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The Differential Impact of WIC Peer Counseling Programs on Breastfeeding Initiation across the State of Maryland
Abstract
This cross-sectional study examines Maryland's women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18,789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared self-reported, breastfeeding initiation rates for 3 groups: peer counselor (PC-treatment group) and two comparison groups, lactation consultant (LC), and standard care group (SCG). Reported breastfeeding initiation at certification was 55.4%. Multiple logistic regression analysis, controlling for relevant maternal and infant characteristics, showed that the odds of breastfeeding initiation were significantly greater among PC-exposed infants (OR [95% CI] 1.27 [1.18, 1.37]) compared to the reference group of SCG infants, but not significantly different between LC infants (1.04 [0.96, 1.14]) and the SCG. LC and SCG infants had similar odds of breastfeeding initiation. In the Maryland WIC program, breastfeeding initiation rates were positively associated with peer counseling.
... The rapid review identified 15 BFPS interventions that were subject to experimental study, which were reported in 16 papers published between the start of January 2000 and the end of January 2016. 29,34,35,[37][38][39][80][81][82][83][84][85][86][87][88][89] Nine interventions were delivered in the USA, all associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). [80][81][82][83][84][85][86][87]89 Five papers related to UK-based interventions 34,35,[37][38][39]88 and one intervention was delivered in Canada. ...
... 29,34,35,[37][38][39][80][81][82][83][84][85][86][87][88][89] Nine interventions were delivered in the USA, all associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). [80][81][82][83][84][85][86][87]89 Five papers related to UK-based interventions 34,35,[37][38][39]88 and one intervention was delivered in Canada. 29 Studies were included if they pertained to a model of BFPS that included planned one-to-one contact between a mother and a peer supporter, reported breastfeeding rates (initiation, continuation or exclusivity) as an outcome measure and if they had been delivered in a developed country setting. ...
... Eleven studies were RCTs, 29,34,35,37,80,81,84,[86][87][88][89] three were area-based controlled studies 38,82,83 and two were natural experiments. 39,85 Applying Cochrane risk of bias criteria, 91 we found that only three studies had a low risk of bias. ...
Background
In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer.
Objective
To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation.
Design
Intervention development and a non-randomised multisite feasibility study.
Setting
Community maternity services in three areas with high levels of social deprivation and low breastfeeding initiation rates in England and Wales.
Participants
Pregnant women considering breastfeeding. Women who did not plan to breastfeed, who had a clinical reason that precluded breastfeeding continuation or who were unable to consent were excluded.
Intervention
The intervention Mam-Kind was informed by a survey of infant feeding co-ordinators, rapid literature review, focus groups with service users and peer supporters and interviews with health-care professionals and a Stakeholder Advisory Group. It consisted of face-to-face contact at 48 hours after birth and proactive one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2–6 weeks.
Main outcome measures
Recruitment and retention of Mam-Kind buddies, uptake of Mam-Kind by participants, feasibility of delivering Mam-Kind as specified and of data collection methods, and acceptability of Mam-Kind to mothers, buddies and health-care professionals.
Results
Nine buddies were recruited to deliver Mam-Kind to 70 participants (61% of eligible women who expressed an interest in taking part in the study). Participants were aged between 19 and 41 years and 94% of participants were white. Intervention uptake was 75% and did not vary according to age or parity. Most contacts (79%) were initiated by the buddy, demonstrating the intended proactive nature of the intervention and 73% ( n = 51) of participants received a contact within 48 hours. Follow-up data were available for 78% of participants at 10 days and 64% at 8 weeks. Data collection methods were judged feasible and acceptable. Data completeness was > 80% for almost all variables. Interviews with participants, buddies and health service professionals showed that the intervention was acceptable. Buddies delivered the intervention content with fidelity (93% of intervention objectives were met), and, in some cases, developed certain MI skills to a competency level. However, they reported difficulties in changing from an information-giving role to a collaborative approach. These findings were used to refine the training and intervention specification to emphasise the focus of the intervention on providing mother-centric support. Health-care professionals were satisfied that the intervention could be integrated with existing services.
Conclusions
The Mam-Kind intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a multicentre randomised controlled trial. The feasibility study highlighted the need to strengthen strategies for birth notification and retention of participants, and provided some insights on how this could be achieved in a full trial.
Limitations
The response rate to the survey of infant feeding co-ordinators was low (19.5%). In addition, the women who were recruited may not be representative of the study sites.
Funding
The National Institute for Health Research Health Technology Assessment programme.
... Two recent studies of Loving Support© PC programs dealt with this bias by making between-site comparisons. Gross et al. (2009) andYun et al. (2010) studied women served by an agency with a PC program compared to those served by an agency without a program. They included in their samples all women at a given site, regardless of PC program participation. ...
... Receipt of peer services was strongly associated with higher odds of initiation, confirming the findings of the prior two analyses of PC programs using the Loving Support model of care, Gross et al. (2009) and Yun et al. (2010). A systematic review of the effectiveness of lactation consultants and lactation counselors (Patel and Patel 2016) found that interventions using consultants and counselors were associated with increased odds of breastfeeding initiation (OR 1.35; 95% CI 1.10-1.67). ...
... The RCT of telephone counseling delivered to WIC clients by Reeder, Joyce, Sibley, Arnold and Altindag (2014) found higher continuation at 3 months for all clients and higher continuation at 6 months for Spanish-speaking clients only. Gross et al. (2009) studied 115 subjects and randomized by site. They found a significant increase in any breastfeeding at 8 and 16 weeks. ...
Background Peer counseling (PC) has been associated with increased breastfeeding initiation and duration, but few analyses have examined the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) model for peer counseling or the continuation of breastfeeding from birth through 12 months postpartum. Objectives Identify associations between Minnesota WIC Peer Breastfeeding Support Program services and breastfeeding initiation and continuation. Methods Retrospective analysis of observational data from the Minnesota WIC program’s administrative database of women who gave birth in 2012 and accepted a PC program referral prenatally (n = 2219). Multivariate logistic regression and Cox regression models examined associations between peer services and breastfeeding initiation and continuation of any breastfeeding. Results Among women who accepted referral into a PC program, odds of initiation were significantly higher among those who received peer services (Odds Ratio (OR): 1.66; 95% CI 1.19–2.32), after adjusting for confounders. Women who received peer services had a significantly lower hazard of breastfeeding discontinuation from birth through 12 months postpartum than women who did not receive services. (Hazard Ratio (HR) month one: 0.45; 95% CI 0.33–0.61; months two through twelve: 0.33; 95% CI 0.18–0.60). The effect of peer counseling did not differ significantly by race and ethnicity, taking into account mother’s country of origin. Conclusion for practice Receipt of peer services was positively associated with breastfeeding initiation and continued breastfeeding from birth through 12 months postpartum. Making peer services available to more women, especially in communities with low initiation and duration, could improve maternal and child health in Minnesota.
