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical
University, Wenzhou, Zhejiang, China
| | - Hong Xue
- Department of Health Behavior and Policy, School of
Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kayoung Park
- Department of Mathematics and Statistics, Old Dominion
University, Norfolk, Virginia, USA
| | - Youfa Wang
- Fisher Institute of Health and Well-being, Department of
Nutrition and Health Sciences, Ball State University, Muncie, Indiana, USA
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Rothstein JD, Winch PJ, Pachas J, Cabrera LZ, Ochoa M, Gilman RH, Caulfield LE. Vulnerable families and costly formula: a qualitative exploration of infant formula purchasing among peri-urban Peruvian households. Int Breastfeed J 2021; 16:11. [PMID: 33468169 PMCID: PMC7816440 DOI: 10.1186/s13006-021-00356-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Substantial evidence exists surrounding the health risks of breast milk substitutes (BMS) in place of exclusive breastfeeding among infants < 6 months of age in resource-poor settings. Yet, mothers' experiences of selecting and purchasing BMS brands have not been well studied to date. This qualitative study explored the factors influencing BMS purchasing practices, along with the consequences of those decisions, in peri-urban Lima, Peru. METHODS We conducted in-depth interviews (IDIs) with 29 mothers who had begun mixed-feeding their infants during the first 6 months of life. Interviews explored participants' reasons for initiating infant formula use and their experiences of selecting, purchasing, and providing BMS to their children. Audio recordings were transcribed, coded, and key themes and illustrative vignettes were identified. RESULTS The primary reported reasons for initiating infant formula use included having received a recommendation for infant formula from a healthcare provider, concerns about an infant's weight gain, and the perception of insufficient breast milk. Mothers tended to initially purchase the BMS brand that had been recommended by a doctor, which was often more expensive than the alternatives. The costs of BMS, which escalated as infants grew, often disrupted the household economy and generated significant stress. While some mothers identified alternatives allowing them to continue purchasing the same brand, others chose to switch to less expensive products. Several mothers began to feed their infants follow-on formula or commercial milk, despite their awareness that such practices were not recommended for infants under 6 months of age. The approval of family members and the absence of an infant's immediate adverse reaction influenced mothers' decisions to continue purchasing these products. CONCLUSIONS The high costs of BMS may deepen existing socio-economic vulnerabilities and generate new risks for infant health. The continued dedication of resources towards breastfeeding education and support is critical, and strategies would benefit from underscoring the long-term financial and health consequences of infant formula use, and from strengthening women's self-efficacy to refuse to initiate infant formula when recommended. In addition, health providers should be trained in counseling to help women to relactate or return to exclusive breastfeeding after cessation.
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Affiliation(s)
- Jessica D Rothstein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Pachas
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Lilia Z Cabrera
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Mayra Ochoa
- Universidad Peruana Cayetano Heredia, Laboratorio de Investigación en Enfermedades Infecciosas, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Universidad Peruana Cayetano Heredia, Laboratorio de Investigación en Enfermedades Infecciosas, Lima, Peru
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Acheampong AK, Aziato L, Marfo M, Amevor P. Breastfeeding and caring for children: a qualitative exploration of the experiences of mothers with physical impairments in Ghana. BMC Pregnancy Childbirth 2020; 20:331. [PMID: 32471372 PMCID: PMC7260762 DOI: 10.1186/s12884-020-03028-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breastfeeding and caring for children demand time, energy and effort. Mothers with physical impairments in Ghana require special needs to be able to achieve optimal motherhood as society demands. Globally, literature on breastfeeding and caring for children among mothers with physical disabilities is limited. Similarly, there is dearth of literature on the experiences of mothers with physical impairments in Ghana. Therefore, this study sought to add to literature by exploring the experiences of mothers with physical impairments with regards to breastfeeding and how they care for their children. Methods Qualitative descriptive exploratory design was used. Twelve mothers with physical impairments who had been purposively sampled gave informed consent before data was collected through in-depth one-on-one interviews. Data was recorded, transcribed and analyzed inductively using the content analysis technique. Results Mothers with physical impairments perceived breastfeeding as difficult and expensive due to issues relating to disruption of sleep, dysfunctional limbs and the need for breastfeeding mothers to eat nutritionally balanced meals. Participants felt prejudged and discriminated at different points in their daily encounters. Conclusion Mothers with physical impairments have challenges. Therefore, attitudinal change should be advocated in the Ghanaian society with respect to issues concerning people living with disabilities.
