WIC – Fighting the good fight against all odds by Karen McCully from BoobieMilk

Karen McCully worked for WIC (Womens, Infants and Childrens Supplemental Nutrition Program) and managed the Anne Arundel County Department of Health WIC Program in Maryland for almost 6 years and breastfeeding is her passion.

Nothing gives me greater pleasure than to see someone” reach their breastfeeding goal.  It’s a common question that I would ask a WIC (Womens, Infants and Childrens Supplemental Nutrition Program) participant when they came in for their appointment pregnant or after having their baby.  “Tell me about your plans for breastfeeding?” or “Tell me about your breastfeeding goals?”  The answers to these questions gave me an insight into how these women felt about breastfeeding, what they had been told about breastfeeding, and helped me to understand the support that they might need from the WIC Program.

WIC is often perceived as the enemy in the breastfeeding world.  The first time I attended an International Lactation Consultant Association (ILCA) conference I was given the cold shoulder on a number of occasions when asked who I worked for and told them “WIC”.  Yes, WIC does provide free formula to millions of infants in the USA.  Under federal mandate, the formula companies also provide this formula at a subsidized rate, and yes, the WIC participants do show brand loyalty to the brand of formula they receive from WIC.  WIC participants have also been shown to breastfeed less than their counterparts who do not receive WIC benefits.

The WIC community has strived for many years to provide the best service for its participants in their endeavour to promote nutrition and breastfeeding.  I want to give you just a snapshot of the ways that WIC fights against this perception and some of the successes that they have achieved (remember that I am talking from the point of view of the Anne Arundel County WIC Program in Maryland, but these changes are going on throughout the US every day).

Each WIC program is run with the same rule book, but every agency is a little bit different in their approaches and priorities.  The focus changes depending on the State agency leadership or is dependent on the local agency manager.  Some managers have a nutrition background, some breastfeeding, and some business.  However, a percentage of each dollar spent on the WIC program has to be used and proven to be used for breastfeeding promotion or support.  When I came to the AAC WIC Program, a marvellous job had been done to provide excellent nutrition support, but little had been done about breastfeeding support.  I do have a nutrition background, and hopefully my staff would agree that we continued to provide amazing nutrition support, but I decided to focus new efforts on the breastfeeding support provided because all great nutrition starts with breastfeeding.

The goal was to increase the initiation rates of the WIC participants in Anne Arundel County to the same level as those of the County average.  To give you an idea of what we were up against, the breastfeeding rate for WIC participants in AAC in 2005 was 46%, with an exclusive breastfeeding rate at birth of just over 10%.  The breastfeeding initiation rate for the whole AAC was over 70%.

The WIC program has remained in the US because of its work feeding hungry children.  Every time a reduction in the formula issued for infants is discussed there are huge protests from the poverty and hunger charities and organizations.  Formula is not going to go away.  Instead, The National WIC Association has worked closely with the USDA to improve the breastfeeding benefits and provide more money for breastfeeding peer counsellor programs.  In 2010 money was awarded to WIC to enable each and every WIC agency to hire peer counsellors.  The money cannot be spent on anything but peer counsellors and their qualifying expenses.

At AAC WIC a breastfeeding program was established to change the way that we did business, a multi-pronged approach was taken to make sure that we promoted, supported and protected breastfeeding for our participants.  We wanted to make sure that they learnt more about the benefits of breastfeeding, and could make an informed decision about their infant feeding choices and we wanted them to reach their breastfeeding goals.  Removing their barriers to breastfeeding was key.