... 3 Numerous observational studies have reported increases in breastfeeding initiation and duration associated with peer counseling programs for WIC clients. [4][5][6][7][8][9][10][11][12] The common approach in these studies has been to compare the outcomes of WIC clients in LWAs with and without a peer counseling program. 4, 5,6,8,12 A systematic literature review of peer counseling initiatives has characterized many of these observational studies as being of moderate to poor quality. ...
... [4][5][6][7][8][9][10][11][12] The common approach in these studies has been to compare the outcomes of WIC clients in LWAs with and without a peer counseling program. 4, 5,6,8,12 A systematic literature review of peer counseling initiatives has characterized many of these observational studies as being of moderate to poor quality. 13 Reviews limited to randomized controlled trials (RCTs) of peer counseling have found that lay support increases exclusive and nonexclusive breastfeeding duration. ...
... Duration of exclusive andnonexclusive breastfeeding was derived from the first time that the mother reported to WIC that she had stopped breastfeeding or introduced formula and the timing of each. Breastfeeding duration and exclusivity were recorded in weekly intervals for the first month and then at intervals of 5,9,13,18,22,26,31,35, 39, 43, 47, 52, and .52 weeks. ...
Objective:
The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity.
Methods:
We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts.
Results:
We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10-1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10-1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68-0.89).
Conclusions:
A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.
... This article outlines WIC policy vs. WIC practice surrounding infant feeding. Specific attention is made to the lack of peer counseling support offered to WIC participants, despite their consistent performance of improved breastfeeding initiation and duration (Gross, 2009;Kistin, Abramson, & Dublin, 1994;Yun et al., 2009). Lastly, recommendations, presented on behalf of the American Academy of Nursing (AAN) Expert Panel on Breastfeeding include budget re-evaluation that improves funding to peer counseling programs. ...
... WIC participants who receive peer counseling support experience higher breastfeeding rates. Gross (2009) conducted a cross-sectional study that examined Maryland WIC participant breastfeeding initiation rates in three groups: peer counselor, lactation consultant, and standard care. Breastfeeding initiation was significantly higher among those who received peer counseling, but not in the lactation consultant or standard care group. ...
... In peer counseling agencies, participation length was positively associated with the likelihood of initiation. Gross et al. (2009) andYun et al. (2009) both revealed a positive impact of peer counseling programs on breastfeeding initiation among WIC participants. Despite this benefit, a survey conducted by Evans, Labbok, and Abrahams (2011) distributed to WIC directors in North Carolina uncovered a racial/ethnic disparity in breastfeeding rates and support services available. ...
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides foods, education, and referrals to participants who are considered to be at nutritional risk. The outreach of the program is impressive, and nearly 9.17 million people participated in the program in 2010. WIC participation is associated with many positive outcomes, including improved birthweights and childhood dietary practices. Despite these benefits, WIC mothers experience lower breastfeeding rates when compared with demographically similar women who do not participate in the WIC program. According to WIC, “A breastfeeding mother and her infant shall be placed in the highest priority level.” Despite this statement and others that support breastfeeding, WIC allocates only 0.6% of its budget toward breastfeeding initiatives. Formula expenses accounted for 11.6% ($850 million) of WIC's 2009 expenses. The inconsistency between WIC's policies that encourage breastfeeding vs. practices that favor formula begs further examination. Research shows consistent success with peer counseling programs among WIC participants; however, little money is budgeted for these programs. Rebates included, WIC spends 25 times more on formula than on breastfeeding initiatives. The American Academy of Nursing Expert Panel on Breastfeeding is calling for a re-evaluation of how these taxpayer dollars are spent. Additionally, the American Academy of Nursing recommends a shift from formula bargaining to an investment in structured peer counseling programs. All WIC programs should offer peer counseling support services that encourage breastfeeding and meet the needs of the families they serve.
... Fifteen intervention cases were identified from 16 index experimental study papers, using the search strategy and eligibility criteria as described in Figure 1. Nine interventions were delivered in the USA, all associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (Chapman, Damio, Young, & Perez-Escamilla, 2004;Anderson et al., 2005;Di Meglio et al., 2010;Gross et al., 2009;Yun et al., 2010;Olson et al., 2010;Chapman et al., 2013;Reeder et al., 2014;Srinivas et al., 2015). Six study papers (Graffy, Taylor, Williams, & Eldridge, 2004;McArthur et al., 2009;McInnes, Love, & Stone, 2000;Muirhead, Butcher, Rankin, & Munley, 2006;Scott, Pritchard, & Szatkowski, 2017) related to five UK-based interventions, and one study paper related to an intervention delivered in Canada (Dennis, Hodnett, Gallop, & Chalmer, 2002). ...
... paper(Gross et al., 2009); sibling qualitative study(Gross et al., 2015); training package (United States Department of Agriculture (USDA), n.d.et al. (2010); training package (loving support and peer counselling training, paper (Di Meglio et al., 2010); training package (La Leche league International, n.d.paper(Olson et al., 2010); sibling study-health outcomes evaluation(Haider, Chang, Bolton, Gold, & Olson, 2014); sibling study-analysis of participant characteristics(Bolton, Chow, Benton, & Olson, 2009); training package (loving support and peer counselling traininget al.(2013); training package (La Leche league International, n.d., ...
The World Health Organisation guidance recommends breastfeeding peer support (BFPS) as part of a strategy to improve breastfeeding rates. In the UK, BFPS is supported by National Institute for Health and Care Excellence guidance and a variety of models are in use. The experimental evidence for BFPS in developed countries is mixed and traditional methods of systematic review are ill-equipped to explore heterogeneity, complexity, and context influences on effectiveness. This review aimed to enhance learning from the experimental evidence base for one-to-one BFPS intervention. Principles of realist review were applied to intervention case studies associated with published experimental studies. The review aimed (a) to explore heterogeneity in theoretical underpinnings and intervention design for one-to-one BFPS intervention; (b) inform design decisions by identifying transferable lessons developed from cross-case comparison of context-mechanism-outcome relationships; and (c) inform evaluation design by identifying context-mechanism-outcome relationships associated with experimental conditions. Findings highlighted poor attention to intervention theory and considerable heterogeneity in BFPS intervention design. Transferable mid-range theories to inform design emerged, which could be grouped into seven categories: (a) congruence with local infant feeding norms, (b) integration with the existing system of health care, (c) overcoming practical and emotional barriers to access, (d) ensuring friendly, competent, and proactive peers, (e) facilitating authentic peer-mother interactions, (f) motivating peers to ensure positive within-intervention amplification, and (g) ensuring positive legacy and maintenance of gains. There is a need to integrate realist principles into evaluation design to improve our understanding of what forms of BFPS work, for whom and under what circumstances.
