Prenatal Perception of WIC Breastfeeding Recommendation Predicts Breastfeeding Outcomes in Infant's First Year

OBJECTIVES: Promoting breastfeeding (BF) is a priority of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior research found that pregnant mothers who believed WIC recommends BF only (versus BF and formula equally OK) were more likely to initiate BF and continue through 1 month postpartum. We examine whether such mothers are more likely to continue to exclusively BF through 5 months and BF at all through the infant's first year. METHODS: Data are from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a longitudinal study that includes 2,649 mothers who completed prenatal interviews. Four BF outcomes were examined: (a) exclusive BF through 5 months, (b) any BF through 11 months, (c) age of the infant (in days up to 7 months) when formula is initiated, and (d) age of the infant (days up to 13 months) when mother stopped BF. We examined the associations of prenatal belief that WIC recommended BF only (yes/no) with each BF outcome using the Cox regression model to estimate the likelihood of breastfeeding outcomes over time while controlling for prenatal infant feeding intention (IFI) and socio-demographic factors. All analyses accounted for complex survey design effects. RESULTS: Of the pregnant mothers, 41% perceived that WIC recommends BF only; 59% perceived that WIC recommends BF and formula equally. Mothers who perceived WIC to recommend BF only were less likely to initiate formula by 7 months than those who perceived WIC recommended BF and formula equally [Hazard Ratio (HR) = 0.84; P < 0.05], after controlling for IFI.WIC perception was a significant predictor only when IFI was not controlled for the other three BF outcomes: stopped exclusive BF through 5 months (HR = 0.83; P < 0.05), stopped any BF through 11 months (HR = 0.80; P < 0.01), and stopped any BF by 13 months (HR = 0.82; P < 0.01). CONCLUSIONS: Perception of WIC BF recommendation can be a significant predictor of BF outcomes in the infant's first year, possibly by affecting BF intention. FUNDING SOURCES: ITFPS-2 is funded by the Food and Nutrition Service, U.S. Department of Agriculture (USDA). Support for the study analysis was provided by the Economic Research Service, USDA CRA 58–4000-8–0038-R. Findings and conclusions are those of the authors and should not be construed to represent any official USDA or US Government determination or policy.