Is WIC shooting the CDC in the foot when it comes to breastfeeding rates?

During the past week two significant studies on breastfeeding in the United States were released.

The Centres for Disease Control and Prevention (CDC) released statistics on Racial and Ethnic Differences in Breastfeeding Initiation and Duration, by State using data from the National Immunization Survey for the period of 2004 to 2008. The racial differences highlighted in the statistics are profound and widening, but the study also noted  statistics for breastfeeding rates based on the mother's education level, age, WIC eligibility, and state of residence. Overall, it found that 73% of mothers initiate breastfeeding, 42% are still breastfeeding at 6 months (although not necessarily exclusively) and 21% are still breastfeeding at 12 months. As a benchmark, Canadian statistics show a 90% initiation rate and 54% still breastfeeding at 6 months (no 12 month stats are available for Canada).

The other study by Harvard researcher Melissa Bartick, MD, MSc and the Alliance for Prudent Use of Antibiotics Arnold Reinhold, MBA was published online in the American Academy of Pediatrics journal Pediatrics and is called The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Their study looked at the cost of low breastfeeding rates and concluded that if 90% of new mothers were able to follow guidelines for six months of exclusive breastfeeding, an estimated 911 deaths could be prevented and $13 billion could be saved (a topic I also addressed last year in my economic cost-benefit analysis of breastfeeding). Please also see Best for Babes excellent analysis of the horrible ABC coverage of the study on the costs of low breastfeeding rates, which featured biased formula company supporting pediatrician Dr. Lillian Beard.

The CDC and Breastfeeding

According to the breastfeeding section of the CDC website:

CDC is committed to increasing breastfeeding rates throughout the United States and to promoting and supporting optimal breastfeeding practices toward the ultimate goal of improving the public's health.

In order to achieve these goals, CDC utilizes an evidence-based policy and environmental approach to breastfeeding protection, promotion, and support. CDC's breastfeeding activities cover a wide range, from conducting and supporting research about breastfeeding to evaluating and sharing information about existing strategies to protect, promote, and support breastfeeding. CDC also works closely with partners and organizations working to improve breastfeeding across the country.

The CDC website provides a lot of information and resources for mothers and for other organizations wishing to support breastfeeding. For mothers it provides information on the U.S. Department of Health and Human Services breastfeeding helpline and on La Leche League. For other organizations, it provides resources for improving breastfeeding interventions at the state and local level, as well as resources for improving maternity care practices in hospitals and birthing centres.

The WIC Program and Breastfeeding

The United States WIC program provides federal grants to States to provide supplemental foods, health care referrals, and nutrition education for low-incomce pregnant, breastfeeding and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Emily from Adventures in [Crunchy] Parenthood wrote a post last year on WIC and infant formula. In her detailed analysis of  WIC, infant formula, and breastfeeding, she wrote that:

Under the WIC program, new mothers are eligible to receive vouchers for free infant formula. This answers a lot of questions by those who wonder how low-income mothers are able to afford formula in the first place. While WIC is supposed to provide counseling and support for breastfeeding, I have found this not to be universally available. WIC office policies can vary by state, and even by city. In many cases, a pregnant woman receives counseling in the form of a 20-minute video they will watch some time during their pregnancy, and maybe a phone number to a local lactation consultant. WIC offices usually provide pumps for free, but this is often not advertised - one must ask for it. Once the new baby arrives, unless a mother indicates otherwise, she is issued vouchers for formula.

It is also important to look at where WIC gets its formula and how much it pays for it. According to the United States Department of Agriculture's Economic Research Service's (ERS) study on WIC and the Retail Price of Infant Formula:

Since 1989, State agencies that administer WIC have been required to operate an infant formula rebate program as a means of containing WIC costs. Under the rebate agreement, a WIC State agency receives significant discounts from a formula manufacturer in the form of rebates for each can of infant formula purchased by WIC participants. In exchange, a manufacturer receives the exclusive right to provide its formula products to WIC participants in a State. In fiscal 2000, infant formula rebates nationwide totaled $1.4 billion.