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Affiliation(s)
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana.
| | - Margaret Marfo
- School of Nursing, Wisconsin International University College-Ghana, Accra, Ghana
| | - Philomena Amevor
- School of Nursing, Wisconsin International University College-Ghana, Accra, Ghana
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Ellison RG, Greer BP, Burney JL, Goodell LS, Bower KB, Nicklas JC, Lou Z, Kavanagh KF. Observations and Conversations: Home Preparation of Infant Formula Among a Sample of Low-Income Mothers in the Southeastern US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:579-587.e1. [PMID: 28689612 DOI: 10.1016/j.jneb.2017.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/14/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Explore infant formula preparation attitudes and beliefs among low-income, formula-feeding, Southeastern US mothers. DESIGN Cross-sectional study using in-home observations and in-depth interviews. SETTING Participant homes. PARTICIPANTS Thirteen low-income mothers of normal birth weight, healthy, term infants aged ≤3 months, who were predominantly feeding powdered or from-concentrate formula. VARIABLES MEASURED Reading formula preparation instructions; order of added ingredients; leveling powdered formula scoop(s); adding cereal or other ingredients to bottles. PHENOMENON OF INTEREST Perceptions of formula preparation or manipulation. ANALYSIS Descriptive statistics described sample characteristics and home observation variables. Thematic analysis of in-depth interviews revealed the following major themes: formula preparation can be intimidating; expressions of complex heuristic perceptions about formula preparation; cost and convenience motivate maternal behaviors; and infant cues override recommendations. Data from qualitative and quantitative activities were triangulated. RESULTS Behaviors, including improper reconstitution and modifications/additions to prepared formula (eg, infant cereal) were observed during home observations and/or described during in-depth interviews. Inconsistencies were detected between observed behaviors (eg, adding too much water to the bottle) and those reported during in-depth interviews (eg, stating over-dilution could be detrimental to the infant's health). CONCLUSIONS AND IMPLICATIONS Targeting knowledge or skills gaps and behavioral motivators in the formula-feeding population could positively affect infant-feeding practices that occur outside of recommendations.
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Affiliation(s)
| | - Betty P Greer
- Department of Family and Consumer Sciences, University of Tennessee Institute of Agriculture, Knoxville, TN
| | - Janie L Burney
- Department of Family and Consumer Sciences, University of Tennessee Institute of Agriculture, Knoxville, TN
| | - L Suzie Goodell
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
| | | | | | - Zixin Lou
- Department of Nutrition, University of Tennessee, Knoxville, TN
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Washio Y, Humphreys M, Colchado E, Sierra-Ortiz M, Zhang Z, Collins BN, Kilby LM, Chapman DJ, Higgins ST, Kirby KC. Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers. Pediatrics 2017; 139:peds.2016-3119. [PMID: 28167511 PMCID: PMC5330404 DOI: 10.1542/peds.2016-3119] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers. METHODS A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $20 to $70 for a total possible of $270. RESULTS The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits). CONCLUSIONS Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.
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Affiliation(s)
- Yukiko Washio
- Christiana Care Health System/University of Delaware, Newark, Delaware;
| | | | | | | | - Zugui Zhang
- Christiana Care Health System/University of Delaware, Newark, Delaware
| | - Bradley N. Collins
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
| | - Linda M. Kilby
- N.O.R.T.H., Inc—Philadelphia WIC program, Philadelphia, Pennsylvania
| | | | | | - Kimberly C. Kirby
- Department of Psychology, Rowan University, Glassboro, New Jersey; and,Treatment Research Institute, Philadelphia, Pennsylvania
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Houghtaling B, Shanks CB, Jenkins M. Likelihood of Breastfeeding Within the USDA's Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children Population. J Hum Lact 2017; 33:83-97. [PMID: 28135478 PMCID: PMC5366039 DOI: 10.1177/0890334416679619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding is an important public health initiative. Low-income women benefiting from the U.S. Department of Agriculture's Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are a prime population for breastfeeding promotion efforts. Research aim: This study aims to determine factors associated with increased likelihood of breastfeeding for WIC participants. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the systematic review of literature. Database searches occurred in September and October 2014 and included studies limited to the previous 10 years. The following search terms were used: low-income; WIC; women, infants, and children; breastfeeding; breast milk; and maternal and child health. The criterion for inclusion was a study sample of women and children enrolled in the WIC program, thereby excluding non-United States-based research. RESULTS Factors that increased the likelihood of breastfeeding for WIC participants included sociodemographic and health characteristics ( n = 17); environmental and media support ( n = 4); government policy ( n = 2); intention to breastfeed, breastfeeding in hospital, or previous breastfeeding experience ( n = 9); attitudes toward and knowledge of breastfeeding benefits ( n = 6); health care provider or social support; and time exposure to WIC services ( n = 5). CONCLUSION The complexity of breastfeeding behaviors within this population is clear. Results provide multisectored insight for future research, policies, and practices in support of increasing breastfeeding rates among WIC participants.
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Affiliation(s)
- Bailey Houghtaling
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Carmen Byker Shanks
- Food and Health Lab, Department of Health and Human Development, Montana State University, Bozeman, MT, USA
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Fornasaro-Donahue V, Tovar A, Sebelia L, Greene GW. Response to letter to the editor. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:e11. [PMID: 25220778 DOI: 10.1016/j.jneb.2014.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Affiliation(s)
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881.
| | - Linda Sebelia
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881
| | - Geoffrey W Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881
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Kent G. Response to Fornasaro-Donahue et al, increasing breastfeeding in WIC participants: cost of formula as a motivator. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:e9. [PMID: 25220779 DOI: 10.1016/j.jneb.2014.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 06/03/2023]
Affiliation(s)
- George Kent
- Professor Emeritus, University of Hawaii, Honolulu, HI.
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