Surprise! WIC program doesn’t increase breastfeeding rates.

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When my youngest son was small, his preschool decided to introduce a program designed to prevent molestation. Looking over the literature for the program, I couldn’t find any evidence that it had been shown to work. I pointed this out to the principal, who responded: “Amy, education isn’t like medicine. We don’t have to prove that it works before we implement it.”

I’m reminded of that incident when contemplating the WIC program designed to improve breastfeeding rates. I consider the program to be punitive, vindictive and unlikely to accomplish its aims. Moreover, just like the preschool program on molestation, no one bothered to show that it would work before they implemented it.

Now, three years into the program, a paper analyzing the effects of the special WIC rewards for breastfeeding mothers has finally been published. The result: the WIC program is utterly ineffective at increasing breastfeeding rates.

The paper Food-package assignments and breastfeeding initiation before and after a change in the Special Supplemental Nutrition Program for Women, Infants, and Children was published online on July 25, 2012.

There were changes in WIC food-package assignments and infant formula amounts but no change in breastfeeding initiation…

After the change, fewer WIC mothers of new infants received the partial breastfeeding package. More WIC mothers received the full breastfeeding package, but more mothers also received the full formula package.

In fact, the amount of formula used increased significantly:

… When measured as a continuous variable in dyads with infants in the birth month, the mean formula amount increased significantly from 546.8 fluid oz (16,171 mL) before implementation to 559.6 fluid oz (16,549 mL) after implementation (t = 4.36, P > 0.001).

There was no increase in the rate of breastfeeding initiation:

As measured in administrative records, the breastfeeding initiation rate for WIC participants was essentially unchanged at 65.5% (preimplementation) and 65.1% (postimplementation). Overall rates of breastfeeding initiation appeared quite stable even as WIC package assignments changed.

Ironically, the program cost more AND made full formula feeding more economically rewarding than partial breastfeeding :

Before implementation, the estimated average market value was $668 for the full breastfeeding package, $1669 for the partial breastfeeding package, and $1380 for the full formula package; hence, the partial breastfeeding package had the highest value. After implementation, the estimated average market value was $1028 for the full breastfeeding package, $1130 for the partial breastfeeding package, and $1345 for the full formula package; hence, the full formula package had the highest value.

I’m glad that the data demonstrates incontrovertibly that the program is completely ineffective, but I could have told them that before they implemented it. It is hardly surprising that it doesn’t work since it was predicated on assumptions that have no basis in fact. The fundamental erroneous assumption, beloved of lactivists, is that the decision to bottle feed is the result of ignorance and cultural pressure.

Lactivists prefer fantasizing about why women bottle feed instead of acknowledging the real reasons. Breastfeeding is hard, often painful (particularly during initiation) and inconvenient.

Faced with the complete failure of the program, it finally occurs to the authors that there was always a very real chance that the program would not work:

An objective of the policy changes was to encourage adoption of the full breastfeeding package and to promote breastfeeding. However, the changes in package options could, in principle, have multiple effects. First, even if infant feeding choices are predetermined or fixed, the policy change could have a reclassification effect that leads fewer cases to be assigned partial breastfeeding status and more cases to be assigned full formula status, without greatly influencing actual breastfeeding behaviors in either direction. A mother who relies principally on infant formula, supplemented by breastfeeding, could have been classified as partial breastfeeding before implementation and full formula after implementation. In this case, there would have been a change in package assignments without large effects on
breastfeeding outcomes…

In other words, the new program simply forced women to commit to full bottle feeding or full breastfeeding and reduced the number of women trying to do both.

Unfortunately, the authors appeared to have learned nothing from their own study. They are still clinging to the cherished lactivist fantasy that they can manipulate women into higher breastfeeding rates through greater “rewards” and more “education”:

A first option is to investigate an additional increase in the economic value of the full breastfeeding and partial breastfeeding packages relative to the full formula package…

A second option is to assess additional improvements in staff training and efforts of breastfeeding promotion … Besides educating mothers about the package changes, an expansion of breastfeeding education programs may offer another approach to breastfeeding promotion. Such programs cover the benefits of exclusive breastfeeding, especially during the first month postpartum.

So let’s see if I get this straight:

The WIC program designed to increase breastfeeding rates by “rewarding” and “educating” women was a complete failure, but the authors think that the next step should be to try higher rewards and more education?

What evidence is there that those steps would work? No evidence, of course, but lactivists would rather cling to their fantasy reasons for not breastfeeding rather than investigate the real ones.

Here’s a thought:

Stop assuming that women in the WIC program are like dogs who can be trained to perform tricks and rewarded with treats.

They are people. Treat them like people! If you want to know why women don’t breastfeed, ASK THEM!

You aren’t going to like the answer, but at least you’ll stop wasting taxpayer dollars on failing programs that rely on demeaning assumptions.

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  • Andrea
  • Kate

    I can’t believe a doctor wrote this message. Breastfeeding is inconvenient? What planet do you live in? You mean you prefer warming bottles, spending a few thousands of dollars a year in formula, washing the bottles, finding a bottle warmer when you are out of your home, rather than just lifting your shirt and nursing your little one? That’s insane! Breastfeeding rates are not up because they still send you formula samples at home for free even when you don’t ask for it (I wonder how they got my address) and keep sending it for months! And yes, the first weeks are so hard that anybody might be tempted to give up and just go the apparently easier route of formula. Oh yes, and many doctors like yourself certainly don’t encourage women to breastfeed. Ever heard of the saying that anything worth a lot requires hard work? You are a doctor, and you should know better… As a member of WIC, I enjoy the fact that they provided me with a pump so that I can keep breastfeeding despite being a full time graduate student.

    • Wren

      Breastfeeding is only convenient if you are home with the baby. For me, it was totally convenient. For my sister, who worked full-time and only had a few weeks of maternity leave, not so much. She made it work, but only because she had an employer who had somewhere private she could pump, somewhere to store the breastmilk and she happened to respond to the pump well. Our cousin had a job where she couldn’t do that and breastfeeding didn’t really work for her at all.

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