In the ERS study and Emily's post about WIC, there is a lot more detail about exactly how this works and what the consequences are. Ultimately, while the pre-rebate cost of infant formula for the WIC program in 2005 equaled $2.34 billion (44% of pre-rebate costs), the post-rebate cost to WIC was only $628 million (17% of post-rebate food purchases), for a total annual rebate of $1.71 billion . Infant formula is by far the most heavily rebated food provided through WIC (ref: WIC Food Package Costs and Rebates Summary: Fiscal Year 2005).

Why am I telling you all of this?

Back to the CDC statistical study that I mentioned at the start of the post. It found that breastfeeding rates among women who are on WIC are significantly lower than the rates among women who are not on WIC. At first glance, people might assume that this is simply a case of lower breastfeeding rates among low income women. However, it is more complex than that.

What is most striking about this data is the significant difference between the breastfeeding rates among women who are on WIC (66% initiation, 33% at 6 months, 17% at 12 months) and women who are eligible for WIC, but not using the program (77% initiation, 50% at 6 months, 30% at 12 months). In fact, low income women who are not on WIC have breastfeeding rates that are more comparable to higher income women than they do to their WIC-recipient low-income counterparts. Looking at these stats, combined with information from a recent Canadian study on the impact of free formula samples on breastfeeding rates,  it would appear that  a good portion 2.22 million infants on WIC in 2009 were being formula fed due to easy access to WIC's formula vouchers.

Interestingly, the Canadian Maternity Experiences Survey, found that the gap in breastfeeding rates among different income levels was not that big (especially when compared with the gap in breastfeeding rates among women with different levels of education or in different age groups). Canadian women who are at or below the low income cut-off had a breastfeeding initiation rate of 88%, with 47% still breastfeeding at 6 months. Women above the low-income cut-off had an initiation rate of 91%, with 56% still breastfeeding at 6 months.

The CDC does mention that one of the limitations of its statistical analysis is that it isn't always clear which contributing factor leads to the lower breastfeeding rates. For example, Black non-Hispanic women were least likely to breastfeed (only 54% initiate breastfeeding) and if non-Hispanic Black women are more likely than other races to participate in WIC, then it isn't clear whether it is race or WIC participation that leads to the lower breastfeeding rates. Either way, pushing formula vouchers on these women is not going to solve the problem.

What needs to change?

I understand that low income women need financial support. However, I think anyone who stops to think about it for a moment will realize that subsidizing the cost of formula, while providing lackluster breastfeeding support (which varies from state to state and is better in some places than others), gives moms a damn good reason to formula feed.  The more women who are enticed by WIC's formula handouts, the further the CDC will be from meeting its goals of increasing breastfeeding rates and the further the country will be from saving that $13 billion and 911 lives.

But what should the United States government do instead?

I think that as a minimum, under WIC, it should:

• Offer quality breastfeeding classes for all pregnant moms


• Have a breastfeeding expert conduct a home visit with all WIC recipients to assess how things are going with the new baby and see if any breastfeeding support is required


• Offer free access to lactation consultants (e.g through bi-weekly free drop-ins)


• Offer free access to breast pumps


• Offer 24/7 access to peer breastfeeding counselors, who should ideally be moms of the same race with significant breastfeeding expertise, but not necessarily former WIC recipients themselves (as is currently the case) because the pool of qualified and interested individuals from that group may be too low to find a large enough pool of quality volunteers (thanks to Elita from Blacktating for making that point on twitter recently)


• Provide extra food vouchers to moms who are breastfeeding and not accepting formula vouchers

This type of breastfeeding support should not be optional. The quality should be consistent across the country and state's should be audited to ensure that they are providing appropriate levels of services as a condition of the grant.

If WIC does offer formula it should do so only when specifically requested by the mom (as opposed to offering it unless it is specifically refused) and it should be in the form of rebates to be used for any brand of formula, rather than entering into a deal with a specific company.

Ultimately, if the point of WIC is to improve the health of low income mothers and babies and if the goal of the CDC is to increase breastfeeding rates in order to improve the health of the nation, all decisions about how WIC's support to moms and infants is provided should be done with a view to supporting breastfeeding first and foremost, with formula as an option only available upon specific request. These moms do not need to be guilted into breastfeeding, but they should be given all the support in the world to help them be successful.

