WIC Participation and Breastfeeding after the 2009 WIC Revision: A Propensity Score Approach

Abstract

In this study, we examined the association between participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and breastfeeding outcomes before and after the 2009 revisions. Four-thousand-three-hundred-and-eight WIC-eligible children younger than 60 months were included from the 2005–2014 National Health and Nutrition Examination Survey (NHANES). We compared two birth cohorts with regard to their associations between WIC participation and being ever-breastfed and breastfed at 6 months. We estimated the average effect of the treatment for the treated to assess the causal effect of WIC participation on breastfeeding based on propensity score matching. The results showed that WIC-eligible participating children born between 2000 and 2008 were significantly less likely than WIC-eligible nonparticipating children to ever receive breastfeeding (p < 0.05) or to be breastfed at 6 months (p < 0.05). Among children born between 2009 and 2014, WIC-eligible participating children were no longer less likely to ever receive breastfeeding compared to WIC-eligible nonparticipating children; the gap remained in breastfeeding at 6-months (p < 0.05). The disparities in prevalence of ever breastfed between WIC-eligible participants and nonparticipants have been eliminated since the 2009 WIC revision. More efforts are needed to improve breastfeeding persistence among WIC-participating mother–infant dyads.

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

“…Social safety-net programs, such as Medicaid, Children's Health Insurance Program (CHIP), and the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, have been shown to improve perinatal and birth outcomes as well as breastfeeding rates [170][171][172][173]. Medicaid and CHIP, joint state-and federal-based programs, provide free medical coverage for low-income pregnant mothers and children.…”

Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review

“…Forty-four studies assessed the association between the 2009 WIC food package revisions and availability of foods and beverages in supermarkets; purchases, redemptions, or dietary intake among WIC participants; obesity in early childhood; perinatal and birth outcomes; or outcomes related to breastfeeding [ 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 ]. There is consistent evidence of an association between the WIC food package revisions and improvements in household food purchases and dietary intake among both adults and children [ 111 , 114 , 115 , 116 ...…”

“…The cash-value voucher, in particular, increased the perceived value of the program for many participants, although voucher redemption varied across communities and may be limited in some areas by poor access to fresh fruits and vegetables or negative store experiences [ 112 , 113 , 117 , 123 , 128 , 131 , 132 , 146 ]. Impacts of the revisions on breastfeeding are mixed, with some studies showing increases in breastfeeding initiation [ 129 , 153 ], others showing no effect [ 118 ], and none finding a relationship with breastfeeding at six months [ 129 , 153 ]. Recent research using interrupted time series or controlled quasi-experimental designs show improvements in maternal and child health outcomes resulting from the food package changes, including reductions in infant and young child obesity [ 125 , 126 , 127 , 130 ], improvements in infant birth weight outcomes (low birth weight, small for gestational age, and large for gestational age) [ 120 ], and reductions in maternal weight gain and preeclampsia [ 120 ].…”

Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads

“…Consistent with previous research [ 34 ], WIC participants in this study were less likely to report any breast milk feeding and were more likely to report early cessation. Although breast milk feeding support is a priority of the WIC program, and rates of breast milk feeding have increased among WIC-participating mother–infant dyads in recent decades, rates of breast milk feeding at age 6 months continue to be lower among WIC participants compared to WIC-eligible nonparticipants [ 35 ]. Further research into these patterns and identifying how federal nutrition assistance programs, such as the WIC, can help improve breast feeding rates and reduce disparities among African American mothers is needed.…”