Maternal WIC participation improves breastfeeding rates: A statewide analysis of WIC participants

Objectives: To examine the association between length of exposure to WIC services and breastfeeding initiation and duration and to identify factors associated with breastfeeding in the Massachusetts WIC population.

Methods: All women with singleton live births, first certified into Massachusetts WIC prenatally or post-partum during 2001-2009, and whose infants had complete breastfeeding and covariate data (maternal race, age, education, smoking status, BMI, household income and size, birthweight and gender) were included in the analysis (n=122,506). Multivariate logistic and general linear model regressions were used to examine timing of WIC entry (i.e., prenatal trimester of entry or postpartum) in relation to: 1) breastfeeding initiation, and 2) mean duration. In addition, factors associated with breastfeeding initiation and duration within this population were indentified.

Results: Among prenatal WIC entrants, first (vs. third) trimester entry was associated with a higher likelihood of initiation, 10% for primiparous, 32% for multiparous mothers (p < .01). Prenatal entrants were more likely than PP entrants (p < .0001) to initiate breastfeeding (13% primi and 23% multiparous). Prenatal WIC entrants breastfed 1.7 (primiparous), and 3.4 (multiparious) weeks longer than PP entrants (p < .0001). Several socio-demographic factors were associated with breastfeeding initiation and duration including maternal race with Hispanic and non-Hispanic black women more likely to breastfeed and Asian women less likely to breastfeed compared to Caucasian women. Greater maternal age and education were also associated with higher likelihood of breastfeeding, whereas positive smoking status and obese/underweight BMI were associated with lower likelihood; overweight BMI was not significantly different from normal weight. Conclusions: The WIC program is in a unique position to promote and support breastfeeding within a high-risk population. Greater exposure to WIC services was associated with higher likelihood of breastfeeding initiation and longer duration. Factors associated with breastfeeding behavior should be given special attention for intervention.