... Of 41 RCTs and quasi-experimental studies, 22 were at high risk for the blinding of participants and personnel criteria, and 20 were classified as high risk due to the lack of outcome assessment blinding. Of six observational studies, two were assessed as high risk in terms of measurement of exposure [34,35], two were assessed as high risk for blinding of outcome assessments [34,36], three were assessed as high risk for incomplete outcome data [36][37][38], and two were assessed as high risk for selective outcome reporting [37,38]. ...
... Of 41 RCTs and quasi-experimental studies, 22 were at high risk for the blinding of participants and personnel criteria, and 20 were classified as high risk due to the lack of outcome assessment blinding. Of six observational studies, two were assessed as high risk in terms of measurement of exposure [34,35], two were assessed as high risk for blinding of outcome assessments [34,36], three were assessed as high risk for incomplete outcome data [36][37][38], and two were assessed as high risk for selective outcome reporting [37,38]. ...
Breastfeeding is associated with reduced mortality in children aged less than 5 years. We conducted a systematic review and meta-analysis (registered as PROSPERO 2015: CRD42015019105) to examine the effectiveness of community-based peer support for mothers on their breastfeeding practices as compared to mothers who have not received such a support.
Methods
We searched for evidence regarding community-based peer support for mothers in databases, such as PubMed/MEDLINE, the Cochrane Library, CINAHL, Web of Science, SocINDEX, and PsycINFO. We selected three outcome variables for breastfeeding practices, namely, exclusive breastfeeding duration, breastfeeding within the first hour of life, and prelacteal feeding. We conducted meta-analyses of the included randomized controlled trials and quasi-experimental studies.
Results
For our review, we selected 47 articles for synthesis out of 1,855 retrieved articles. In low- and middle-income countries, compared to usual care, community-based peer support increased exclusive breastfeeding at 3 months (RR: 1.90, 95% CI: 1.62–2.22), at 5 months (RR: 9.55, 95% CI: 6.65–13.70) and at 6 months (RR: 3.53, 95% CI: 2.49–5.00). In high-income countries, compared to usual care, peer support increased exclusive breastfeeding at 3 months (RR: 2.61, 95% CI: 1.15–5.95). In low- and middle-income countries, compared to usual care, peer support increased the initiation of breastfeeding within the first hour of life (RR: 1.51, 95% CI: 1.04–2.21) and decreased the risk of prelacteal feeding (RR: 0.38, 95% CI: 0.33–0.45).
Conclusions
Community-based peer support for mothers is effective in increasing the duration of exclusive breastfeeding, particularly for infants aged 3–6 months in low- and middle-income countries. Such support also encourages mothers to initiate breastfeeding early and prevents newborn prelacteal feeding.
... Participants enrolled in WIC during the Meehan, 2008 Mothers receiving pump as soon as requested did not request formula supplementation until 8.8 months on average and 5.5 times more likely to not request formula at 6 months Sayegh, 2007 Postcampaign, providers reported more breastfeeding-specific questions being asked; intention to breastfeed Married mothers 3.47 times more likely to initiate breastfeeding and 4.08 times more likely to continue through 3 months. Not receiving food stamps; not diagnosed with postpartum depression or not depressed (not statistically significant) Dodgson, 2007 a Multiparous; older age (not significant) Gross, 2009 a Hispanic participants had highest breastfeeding rates in all categories; larger infants in comparison with low-birth-weight infants Haughton, 2010 a Additional year of maternal age, less time spent in United States associated with breastfeeding at 6 months; planned pregnancies 2 times as likely to breastfeed for at least 6 months Hildebrand, 2014 a White women more likely to breastfeed compared with American Indians/Alaska Natives; women with one child in comparison with women with two or more children; age 28 or older Hurley, 2008 Hispanic mothers more likely (91%) than African American (65%) or white (61%) to initiate; maternal age; decreased infant age; more than high school education Jacobson, 2015 a Urban women: Hispanic; 18-19 years old; more than a high school education; earning more than $10,000 per year; prenatal care early in pregnancy; nonsmoking; use of multivitamins. Not variable within rural population (age, income, prenatal care, WIC enrollment timing not statistically significant predictors) Langellier, 2012 a Non-Hispanic white mothers had 2.9 times the odds of Hispanic mothers to breastfeed exclusively at 6 months; foreign-born mothers more likely to breastfeed at 6 and 12 months; Spanish-speaking mothers more likely to breastfeed at 6, 12, and 24 months; mothers living with child's parent 21% increased odds of breastfeeding at 6 months and 31% increased odds at 12 months; mothers returning to work after 7 months postpartum more likely to breastfeed at 6, 12, and 24 months Langellier, 2014 a Latinas in comparison with blacks more likely to initiate breastfeeding but less likely to exclusively breastfeed at 6 months; white mothers more likely than Latinas to exclusively breastfeed at 3 and 6 months; children's age, mother's education, foreign nativity, and Spanish speaking Ma, 2012 a White: increased breastfeeding initiation by maternal age and education, more likely to initiate breastfeeding when compared with black mothers. ...
... One mother in sample reported positive, consistent support and information from health care provider and was only mother who breastfed exclusively for at least 10 months Gross, 2009 a Odds of breastfeeding initiation 21% greater for PC-exposed infants Haughton, 2010 a Women who consulted with lactation consultants or WIC staff with breastfeeding issues Hildebrand, environment on breastfeeding rates. Results could guide specific policy guidelines about facility layouts for health promotion. ...
Background: Breastfeeding is an important public health initiative. Low-income women benefiting from the U.S. Department of Agriculture’s Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are a prime population for breastfeeding promotion efforts.
Research aim: This study aims to determine factors associated with increased likelihood of breastfeeding for WIC
participants.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the systematic review of literature. Database searches occurred in September and October 2014 and included studies limited to the previous 10 years. The following search terms were used: low-income; WIC; women, infants, and children; breastfeeding; breast milk; and maternal and child health. The criterion for inclusion was a study sample of women and children enrolled in the WIC program, thereby excluding non-United States–based research.
Results: Factors that increased the likelihood of breastfeeding for WIC participants included sociodemographic and health characteristics (n = 17); environmental and media support (n = 4); government policy (n = 2); intention to breastfeed, breastfeeding in hospital, or previous breastfeeding experience (n = 9); attitudes toward and knowledge of breastfeeding benefits (n = 6); health care provider or social support; and time exposure to WIC services (n = 5).
Conclusion: The complexity of breastfeeding behaviors within this population is clear. Results provide multisectored insight for future research, policies, and practices in support of increasing breastfeeding rates among WIC participants.
... 37 Studies have shown that WIC participants who use peer counseling programs have experienced higher breastfeeding rates. 38 Furthermore, a common reason for the low use of peer-counseling programs among WIC programs is lack of financial support. 38 Ongoing research is needed about the influence of WIC's formula rebate system on breastfeeding initiation and duration. ...
... 38 Furthermore, a common reason for the low use of peer-counseling programs among WIC programs is lack of financial support. 38 Ongoing research is needed about the influence of WIC's formula rebate system on breastfeeding initiation and duration. ...