Note: As a Canadian, I do not have any direct experience with WIC myself, so please correct and/or elaborate on any of my points if they are inaccurate or could be expanded on. What I do, however, have experience with are excellent government run programs that support breastfeeding and that appear to be severely lacking in much of the United States.

Comments

[Christina]

I am the breastfeeding coordinator of a WIC agency that serves about 5,000 participants monthly. This is a great topic for discussion. WIC has long been known as the "free formula program", a reputation that they are actively trying to reverse through more and more funding and policy changes regarding the food package, breast pump provision, and peer counseling programs.

When we look at the difference in rates of breastfeeding between WIC participants and WIC-eligible nonparticipants, part of that is because of WHY many people come to WIC in the first place. I'm not saying the free formula doesn't influence breastfeeding decisions- it does. But many WIC-eligible pregnant women who plan to breastfeed, or mothers who are currently breastfeeding, don't realize how much they will benefit from enrolling in WIC as a breastfeeding mother, so they feel they have no need for the program. On the other hand, pregnant mothers who expect to formula-feed and mothers who are currently using formula, are more likely to enroll in WIC.

Other readers have already commented on the food package changes in October 2009 that greatly increased the food package for exclusively breastfeeding women. This financial incentive is powerful: my agency's breastfeeding rates have nearly doubled as a result. In addition, many State WIC programs have implemented a policy of denying supplemental formula to breastfeeding mothers in the first month to support the establishment of breastfeeding and her milk supply.

I suspect that this disparity that you highlight is already on its way out. WIC will have to make more changes to eliminate it. I love your suggestions for the support WIC should provide. I hope your readers will advocate for WIC funding through their legislators since these measures cost the program more than heavily-discounted infant formula, but as we know from the new study, they will save money in the long run!

[BFPC]

Interesting article - here are some thoughts....

1. Alot of agencies, at least in Indiana, are doing several of the things she suggests should be done.
2. If WIC were able to allow all formulas to be allowed on vouchers, rebates would no longer be offered - the companies do that to ensure that only their formula is used.
3. I highly suspect that WIC participating moms' overall breastfeeding rates are lower than moms who are WIC eligible but not on the program because so many moms come to WIC for specifically for the formula. If a mom is WIC eligible, but breastfeeding, she is less likely to apply since she doesn't need formula. What I believe is that the moms who come to WIC in order to get formula to feed the baby, through our breastfeeding promotion, actually end up breastfeeding, at least some. So we are increasing the breastfeeding rates among many moms who probably never intended to breastfeed in the first place.

[Olivia]

Sounds like WIC needs to update their growth charts! My daughter is in the 10th percent range and WIC nurses kept trying to make suggestions on how to get her to eat more despite the fact she is thriving.

[Krista S.]

I wrote a post about my experiences with WIC and how I think WIC needs to change last summer. You can read that post here - http://typical-ramblings.blogspot.com/2009/08/breastfeeding-and-wic-is-that-oxymoron.html

[Rebecca]

I'm in Louisiana, something like the third lowest breastfeeding rates in the country. Most people are shocked that I BF at all, much less that I'm still BFing at 10 months. I agree with another commenter that poor maternity leave is a large factor, I do want to point out that from my own observation, there were many moms receiving WIC formula who were not working- from what they were telling me while chatting in the waiting room. Of course that's not a representative sample. I had my prenatal care at the state hospital, and when they explained you wouldn't be able to get WIC at first the counselor (talking to the whole waiting room) said you could use food stamps, or buy formula yourself- or you could breastfeed.

[Boozehound]

I freaking haaaate the mandatory BF classes. They're well-intentioned but the whole setup is enough to drive you nuts.

The office is small, hot, and cramped, and there is NOTHING for children to do there except get into trouble. There is no childcare provided, and clearly if I could afford a babysitter to listen to a "breastfeeding counselor" read me stuff she printed off kellymom, I wouldn't be on WIC at all.

ahem.

Mostly I'm in it for the cheese. And, of late, the fruit/veg checks. THOSE are REALLY AWESOME. I'd wrangle four kids in the WIC office every month for those. I think.

Anyway, I imagine BFPC has a point. We've always qualified, but not always bothered to stay on the program, especially when crossing state lines into a new office.