1.  Consider breastfeeding as the normal way to feed an infant.  WIC staff took the approach to assume that all women wanted to breastfeed, and had chosen to breastfeed when they called for an appointment or came into the clinic.  Over 70% of Marylanders initiate breastfeeding, so we considered it the norm and participants were always quick to tell us otherwise if that was the case.
2. Create a baby friendly environment.  No advertising of any form is allowed in the WIC clinic.  Bulletin boards were designed to provide lots of breastfeeding information targeting areas such as fathers and breastfeeding and feeding in public.  Posters of breastfeeding were hung in all offices and staff were given t-shirts with the Texas WIC breastfeeding logo on them (Born to be Breastfed) to wear in clinic.  National breastfeeding month in August was celebrated with style each year, giving certificates to breastfeeding Mums to celebrate their success and holding events to make breastfeeding Mums feel special.  The AAC Department of Health also strived to become a breastfeeding friendly employer in Maryland, and achieved recognition in 2011 just after I returned to the UK.  The two main Health Department buildings provided a safe and clean nursing room for all clients and staff as part of this initiative.
3. Promote breastfeeding to all WIC staff.  All WIC staff underwent additional training to learn more about breastfeeding and simple things they could do to help new Mums.  It is now policy for WIC employees in the US to go through a similar training when they start work.
4. Promote breastfeeding to all participants.  Nutrition education is a mandatory part of the WIC program for participants.  We made sure that the education during breastfeeding month was breastfeeding related so that not only did the women receive the knowledge about breastfeeding benefits, but so did the grandparents, foster parents and Dads.  Comprehensive breastfeeding classes were also offered to all pregnant women before their due date.
5. Hire a Lactation Consultant.  You can train WIC staff in all areas of breastfeeding, but for some breastfeeding issues a professional referral is needed.  An in-house IBCLC (Internationally Board Certified Lactation Consultant) was crucial for all high risk breastfeeding referrals.  Free lactation help for all participants was something that our participants had never had access to before.
6. Provide a support network with Breastfeeding Peer Counsellors.  We hired a number of peer counsellors that had received WIC benefits before and had breastfed successfully for at least 6 months to provide support to pregnant women and breastfeeding women through a number of avenues.  Each participant was assigned to a specific peer counsellor which was dependent on their age, race and language.  The peer counsellor was then responsible for calling the participant to answer any questions they might have and encourage them to come to support groups or to refer them to the IBCLC when needed.  Support groups were scheduled weekly as drop in sessions for participants to find support from peer counsellors, other Mums and to provide a safe place for them to share their thoughts and concerns.
7. Provide pumps.  We provided manual, electric and hospital grade pumps for those that requested them.  Exclusively breastfeeding women were given the option of a personal use pump, and hospital grade pumps were only distributed on a loaner basis for sick babies on a case by case basis.
8. Provide the right incentives to encourage women to breastfeed exclusively and for longer.  The formula food package benefits may seem enticing for a new Mum, they are worth a lot of money.  We tried to find incentives that would balance out the costs of not receiving these formula packages.  Exclusively breastfeeding Mums already get more food from WIC, they also receive food for up to 12 months (6 months for non-exclusive Mums and formula feeding Mums).  Exclusively breastfed babies also receive more food at 6 months (baby meat and twice as much fruit and vegetables jars as formula fed babies).  We provided free nursing bras for exclusively breastfeeding Mums for every 3 months that they continued to breastfeed (up to a maximum of 5 per pregnancy).  We also provided a hands-free bustier for those returning to work (12 weeks is the maximum leave a man or woman can take off work without losing their position in the US, it is not paid leave).  Pumping at work is much more common in the US.  Staff were trained to fit the nursing bras and issue pumps so that it could be done during appointments.
9. Hire full time peer counsellors.  Two peer counsellors were hired full time to provide full time availability of breastfeeding support to all participants at all times.  This was also a great opportunity to train new IBCLC candidates.
10. Provide services to women in the hospital.  In 2010 AAC WIC sent their first staff to work in the hospital.  Breastfeeding support can now begin right away, and referrals can be made immediately for pumps and IBCLC help.  The staff all speak Spanish too which is a great help to the hospital.  Plans are also underway to provide lactation support at home after discharge so that breastfeeding doesn’t stop before their first WIC appointment if of course breastfeeding is the goal.  Support is crucial during the first few weeks because breastfeeding women are given formula discharge bags when leaving the hospital filled with bottles of ready to feed formula and pre-sterilised nipples.  On returning home, there is also usually a case of formula waiting for them.

The results are in.  I left the AAC WIC Program in December of 2010 with a caseload of over 9000 participants (4500 in January 2005).  The breastfeeding initiation rate was 69%, and the exclusive breastfeeding rate was up to 24%.  I think this shows that WIC participants do choose to breastfeed when they are given the facts and the support to succeed.

Yes, WIC gives free formula to low income women.  But look at all the good that we were able to accomplish when breastfeeding became the focus and staff were trained and passionate about a common goal.  A comment heard regularly in the WIC clinic from staff and participants is that “If only I had known about …. I would have made a different decision”.  This is especially true for many of our peer counsellors.  They did not even try to breastfeed their first for numerous reasons, but after coming to WIC and learning about the benefits and being supported in their decision, they made a different decision the second time around and now have become breastfeeding advocates and supporters for people in the same situation they had been in.  It definitely is these shared life experiences that sets peer counsellors apart from other forms of support.  This is why peer counsellors have been shown to make the biggest difference in breastfeeding outcomes.

So please, when you think about WIC don’t immediately think of free formula, WIC is so much more than that.  After hospitals, WIC is probably the biggest employer of lactation consultants and paid peer counsellors helping hundreds of thousands of babies each day to continue to receive breast milk, and helping mothers to reach their own breastfeeding goals.

AAC Dept of Health, Maryland – www.aahealth.org

Maryland WIC Program – http://fha.maryland.gov/wic/

NWICA – http://www.nwica.org/

USDA – http://www.fns.usda.gov/wic/breastfeeding/mainpage.HTM

J Hum Lact. 2009 Nov;25(4):435-43. Epub 2009 Aug 3.

The differential impact of WIC peer counseling programs on breastfeeding initiation across the state of Maryland.

Gross SM, Resnik AK, Cross-Barnet C, Nanda JP, Augustyn M, Paige DM.

Source

Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Johns Hopkins University, W4033 Wolfe Street Building, 615 North Wolfe Street, Baltimore, MD 21205, USA. sgrossphd@yahoo.com

Abstract

This cross-sectional study examines Maryland’s women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18,789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared self-reported, breastfeeding initiation rates for 3 groups: peer counselor (PC-treatment group) and two comparison groups, lactation consultant (LC), and standard care group (SCG). Reported breastfeeding initiation at certification was 55.4%. Multiple logistic regression analysis, controlling for relevant maternal and infant characteristics, showed that the odds of breastfeeding initiation were significantly greater among PC-exposed infants (OR [95% CI] 1.27 [1.18, 1.37]) compared to the reference group of SCG infants, but not significantly different between LC infants (1.04 [0.96, 1.14]) and the SCG. LC and SCG infants had similar odds of breastfeeding initiation. In the Maryland WIC program, breastfeeding initiation rates were positively associated with peer counseling.