For the first time since 1980, the US Department of Agriculture Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policies were revised in 2009 to meet the Institute of Medicine's nutrition recommendations. These changes included increases in fruits, vegetables, whole grains, and low-fat dairy to improve nutrition and health of WIC participants. Our systematic review of the literature assessed the influence that the 2009 WIC food package revisions have had on dietary intake, healthy food and beverage availability, and breastfeeding participation. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Four electronic databases were searched between April 1 and 30, 2014, for peer-reviewed research. Two reviewers screened the articles, extracted the data, and established inter-rater reliability by discussing and resolving discrepancies. Twenty articles were included that met our inclusion criteria. Nine of the studies analyzed changes in dietary intake, eight examined changes in healthy food and beverage availability, and three evaluated breastfeeding participation exclusively. The review demonstrated an improved dietary intake and an increase in the availability of healthier foods and beverages in authorized WIC stores. The revised food package was also associated with improved dietary intake of WIC participants. Mixed results were demonstrated in regard to improved breastfeeding outcomes. Further research is needed to assess the influence of WIC 2009 food package revisions on breastfeeding outcomes and to make conclusions about broad nutrition-related implications.
Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
... 16 Several studies have noted positive findings specifically with WIC peer counseling and African American women. [17][18][19][20][21] In the Maryland WIC program, African American women receiving PC support were more likely to initiate breastfeeding compared with those receiving standard care or lactation counselor support. 19 A focus group study in a primarily African American sample of WIC participants found women had positive experiences with their WIC PCs and received positive social support. ...
... [17][18][19][20][21] In the Maryland WIC program, African American women receiving PC support were more likely to initiate breastfeeding compared with those receiving standard care or lactation counselor support. 19 A focus group study in a primarily African American sample of WIC participants found women had positive experiences with their WIC PCs and received positive social support. 20 In metropolitan New York, an ethnographic study of WIC clinics found African American women viewed WIC as a supportive environment, a "trusted source of assistance," where WIC providers were sensitive and attentive to women's individual needs. ...
African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors' perceptions of breastfeeding in African American women.
As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs).
Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner's socioecological model was used to group categories into themes.
Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs' low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a "sense of security," (2) cultural pressures to be a "strong black woman" can impede breastfeeding support, and (3) breastfeeding "generational gaps" have resulted from American "slavery" and when formula was "a sign of wealth."
As PCs described, low-income African American women's breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.
© The Author(s) 2014.
... Most studies evaluating peer counselors (PCs) have been intensive, with frequent telephone and clinic contact, often involving home visits. [6][7][8][9] Retrospective reports across the country of WIC-operated PC programs reveal inconsistent results [10][11][12] as well as difficulty maintaining programs due to variability in WIC funding. 13 We proposed to evaluate the effectiveness of a model of PC contact in our outpatient clinic serving a low-income urban population that we felt would be sustainable within our constraints. ...
... This result is contradictory to other studies on the effect of peer counseling on some or all breastfeeding rates. Retrospective program reviews of peer counseling in a wide variety of WIC settings, including statewide assessments with a mix of rural and urban populations [10][11][12] and Native Americans, 20 have demonstrated some combination of increased initiation, exclusive breastfeeding, and longer duration. Randomized controlled trials have similarly demonstrated some effect on breastfeeding rates. ...
Background:
Whereas breastfeeding initiation rates have risen in all groups throughout the country, rates of breastfeeding duration have changed more slowly. Peer counseling has had some success in sustaining breastfeeding, but with intensive programs and variable effects.
Objectives:
We aimed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally. We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention.
Methods:
One hundred twenty prenatal women underwent stratified randomization based on breastfeeding attitude, measured by the Iowa Infant Feeding Attitude Scale (IIFAS). The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery. Study groups were compared on breastfeeding outcomes, adjusting for IIFAS strata, and on interactions with self-efficacy.
Results:
One hundred three women were followed to at least 1 month. Women with positive attitudes had significantly higher rates of initiation (93% vs 61%) and breastfeeding at 1 and 6 months (79% vs 25% and 12% vs 0%, respectively) than those with negative attitudes, regardless of intervention. After adjusting for self-efficacy, women who received peer counseling had significantly higher breastfeeding rates at 1 month (odds ratio = 3.2; 95% confidence interval, 1.02-9.8). The intervention group was marginally more likely to achieve their breastfeeding goal (43% vs 22%, P = .073).
Conclusion:
Breastfeeding rates in all women improved during the study period. Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support. Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals.
... The concept of peer within these community-based groups has been almost entirely based on race, income, and community of residence. [15][16][17] Mothers of hospitalized infants often do not share these common ties, but rather the experience of having an ill infant bonds them together. This shared experience of having a hospitalized infant is what creates a peer relationship between these mothers. ...
... Supporting mothers in the production of human milk and reinforcing their ability to breastfeed will not only encourage them to provide human milk during the infant's hospital stay, 15 , 20 but also facilitate efforts at home. 17 In a unique atmosphere, the hope is to mirror the success of La Leche League International and other mother support groups. The intent is to act as a vessel to encourage peer relationships between the mothers, and as educators to empower mothers in what feels like a powerless situation at times. ...
The need to support and promote breastfeeding is unquestionable. The World Breastfeeding Week 2013 theme, "Breastfeeding Support: Close to Mothers," focuses on "breastfeeding peer counseling." Mother support groups are traditionally community-based and little is published about peer-to-peer support for mothers who have critically ill newborns. This study describes the development of a support group established in a children's hospital. The Group of Empowered Mothers focuses on a unique population of mothers (those with critically ill hospitalized infants) and involves 3 basic tenets: healthcare provider support; mother-to-mother support; and Certified Breastfeeding Consultant Support.
... Whether that help relates to depression in seniors, diabetes management , surviving with HIV/AIDS, improving nutrition, recovering from alcohol abuse, coping with breast cancer , or any other health concern, is determined by the program that implements it12131415161718 . Over the years, studies have shown time and again that CBC is an exceptionally effective means of implementing positive behavioral and lifestyle changes101112131415161718. CBCs have been used to promote breastfeeding by agencies such as the Expanded Food and Nutrition Education Program (EFNEP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and the Breastfeeding Heritage and Pride Program with great success [19,20] . These communitybased breastfeeding counselors have been used extensively and effectively to promote breastfeeding in selected communities, especially low-income minority communities who otherwise do not breastfeed. ...
... What makes a peer so successful at giving support are her previous experiences that she can share and relate to her client, which in turn helps the client to open up about themselves and build rapport. CBBCs have repeatedly produced positive outcomes regarding breastfeeding, particularly with regards to increasing the rate of breastfeeding initiation and exclusivity, as well as extending breastfeeding duration [19,21,23,24]. In many cases, a CBBC is recruited from the target population/ community, which allows them to identify and reach people who may otherwise be isolated, underserved, or potentially unaware of the services and information available to them [15]. ...