In the past, it has been much more of a hassle than it was worth, since the food dollar amounts are fairly small and the choices quite restricted. If you were getting formula, though, you have a lot more motivation to get and stick with the program.

But it's gotten more worthwhile with the addition of the veg checks and the wholegrain products. So I got back on, stupid BF classes or not. lol

[Boozehound]

I really must say, though, that in the five years I've been on the program in one place or another, the workers have always been very verbally supportive of breastfeeding.

I don't know how much help they are, or could even possibly be expected to be, when the going gets hard, though-- issuing formula checks has GOT to be a lot easier than trying to figure out what's gone wrong with a breastfeeding situation, particularly when you're already pressed for time.

But as long as BF is going well, they've always done everything but roll out the red carpet for my breastfeeding efforts.

[Kelly]

I'm so sorry about the weird lady at the zoo. I had a manager at a grocery super store threaten to have me arrested for doing the same thing, regardless of how politely I informed her that I was violating no law (my state specifically exempts breastfeeding from indecency statutes). Sometimes I wish I would have let her call the police...especially after I heard of other people in similar predicaments.

[Summer]

I used to work for WIC as a breastfeeding counselor. We did in depth classes, and called moms at home on a regular basis to ask if they had any problems. Our job was to encourage long term breastfeeding as much as possible. I wish that program got more funding so that every WIC office could afford to hire people to do this.

[Sherry]

I've been on WIC in 3 different states during my hubby's schooling career (just started grad school) and have seen different approaches on BFing in all 3. In Utah it was more acceptable and almost expected that you BF. I don't remember having to make a huge decision whether to BF or formula feed my first... maybe because it is just plain cheaper to nurse. Oh, and after 48 hours of not being able to nurse when my first was 5 weeks I vowed I wouldn't go through the hassle of formula! Pennsylvania as well as Maryland promoted BFing, but didn't offer any classes or instruction. I'm sure that it made a difference that I planned on nursing and had experience, but if I hadn't had the experience or support and didn't make the decision beforehand, well...Anyway, the WIC food package was completely revamped as of October 2009 to include foods for a more rounded diet. BFing moms get fruits, veggies, whole grain bread, tortillas, or brown rice, milk, eggs, cheese, fish (not just tuna anymore), beans or peanut butter, and cereal. Some weeks or months we have depended on this as our staples for meals.
I do wish that the individual states would do more to promote BFing where it isn't as normal as formula. Since reading this post I will be talking to a friend who works for WIC in our area about becoming a peer educator!

[Stephanie]

I live in Kentucky & I get WIC & exclusively breast feed my daughter! WIC has been very helpful & supportive. My daughter would not latch so I ended up exclusively pumping & they gave me a Medela Pump in Style back pack!! I went to a LC, at the hospital where I delivered, for a couple months (for free) trying to get her to latch. WIC also had a breastfeeding peer councilor who checked in with me several times in the beginning. I get milk, eggs, cheese, bread, cereal, beans, tuna, fresh produce, juice & peanut butter, it's great!! & for my daughter, once she turned 6 months old, i started getting: cereal, and baby food (fruits, veggies & meat)... way more than what we need!! My daughter is really not interested in foods, except for things she can feed herself, like cheerios & puffs (she is 7.5 months). I still keep trying to feed her the baby food, but it would be nice if we had the option to get fresh produce to MAKE food for her and if we could get cereal such as cheerios for her rather than the baby food. But I still appreciate what we get & I've started buying more fruit (baby food) because I figure that I can put it in her oatmeal or yogurt later once she decides she will eat foods like that, LOL. Also, I like some of the fruits for myself... haha... so I just eat some and then she can get it through my milk =) I've also researched and found some recipes that call for baby food so I may try that out. & I've also made popsicles out of baby food (fruit), yogurt &/or breast milk just to try to get my daughter to try things & when she is a little older I can use the pureed fruits to make smoothies too =)
Also, I should add that my daughter has never been sick & I have had e few very bad colds & she didn't seem affected at all!! Breast milk is amazing!! I also feel very blessed that I have more than enough milk for my daughter even though she wouldn't latch. We are moving to Indiana soon & I wonder if anybody reading this might know if I will get the same things from WIC in Indiana...? I know it can vary from state to state.
OVERALL I THINK WIC IN KENTUCKY IS WONDERFUL!
Oh & one interesting thing I've noticed though is that the cashiers always seem a little confused by my vouchers, I don't think they see many vouchers for breast feeding moms.... I don't know why more people wouldn't want to take advantage of it though, I think it's great!!

