Breastfeeding rates among mothers in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lower than for other mothers in the United States. The objective of this study was to test the acceptability and feasibility of the Lactation Advice thru Texting Can Help intervention. Mothers were enrolled at 18-30 weeks gestation from two WIC breastfeeding peer counselling (PC) programmes if they intended to breastfeed and had unlimited text messaging, more than fifth-grade literacy level, and fluency in English or Spanish. Participants were randomized to the control arm (PC support without texting) or the intervention arm (PC support with texting). The two-way texting intervention provided breastfeeding education and support from peer counsellors. Primary outcomes included early post-partum (PP) contact and exclusive breastfeeding (EBF) rates at 2 weeks PP. Feasibility outcomes included text messaging engagement and mother's satisfaction with texting platform. Fifty-eight women were enrolled, 52 of whom were available for intention-to-treat analysis (n = 30 texting, n = 22 control). Contact between mothers and PCs within 48 hr of delivery was greater in the texting group (86.6% vs.27.3%, p < .001). EBF rates at 2 weeks PP among participants in the texting intervention was 50% versus 31.8% in the control arm (p = .197). Intervention group mothers tended to be more likely to meet their breastfeeding goals (p = .06). Participants were highly satisfied with the Lactation Advice thru Texting Can Help intervention, and findings suggest that it may improve early post-delivery contact and increase EBF rates among mothers enrolled in WIC who receive PC. A large, multicentre trial is feasible and warranted. KEYWORDS breastfeeding, breastfeeding support, infant, low income, peer support, newborn feeding behaviours

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The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) breastfeeding peer counselling (BFPC) program supports optimal early life nutrition by providing evidenced‐based breastfeeding protection, promotion, and support. The Lactation Advice Through Texting Can Help (LATCH) study was a randomized controlled trial that tested the effectiveness of a text messaging intervention designed to augment the BFPC program. The purpose of the present study was to understand the topics discussed during the text message exchanges between breastfeeding peer counsellors (PCs) and their clients in the intervention arm of the LATCH study, from the time of enrollment up to two‐weeks postpartum. Text messaging data were first coded and analysed for one‐ and two‐way text message exchanges. Text messages of participants with a high volume of two‐way exchanges were then analysed qualitatively. Four domains were identified in both the prenatal and postpartum periods: the mechanics of breastfeeding, social support, baby's nutrition, and PCs maintaining contact with participants. Additional themes and subthemes identified in the postpartum period included the discussion of breastfeeding problems such as latching trouble engorgement, plugged ducts, pumping, other breastfeeding complications, and resuming breastfeeding if stopped. Two‐way text messaging in the context of the WIC BFPC program provides an immediate and effective method of substantive communication between mothers and their PC.

In the U.S. low income women lack breastfeeding education and support. LATCH was a multi‐site single‐blind randomized controlled trial designed to test the effectiveness of a two‐way text messaging intervention encouraging exclusive breastfeeding among low‐income women enrolled in breastfeeding peer counseling programs in four WIC clinics. LATCH combined in‐person prenatal and post‐partum (pp) breastfeeding education and support (breastfeeding peer counseling) with mHealth technology based on behavior change evidence‐based prenatal, perinatal and postnatal text messaging. The purpose of LATCH was to determine whether the two‐way interactive SMS intervention: (1) improved the time‐to‐contact between participants and their breastfeeding peer counselors; and (2) had an impact upon exclusive breastfeeding rates at two weeks pp.At baseline (N = 174) participants ranged in age from 18 to 42 and were on average 26.8 (SD 5.6) years old. Participants were on average 23.3 weeks gestation, 152.4 (SD 43.7) pounds, and had an average BMI in the overweight range (28.0 kg/m2). Nearly three‐quarters of the sample self‐identified as Hispanic, 71.8% were single – never married, 69.4% were living with their partner, and 43.0% had graduated from high school or obtained their GED. Participants also planned to provide their child with any breast milk for an average of 9.3 (SD 5.5) months, exclusively breastfeed for an average of 5.1 (SD 4.9) months, and partially breastfeed for an average of 4.1 (SD 4.8) months.The follow‐up rate at two weeks pp was 73.0% (127/174). LATCH had a significant impact on facilitating early contact between participants and their peer counselors. Almost sixty percent (58.7%) of women in the intervention group contacted their BFPC either immediately or within the first 48 hours after the baby was born, compared to 34.6% in the control group (p = 0.018). This finding was seen across study sites, although the within clinic differences were not always statistically significant due to limited statistical power for the within site comparisons. At two weeks pp the effect of LATCH was in the expected direction but not statistically significant: 50.7% of women in the intervention group were exclusively breastfeeding versus 44.6% in the control group (p = 0.497). Effect modification analyses showed large effect size differences in exclusive breastfeeding at two weeks pp as a function of study site, level of maternal education, income, ethnicity, English speaking, planned breastfeeding for > 6 months, and pre‐pregnancy BMI.LATCH improved exclusive breastfeeding at two weeks pp among women who were more motivated to breastfeed, spoke English and somewhat socio‐economically better off. By contrast it had no impact in exclusive breastfeeding at two weeks among women who spoke Spanish or who were more socio‐economically vulnerable and less motivated to breastfeed. Our process evaluation findings indicate that is key for WIC clinics to have adequate IBCLC/PC coverage to be able to properly meet the demand for their services created by LATCH.Support or Funding InformationThis project has been funded with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service through grant WIC NEI‐12‐TX to Baylor College of Medicine to Dr. Rafael Pérez‐Escamilla at Yale University. The contents of this publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.