Studies using community-based breastfeeding counselors (CBBCs) have repeatedly shown positive impact on breastfeeding initiation, exclusivity and duration, particularly among low-income mothers. To date, there has not been a comprehensive study to determine the impact of CBBC attributes such as educational background and training, on the type of care that CBBCs provide.
This was a cross-sectional study of a convenience sample of CBBCs to ascertain the influence of counselor education and type of training on type of support and proficiency of CBBCs in communities across the United States. Invitations to participate in this online survey of CBBCs were e-mailed to program coordinators of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), La Leche League, and other community-based health organizations, who in turn invited and encouraged their CBBCs to participate. Descriptive analysis was used to describe participants (N = 847), while bivariate analysis using χ2 test was used to examine the differences between CBBC education, training received and breastfeeding support skills used. Multivariate logistic regression was used to assess the independent determinants of specific breastfeeding support skills.
The major findings from the research indicate that overall, educational attainment of CBBCs is not a significant predictor for the curriculum used in their training and type of support skills used during counseling sessions, but initial training duration was positively associated with the use of many breastfeeding support skills. Another major influence of counselor support to clients is the type of continuing education they receive after their initial training, with higher likelihood of use of desirable support skills associated with counselors continuing their breastfeeding education at conferences or trainings away from their job sites.
Our results show that different programs use different training curricula to train their CBBCs varying in duration and content. Counselor education is not a significant predictor of the type of training they receive. Continuing breastfeeding education is a significant determinant of type of counseling techniques used with clients. Further research is therefore needed to critically examine the content of the various training curricula of CBBC programs. This may show a need for a standardized training curriculum for all CBBC programs worldwide to make CBBCs more proficient and efficient, ensuring successful and optimum breastfeeding experiences for mothers and their newborns.
... Policy approaches were less represented than systems or environmental approaches, which may be due to difficulties changing policies at the state or national level as well within community programs themselves.breastfeeding support.100 In general, there were positive outcomes from changes to WIC, which is promising for future policy updates. ...
Community‐based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community‐based diet and obesity‐related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60–69%) occurred in the prenatal period and early infancy (0–3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.
... A Breastfeeding Peer Counselor is a lay health worker with similar cultural, demographic, and socioeconomic background to the population they serve, who has had personal success breastfeeding, and has completed a breastfeeding training program [10]. BPC programs have been implemented all over the United States in a variety of practice patterns including the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programs with most reporting improvement in breastfeeding initiation, exclusivity, and continuation [11][12][13][14]. ...
Background
Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity.
Methods
This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate.
Results
Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13–5.43; 2014 aOR 1.82, 95%CI 1.24–2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01).
Conclusion
Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations.
... Our finding also aligns with other studies showing an increase of 10-15% in rates of any breastfeeding among those receiving peer counseling in urban settings compared to control groups. [18,21,32]. ...
Background
One approach for improving breastfeeding support and alleviating breastfeeding disparities is the implementation of a clinic-based peer counselor. Our objective was to assess the “real life” effects of an autonomous peer counselor who provides tailored support to low-income, minority women based on individual needs rather than a pre-determined research protocol.
Methods
This is a secondary analysis of a prospective cohort study of women receiving publicly funded prenatal care during the 6 months before and after introduction of a peer counselor in a single prenatal clinic. The peer counselor provided one-on-one antenatal and postpartum lactation support. Electronic medical record and survey data were collected. The primary outcome was breastfeeding continuation at 6 weeks postpartum. Secondary outcomes included breastfeeding comfort, confidence, and training satisfaction, any breastfeeding, and total breastfeeding duration. Bivariable and multivariable analyses were performed.
Results
Peer counselor exposure was not associated with the primary outcome of continued breastfeeding at 6 weeks (55.6% with peer counselor versus 49.1% without; aOR 1.26, 95% CI 0.69–2.31). However, women with peer counselor exposure were more likely to be satisfied with breastfeeding training at the time of delivery (98.2% vs. 83.6%, p = 0.006) and were more likely to have performed any breastfeeding (89.8% vs. 78.9%, p = 0.04), which remained significant on multivariable analysis (aOR 2.85, 95% CI 1.11–7.32).
Conclusions
Peer counselor interventions are a promising approach to increase breastfeeding initiation. Further research is required to inform the most efficacious approach while also allowing peer counselors to operate independently and in line with the specific needs of their clients.
... A realist review [18] identified ten Randomised Controlled Trials [15,[19][20][21][22][23][24][25][26][27] and five quasi-experimental studies [28][29][30][31][32] of one-to-one breastfeeding peer-support interventions for breastfeeding continuation. Only two of the studies identified theoretical models underpinning their interventions, citing social support theory [27] and social cognitive theory [32]. ...
Background:
Many women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the potential health benefits for mother and baby, new ways of supporting women to breastfeed for longer are required. The purpose of this study was to develop and characterise a novel Motivational Interviewing (MI) informed breastfeeding peer-support intervention.
Methods:
Qualitative interviews with health professionals and service providers (n = 14), and focus groups with mothers (n = 14), fathers (n = 3), and breastfeeding peer-supporters (n = 15) were carried out to understand experiences of breastfeeding peer-support and identify intervention options. Data were audio-recorded, transcribed, and analysed thematically. Consultation took place with a combined professional and lay Stakeholder Group (n = 23). The Behaviour Change Wheel (BCW) guided intervention development process used the findings of the qualitative research and stakeholder consultation, alongside evidence from existing literature, to identify: the target behaviour to be changed; sources of this behaviour based on the Capability, Opportunity and Motivation (COM-B) model; intervention functions that could alter this behaviour; and; mode of delivery for the intervention. Behaviour change techniques included in the intervention were categorised using the Behaviour Change Technique Taxonomy Version 1 (BCTTv1).
Results:
Building knowledge, skills, confidence, and providing social support were perceived to be key functions of breastfeeding peer-support interventions that aim to decrease early discontinuation of breastfeeding. These features of breastfeeding peer-support mapped onto the BCW education, training, modelling and environmental restructuring intervention functions. Behaviour change techniques (BCTTv1) included social support, problem solving, and goal setting. The intervention included important inter-personal relational features (e.g. trust, honesty, kindness), and the BCTTv1 needed adaptation to incorporate this.
Conclusions:
The MI-informed breastfeeding peer-support intervention developed using this systematic and user-informed approach has a clear theoretical basis and well-described behaviour change techniques. The process described could be useful in developing other complex interventions that incorporate peer-support and/or MI.
... A notable example is the Child Nutrition and WIC Reauthorization Act of 2004, 27 which provided funds to establish and support BF peer counseling activities to reflect research that demonstrates the significance of these programs in improving BF initiation and duration rates. [36][37][38] A majority of WIC state agencies support and integrate peer counseling programs as a core component of WIC services. 38 The WIC BF peer counselors provide a valuable service to their communities, addressing barriers to BF by offering BF education, support, and role modeling. ...