[Birth_Lactation]

Hi Annie.. Very thorough and interesting as always.
I found out in October 2009 that the PA WIC was NOT giving formula to breastfeeding moms for the first month. They were getting a larger food package instead. I haven't been able to find out if there has been data collected to evaluate this change yet. When I was researching the state site and came across our county, I was AMAZED to find that I was listed as the local resource!!!!! I had NO Idea and I have no idea how long it has been listed that way!! Amazing!
They have a nice educational poster for moms explaining why no formula for the first month. hope the link shows up here:
http://www.portal.state.pa.us/portal/server.pt/gateway/PTARGS_0_624657_0_0_18/Breastfeeding%20without%20WIC%20formula.pdf
This is what it says in their newsletter:
"In order to encourage moms to fully breastfeed their infants, the new food vouchers for breastfeeding women are the largest checks given. Fully breastfed infants also receive infant meats in addition to fruits and vegetables at 6 months of age. To allow moms and babies to get breastfeeding started in the first month after birth, formula supplementation is not permitted, and moms are offered a breastpump if they need one. Chester County WIC (the pilot county)currently leads the state in the initiation of breastfeeding with 65% of our moms nursing their babies."
The system needs a lot of work. I know our county is is need of good peer counselors.

[It’s not about picking o]

[...] study The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis, which I wrote about a few days ago,  Lenore says: Why are we so eager to terrify mothers who don’t breast-feed? [...]

[julie]

I have had experience with WIC in two separate cities. With my 2.5 yr old, I stopped nursing at 6 wks. I am completely confident in saying that if I had approached the WIC office for support in continuing nursing, they would have made me an appt in 3 wks, and I would have had to wait in the office for 2 hrs before being seen for a 15 min appt that was useless. btw, I quit because of severe postpartum anxiety, and I needed meds that I couldn't take while nursing.

In our current city, I have been impressed by the commitment of the employees to nursing. I have been seen immediately for supply issues, received follow-up appointments and information in the mail pertaining to nursing and my food allergies. They provided both a manual and an electric pump. In the office, they also offer several classes on breastfeeding, and readily provide the info for the LLL meetings in town. In addition to extra food vouchers, vouchers for the farmers market and friendly prompt service.

Honestly, the experience in this city made me sad for the ladies who didn't qualify.

[Alicia]

Here in southern Minnesota, the WIC program was so awful I stopped using it.

In the first place, I didn't want to cost the government money if I could afford the foods myself (I feel the income level is very high in our area -- almost every mother I know qualifies).

In the second place, I thought it was wasteful. The administrator actually told me to make bean bag toys with the extra dried beans I could get! They gave vouchers for WAY more juice, milk, cheese and cereal than was healthy for the size of our family. I don't know a single family on WIC in my town that doesn't give extra foods to friends and relatives because they get so much extra.

In the third place, I found that they were very anti-breastfeeding. You get free formula automatically and the nods towards breastfeeding were a joke. They acted surprised I was nursing and I never saw anything about support in any form. It makes me furious that my tax dollars are paying to get poor women to give up breastfeeding. The attitude is, "Why breastfeed? WIC will give you formula to use for free."

In the fourth place, I found their dietary advice to be horrible. When I mentioned that I tried not to just give my young daughter apple juice all the time in favor of more nutritious juices like orange juice, the worker said "One juice is as good as any other kind, and apple juice is just as nutritious as eating apples." My child would have been drinking up to 6 cups of apple juice a day to keep up with their program, which I know is ridiculous and would just lead to cavities and weight problems, not to mention masses of sugar. They also gave me false information about eggs and allergies (saying it was fine to give an infant eggs) and told me I was endangering my health by being a vegetarian.