... Also needed is coordination between WIC offices and local hospitals to promote breastfeeding because these services have been shown to positively influence infant feeding practices. [22][23][24] Several studies have also found a positive correlation between breastfeeding and WIC peer-counseling programs [25][26][27] ; 69% of local WIC agencies offer peer-counseling programs. 22 By increasing access and availability to these services, WIC may be able to substantially improve feeding practices among participants. ...
CONTEXT: Existing literature suggests participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the prenatal and postnatal periods is associated with lower rates of breastfeeding among WIC-eligible mothers. However, minimal research has been published on the association between WIC enrollment and exclusive breastfeeding.
OBJECTIVE: To examine the association between WIC exposure and exclusive breastfeeding at 3 months postpartum.
METHODS: We conducted a secondary data analysis using information on 784 low-income women who participated in the longitudinal population-based Infant Feeding Practices Study II between May 2005 and June 2007. The main outcome of interest was exclusive breastfeeding at 3 months postpartum. Logistic regression analysis was used to estimate OR and 95% CI for exclusive breastfeeding relative to WIC enrollment status, controlling for the confounding effects of other maternal characteristics. We further conducted a subgroup analysis among those participating in WIC prenatally to examine the association between receipt of information about infant feeding from WIC and exclusive breastfeeding at 3 months postpartum.
RESULTS: The crude prevalence of exclusive breastfeeding at 3 months postpartum was 18.1% of women enrolled in WIC and 41.1% of WIC-eligible nonparticipants (P<.0001). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding at 3 months were lower for women enrolled in WIC (OR, 0.57; 95% CI, 0.37-0.88) when compared with women not enrolled in WIC. In the subgroup analysis, receipt of information from WIC about feeding infants during the prenatal period was not significantly associated with exclusive breastfeeding at 3 months (OR, 0.86; 95% CI, 0.39-1.89).
CONCLUSION: Women who were enrolled in WIC and who received information about feeding infants were less likely to exclusively breastfeed than women not in WIC. Continued improvement and adjustment to the existing WIC breastfeeding program could potentially improve these rates. Additional studies that examine the quality of WIC services provided, especially those pertaining to breastfeeding programs, are warranted.
... As breastfeeding rates among WIC participants are consistently lower than non-WIC participants, the present PC program may not have been intensive enough to overcome this observed trend to positively impact duration of human milk provision. 23 Further, prior research highlighted associations between lower socioeconomic status and maternal occupation, and reduced rates of breastfeeding. 24,25 Although our multivariate model controlled for level of education, maternal occupation was unknown and insurance status was used as a proxy for income and did not provide sufficient granularity to fully adjust for socioeconomic status. ...
Objective:
Evaluate the impact of a non-neonatal intensive care unit (NICU)-specific peer counseling (PC) program on the cessation of human milk receipt at and post-NICU discharge.
Study design:
A multivariable logistic regression model used data from 400 mother-infant dyads from a level IV NICU to compare cessation of human milk receipt at NICU discharge by PC program status. Kaplan-Meier distributions and a multivariable Cox proportional hazards model assessed the relationship between participants/non-participants and cessation of human milk post-NICU discharge.
Results:
No statistically significant differences between groups in cessation of human milk either by or post-discharge were observed. Identified variables associated with the outcome(s) of interest included maternal and infant age, length of stay, presence of a breastfeeding duration goal and frequency of NICU lactation consultant contact.
Conclusion:
Exposure to a non NICU-specific PC program was not associated with human milk receipt either by or post-NICU discharge.Journal of Perinatology advance online publication, 26 May 2016; doi:10.1038/jp.2016.75.
... The findings in our study reinforced the results reported in the current literature that use of BPCs had a positive effect on breastfeeding outcomes among low-income women who participate in WIC. Those who received support from BPCs had greater breastfeeding initiation rates than those who did not receive support (Campbell et al., 2013; S. M. Gross et al., 2009; Pugh et al., 2010). Furthermore, BPCs had positive effects on breastfeeding continuation, especially if initial contact was made prenatally (Rozga et al., 2015aRozga et al., , 2015b) Lack of breastfeeding role models and lack of self-confidence in breastfeeding were noted as barriers to breastfeeding initiation and continuation among low-income African American women (Hedberg, 2013; Robinson & VandeVusse, 2011), and researchers found that African American women expressed the need for breastfeeding support from other African American women (Lewallen & Street, 2010). ...
Objective:
To examine the influence of breastfeeding peer counseling on the breastfeeding experiences of African American mothers who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Design:
Qualitative study using focus groups.
Setting:
Two WIC clinics in Southeast Wisconsin were used for recruitment and data collection.
Participants:
A convenience sample of nine African American mothers participated in one of two focus groups.
Methods:
The women responded to a series of open-ended questions about their breastfeeding experiences and the effect of breastfeeding peer counselors (BPCs). Content and thematic analyses were used to analyze patterns related to the influence of BPCs on breastfeeding.
Results:
Four themes were categorized: Educating With Truth, Validating for Confidence, Countering Others' Negativity, and Supporting With Solutions. Mothers in this study expressed positive reactions to educational, emotional, and social support from BPCs. The mothers noted that the contact they had with BPCs had a direct positive influence on their breastfeeding experiences. However, the contact from BPCs varied between the two WIC clinics.
Conclusion:
The findings demonstrate the positive effects of BPCs on breastfeeding experiences among African American WIC participants. Findings from this study can guide future explorations using BPCs. Interventions are needed to develop standardized guidelines to bring about homogeneity of, better access to, and greater use of BPCs.
... A cross-sectional study of WIC mothers in Maryland (N=18,789) found that peer counseling was positively associated with breastfeeding initiation. 44 It has also been found that peer supporters may provide additional benefits to new mothers, such as increased self-esteem, greater confidence, parenting skills, and improved family diet. 45 In addition, the use of community peer support programs is one of the recommendations for improving breastfeeding, as outlined in the White House Task Force Report on Solving the Problem of Childhood Obesity Within a Generation. ...
... If the doctor cannot provide the level of attention a mother needs, referrals must be available. Lay workers such as doulas and breastfeeding PCs have been shown to be effective in helping mothers to initiate and sustain breastfeeding [31,44]. Only one mother in our study had access to a doula, and no mother mentioned that her physician or hospital had offered her the option of doula care. ...
This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child's first year. A convenience sample of 75 black and white WIC participants with infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers' comprehensive experiences of breastfeeding education and support from pregnancy through the interview date. Most mothers received education or support from a medical professional prenatally, at the hospital, or during the child's infancy, but most also reported receiving no education or support at one or more of these stages. Mothers often felt provided education and support was cursory and inadequate. Some mothers received misinformation or encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not given referrals to available resources, even after reporting breastfeeding challenges. Mothers received inconsistent messages regarding breastfeeding within and across institutions. Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals. Medical professionals should follow guidelines issued by their own organizations as well as those from the US Surgeon General, Healthy People 2020, and the Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should coordinate to provide consistent messages and practices within and across sites of care.