In the fifth place, they were just plain rude. A worker ridiculed my toddler for crying when she stuck her for a lead test, saying, "Oh quit crying, it's just a prick!". Another one outright laughed when we told her we planned to homeschool our children (the oldest is now entering 7th grade at home and well past high school level in many subjects, thank you). Another one made fun of the way we spelled our son's name (and no, it's not a crazy spelling, though it would be rude even then).

It makes me sick to think of how many billions we spend on this program. I'm glad some states are doing a better job from the sounds of it.

As for the "extra food," when I was on it I got a can of tuna and a bag of carrots each week instead of all the formula. It wasn't exactly a huge incentive.

Oh, and here, you just get vouchers. You can use them on any brand that's approved (but no organic foods). So most mothers I know buy the most expensive of everything, costing the government that much more money.

It's a cash cow for the formula industry, Gerber and Juicy Juice, funded by the tax payers. I am so not a fan!

[Anna]

They cannot refuse you benefits if you qualify financially if you do not vaccinate. It's simply another avenue for the government/public health officials to propagandize. Tell them you don't for religious reasons and threaten legal action. They cannot discriminate based on religion and there is a USDA hot line specifically for WIC discrimination complaints.

If you think that's bad, I've had several FAAPs tell me various outright false information regarding formula and breastfeeding.

One, an allergist, said he believed every newborn's first meal should be a formula containing different allergy food proteins to "sensitize" their immune systems. Needless to say, I didn't go back even for my own care.

One, a partner at a children's hospital general pediatriac practice, told me that breastmilk was worthless after 4 months because that is when the child should be started on solids and formula was clearly a better nutritional choice. He about wet himself having fits telling me why tandem nursing and breastfeeding while pregnant were dangerous to me and my children and dismissed as irrelevant questions I asked that were pretty much straight out of Breastfeeding and the Use of Human Milk, the AAP's policy statement on breastfeeding.

But speaking of vaccines... Another partner at the same children's hospital practice ignored my concerns about green frothy poop and diaper rash to browbeat me into vaccination for my 2 month old, only to have her have a serious adverse event once we got home that was never documented in her chart.

As to WIC supporting breastfeeding, there is a wide variation in what is offered from clinic to clinic, let alone state to state. And even the clinics with the best programs will fail to increase breastfeeding initiation and sustaining rates if people don't bother to show up. I worked as a breastfeeding peer counselor for WIC. Part of my job was sitting in the waiting areas, nursing my baby, and talking to other mothers about breastfeeding in an effort to normalize breastfeeding since many of our moms had never or seldom seen anyone breastfeed in person. I also had an approximately 500 piece mailing list that included the prenatal and breastfeeding mothers in my district where I would advertise monthly classes focusing on a specific breastfeeding topic at each clinic, services available, and where to call for breastfeeding questions or support. I was happy if I had 2 people show up at each class because they were not required in order for the moms to get their vouchers even though we had give-aways at every class and older children were welcome. I did home visits, and phone calls, and regular breastfeeding education, pump loans, and community outreach to the medicaid HMO prenatal program coordinators. I only had a maximum of 25 hours a week, but it was enough work for three people working full time. And because of a state hiring freeze (that also counts toward grant funded positions like mine was) I don't know that there has been anyone hired to replace my replacement after she left.

[Samantha]

WIC does offer extra food vouchers for breastfeeding moms. As a breastfeeding mom on WIC I get tuna, extra produce money, extra milk, cheese, and cereal that I wouldn't otherwise get if my daughter were getting formula through them instead. As for the other suggestions I think it would be fantastic for them to offer strong breastfeeding counsel but I do have to wonder how many people would even be interested in utilizing such services. My particular office promotes breastfeeding a lot from what I can tell - every room has pictures of breastfeeding moms and informational posters about the benefits of breastfeeding/breastfeeding and returning to work etc.

[Samantha]

we had a huge surplus of the jarred foods and I found ways to add it to our meals - such as putting a jar of carrots into spaghetti sauce or chili, adding butternut squash to mac and cheese, adding a jar of bananas to banana bread mix, and using the sweet potatoes in pancake batter with cinnamon to make yummy pancakes. Also I think that the applesauce can be used in some baking recipes in exchange for butter/oil.