... 3) in the current study, length of stay in the hospital was not Previous studies have reported that interventions aimed at increasing breastfeeding initiation do not have similar impact across all groups in the society [37]. Race, age and education status were the strongest risk factors for not breastfeeding in this study sample. ...
Positive deviance inquiry is effective in identifying advantageous health behaviors and improving health outcomes among disadvantaged resource-poor populations. The objective of this study was to apply the positive deviance concept to explore the characteristics of positive deviants for breastfeeding among WIC-enrolled first-time mothers in Louisiana. The cross sectional study included data on 2,036 WIC-enrolled first time mothers (52.6% black) from the LaPRAMs, 2000-2004. Chi-square test was used to compare groups. Multivariable logistic regression was applied to calculate adjusted OR and 95% CI by breastfeeding initiation status. The average age was 21.3 years, 31.5% had less than 12 years of education, and 44.6% of the sample reported having initiated breastfeeding. Black mothers were less likely to initiate breastfeeding than their white counterparts (OR 0.39 (95% CI: 0.31, 0.48)). Among 641 WIC-enrolled first time mothers with less than 12 years of education, 28.4% were identified as positive deviants for breastfeeding initiation. Among the black mothers 19.8% were positive deviants compared to 40.3% of the white mothers. Breastfeeding in the hospital after delivery (P < 0.0001) and having received help on how to breastfeed in the hospital (P < 0.0001) were significantly associated with breastfeeding initiation in white and black mothers. In addition, the black positive deviants were more likely, OR 2.80 (95% CI: 1.20, 6.56) to have initiated breastfeeding if their baby was low birth weight. Breastfeeding practices shortly after delivery including assistance and education from staff in the hospital, are related to breastfeeding initiation among less educated WIC-enrolled mothers.
... Studies of WIC groups suggest that participants are aware of the health benefits of breast-feeding for their infants, and that structural barriers such as return to work are less of a problem than attitudinal barriers, including embarrassment about public feeding, the perception of breast-feeding as limiting or inconvenient, and fears of inadequate supply (38) . Such attitudes are amenable to intervention and education, and WIC Programmes designed to educate participants and provide peer-counselling support services have shown that they can positively impact breast-feeding in this population (39)(40)(41) . ...
Pregnancy-related weight retention can contribute to obesity, and breast-feeding may facilitate postpartum weight loss. We investigated the effect of breast-feeding on postpartum weight retention.
A retrospective follow-up study of weight retention, compared in women who were fully breast-feeding, combining breast-feeding with formula-feeding (mixed feeding), or formula-feeding at 3 months (n 14 330) or 6 months (n 4922) postpartum, controlling for demographic and weight-related covariates using multiple linear regression.
The North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Participants in the North Carolina WIC Programme who delivered a baby between 1996 and 2004.
In covariate-adjusted analyses, there was no association between breast-feeding and weight retention at 3 months postpartum. At 6 months postpartum, as compared to formula-feeders, mean weight retention was 0·84 kg lower in mixed feeders (95 % CI 0·39, 1·29; P = 0·0002) and 1·38 kg lower in full breast-feeders (95 % CI 0·89, 1·87; P ≤ 0·0001).
Breast-feeding was inversely associated with weight retention at 6 months postpartum in this large, racially diverse sample of low-income women. Further, full breast-feeding had a larger protective effect than did breast-feeding combined with formula-feeding.
... Participation in WIC has been shown to increase birth weight, reduce the incidence of low birth weight, prevent preterm delivery, increase breastfeeding rates, and reduce Medicaid costs among high-risk pregnant women (5,27,(33)(34)(35)(36)(37). A study of WIC in five states showed a savings of $3.13 in Medicaid costs for infants during the first 2 months of life for every $1 spent on WIC prenatal services (5,33). ...
t is the position of the American Dietetic Association that children and adolescents should have access to an adequate supply of healthful and safe foods that promote optimal physical, cognitive, and social growth and development. Nutrition assistance programs, such as food assistance and meal service programs and nutrition education initiatives, play a vital role in meeting this critical need. Nutrition assistance programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply. Federally funded nutrition assistance programs help ensure that children and adolescents receive meals that provide adequate energy and nutrients to meet their growth and development needs; children and adolescents have access to adequate food supplies; and women, infants, and children who have nutritional or medical risk factors, such as iron-deficiency anemia or overweight, receive supplemental nutritious foods as well as nutrition education. In addition, federally funded nutrition assistance programs serve as a means to combat hunger and food insecurity and as a vehicle for nutrition education and promotion of physical activity designed to prevent or reduce obesity and chronic disease. It is important that continued funding be provided for these programs that have been consistently shown to have a positive influence on child and adolescent well-being. Registered dietitians and dietetic technicians, registered, are uniquely qualified to design, implement, and evaluate nutrition assistance programs for children and adolescents. Registered dietitians and dietetic technicians, registered, are the only food and nutrition practitioners with adequate training in food science, nutrition, and food systems to implement research and surveillance programs to monitor, evaluate, and improve the nutritional status of children and adolescents.
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC’s population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
Breast milk provides optimal nourishment for all infants and has special advantages in preterm infants. Breast milk is associated with lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia and improved neurodevelopmental outcomes in the preterm population. Mothers in the NICU may experience multiple psychological, physical, and social/cultural barriers that impede successful breastfeeding. Professional lactation support is of crucial importance in this population. With the social distancing requirements of the pandemic, many clinicians have adopted novel methods of education and communication to ensure continued timely support for NICU mothers.
Background:
In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems.
Objectives:
To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost).
Search methods:
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
Selection criteria:
Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials.
Data collection and analysis:
Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables.
Main results:
We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33.
Authors' conclusions:
This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.
Between July 2005 and July 2007, the Oregon Supplemental Nutrition Program for Women, Infants and Children program conducted the largest randomized field experiment (RFE) ever in the United States to assess the effectiveness of a low-cost peer counseling intervention to promote exclusive breastfeeding. We undertook a within-study comparison of the intervention using unique administrative data between July 2005 and July 2010. We found no difference between experimental and nonexperimental estimates but failed to determine correspondence based on more stringent criteria. We show that tests for nonconsent bias in the benchmark RFE might provide an important signal as to confounding in the nonexperimental estimates.
Objective:
To evaluate the effectiveness of different quantities and types of breastfeeding (BF) peer counselor (BFPC) support on BF outcomes in women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Design:
Secondary data analysis using BFPC data from an upstate New York county WIC (April 1, 2009 to March 30, 2011) merged with New York State Department of Health WIC surveillance data.
Participants:
A total of 2,149 WIC-enrolled mothers with live singleton births who accepted a BFPC referral and received different quantities and types of BFPC support (telephone, in person, and mailings).