[Miranda]

I think you'd be amazed by the work that California WIC is doing to promote breastfeeding in our state! Just yesterday I was at a Breastfeeding Walk at the state capitol (co-sponsored by the California WIC Association and the California Breastfeeding Coalition), where state and local employers were given awards for supporting breastfeeding employees in the workplace. Moms got up to say that their local WIC office allowed them to stop in and use their lactation rooms for a private space to pump (and these moms weren't even on WIC)! WIC moms often have access to breastfeeding peer counselors, lactation consultants, and pumps through WIC. And exclusively breastfeeding moms get a lot more food than formula feeding moms. Because of all this, our WIC breastfeeding rates, though indeed lower than the general population, are going up! Someone mentioned hospitals and doctors and WIC - currently, the CA WIC Association is sponsoring a state bill requiring maternity hospitals to have a breastfeeding policy and train their staff. Such good stuff - a model for the whole country! Check out CA WIC Association's website here: http://www.calwic.org/focus-areas/breastfeeding

[Kathleen]

I am sorry to hear that so many people have had bad experiences on WIC but I'd also like to point out that many people are referring to WIC experiences from several years ago. The new WIC food package for breastfeeding mothers includes a cash value check for fresh, frozen, and/or canned vegetables and fruits and in some places at least this check can be used in authorized farmers' markets. Other foods include whole grain breads/brown rice or whole grain tortillas, soy milks, tofu, among others. Rudeness of staff should always be reported to supervision. Here in NYC, many, if not most WIC Programs, go above and beyond for their breastfeeding mothers. And, for those complaining of too much food, you can always ask for your food package to be modified. Also: USDA would be very happy to hear comments on the food package so take a minute to log on and let them know. WIC is not a perfect program but it has helped many families in many ways.

[Kristen]

I agree with your post - as a WIC Breastfeeding Peer Counselor I think we could do much more for our clients. However, there is one great error with the statistics that is being overlooked. When I was breastfeeding my first child, I though of WIC as "the formula program," and since I didn't need formula I didn't even apply for the program even though I would have qualified for it. I have a feeling that many women feel the same way. It wasn't until my husband was laid off after we had our second child that I realized that they provided food for breastfeeding moms and children. I think in the last few years (at least in our state) there has been a big campaign to promote breastfeeding. In 2010 the breastfeeding peer counselor program started in my county, and I jumped at the opportunity to become one. I love my job but I'm spread soooo thin. Just this month we have 120 moms due - I work 12 hours a week! I can't possibly talk with every single one of them. But our staff is great at letting expecting and breastfeeding moms know that help is available. We offer classes and individual appointments with the BFPC, but most of the work I do is on the phone. Unfortunately, very few moms actually call me. I'm usually the one calling and following up with them (which I'm more than happy to do). I just wish they would be more proactive about getting help - a phone call is all it takes!

[liz brown]

I am an IBCLC for the ohio WIC program and we already do everthing on you list except home visits!

[Leigh]

I qualify for WIC since I am low-income. I am hoping to breastfeed my child when it arrives (March 2013), but I am currently on medication, which is preventing me from doing so. My doctors are hoping to get me off my medication by 5-6 months so I can. My WIC can provide me with a breastpump if I exclusively feed my child for 4 weeks, which isn't a problem. I am more than glad to ask for the help I need and call my office regularly with questions about my services. I know that if I am able to EBF, that I will get more food vouchers instead of formula vouchers. If my child isn't breastfed, that doesn't mean it has a greater chance of death than a child who is. That isn't necessarily fair, trying to scare mothers into it and guilt them about it if they can't. My mother wasn't able to EBF me because I wouldn't latch, and here I am 21 years alter, healthy as a horse with a baby of my own on the way. Pretty sure I am healthier than most people my age that were breastfed as well. That's because my parents took care of me when I was younger and gave me everything I needed to stay healthy. It is keeping your child healthy that counts, not the method you use to do it. WIC is VERY understanding about that and those types of situations. They will do the home visits to be sure everything is going smoothly. But I sure don't think they are shooting the CDC in the foot because they are supportive of women who CANNOT EBF. If anything, the CDC is shooting those kinds of mothers in the foot for something they can't control.