Main outcome measures:
Self-reported BF initiation and duration at 30 days.
Analysis:
Multivariable logistic regression was used to estimate the odds of BF outcomes at 30 days associated with different levels of BFPC support.
Results:
Mothers who accepted BFPC referrals and had at least 1 phone conversation or in-person contact had a significant 35% to 164% increased odds of positive BF outcomes. Mailings did not significantly improve outcomes.
Conclusions and implications:
The Special Supplemental Nutrition Program for Women, Infants, and Children may need to identify barriers to BF duration and implement interventions in communities with low BF rates. Future studies may benefit from evaluating the impact of combined in-person support and phone contacts during the prenatal and postpartum periods on BF outcomes.
Background:
Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation.
Objective:
This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns.
Methods:
Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation.
Results:
Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation.
Conclusion:
Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.
An evidence review into the contribution of volunteering to improving young children's outcomes in communication and language, social and emotional development, and diet and nutrition, commissioned by the Big Lottery Fund to support the development of the A Better Start early intervention sites.
Changes in society have caused a dramatic rise in child obesity over the last 30 years. Although rates have recently stabilized, they still remain high and there are wide disparities between different communities. Rates of obesity-related morbidities are high, with attendant high rates of public health consequences in terms of healthcare, productivity and societal costs. Effective prevention efforts are needed across the lifespan, from the prenatal period through ado lescence, and at multiple levels (individual, family, health care, community and society). Successful preventive efforts have the potential to avert a public health crisis.
Background:
Peer counseling (PC) breastfeeding support programs have proven effective in increasing breastfeeding duration in low-income women.
Objectives:
This study aimed to describe program participants and breastfeeding duration in a PC program according to (1) timing of enrollment (prenatal vs postnatal) and (2) breastfeeding status at program exit (discontinued breastfeeding, exited program while breastfeeding, and completed 1 year program) to improve understanding of how these groups differ and how services might be optimized when resources are limited.
Methods:
This study is a secondary analysis of data from low-income women enrolled in a PC breastfeeding support program. Participant characteristics and breastfeeding duration were described using chi-square tests, analyses of variance, and logistic regression.
Results:
Postnatal enrollees had longer breastfeeding duration than prenatal enrollees (F < .001) and were more likely to be older, to be married, to be more educated, and to have prior breastfeeding experience (each variable P < .01). Women who withdrew from the program while breastfeeding were more demographically similar to those who discontinued breastfeeding prior to 1 year than to those who continued in the program breastfeeding for 1 year, although they breastfed for significantly longer at exit (mean ± SD = 27.8 ± 14.8 weeks) compared to women who discontinued breastfeeding while in the program (15.7 ± 13.3 weeks) (P < .001).
Conclusion:
It may be advantageous for peer counselors to direct fewer resources to later postnatal enrollees and more to prenatal or early postnatal enrollees. It may also be advantageous to focus on supporting women at high risk of discontinuation rather than on retaining women who choose to withdraw from the program while breastfeeding.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a proven, cost-effective investment in strengthening families. As part of the United States Department of Agriculture's (USDA) 15 federal nutrition assistance programs for the past 40 years, WIC has grown to be the nation's leading public health nutrition program. WIC serves as an important first access point to health care and social service systems for many limited resource families, serving approximately half the births in the nation as well as locally. By providing nutrition education, breastfeeding promotion and foods in addition to referrals, WIC plays a crucial role in promoting lifetime health for women, infants and children. WIC helps achieve national public health goals such as reducing premature births and infant mortality, increasing breastfeeding, and reducing maternal and childhood overweight. Though individuals and families can self-refer into WIC, physicians and allied health professionals have the opportunity and are encouraged to promote awareness of WIC and refer families in their care.
Peer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.
Secondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered 'optimal' if they adhered to standard programme guidelines.
Programme data collected from 2005 to 2011 in Michigan's Breastfeeding Initiative Peer Counseling Program.
Low-income (n 5886) women enrolled prenatally.
For each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95 % CI 0·88, 0·92); HR=0·89 (95 % CI 0·87, 0·90); and HR=0·93 (95 % CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95 % CI 0·89, 0·95); HR=0·90 (95 % CI 0·88, 0·91); and HR=0·93 (95 % CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95 % CI 0·14, 0·20) and HR=0·28 (95 % CI 0·23, 0·35), respectively).
Specific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.
Prenatal health care counseling is associated with positive health outcomes for mothers and infants. Moreover, pregnant women are considered a vulnerable population at risk of being victims of intimate partner violence. Pregnancy provides a unique opportunity to identify and refer women experiencing intimate partner violence to community resources; however, in prior research, most women reported that their prenatal care providers did not talk to them about intimate partner violence. Given the importance for providers to offer prenatal health care counseling on intimate partner violence, it is concerning that there is scant knowledge on Asian, Native Hawaiian, and other Pacific Islander mothers’ experiences in this area. The study’s objectives were (a) to determine the proportion of mothers who received prenatal health care counseling on intimate partner violence; and, (b) to examine racial differences of those who received prenatal health care counseling on intimate partner violence. Hawai‘i’s Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2004-08 were analyzed for 8,120 mothers with information on receipt of intimate partner violence prenatal health care counseling. Overall, 47.7% of mothers were counseled on intimate partner violence. Compared to Whites, Native Hawaiians, Japanese, Chinese, and Koreans were significantly less likely to report receiving prenatal health care counseling in intimate partner violence, but the opposite association was observed for Samoans. Intimate partner violence continues to be a significant problem for women, thus, this study’s findings may be used as important baseline data to measure the progress made given the implementation of the new Guidelines for Women’s Preventive Services in intimate partner violence screening and counseling.
This study examined the association between length of exposure to Women, Infants, and Children (WIC) services and breastfeeding initiation/duration. All women with singleton live births, first certified into MA WIC prenatally or postpartum (2001-2009), with complete breastfeeding and covariate data (maternal race, age, education, smoking status, BMI, HH income and size, birth weight, whether full or preterm, and sex) were included (n = 122,506). Regressions models were used to examine timing of WIC entry (i.e., trimester of prenatal or postpartum) with: (1) breastfeeding initiation, (2) mean duration (3) and 3, 6 and 12 month durations. Among prenatal entrants, first (vs. third) trimester entry was associated with a higher likelihood of initiation for both primiparous, and multiparous mothers (10 and 32 % respectively; p < .01). Prenatal entrants breastfed 1.7 (primiparous), and 3.4 (multiparous) weeks longer than postpartum entrants (p < .0001). Among multiparous women, first trimester entry was associated a greater likelihood of breastfeeding for three (15 % greater), six (25 % greater) and twelve (33 % greater) months compared to third trimester entrants (p < .0001). Greater exposure to WIC services improves breastfeeding rates among a low income diverse population of women.
Breastfeeding (BF) initiation rates in the United States have increased over the past 11 years by 3.6%. However, women who participate in the Women, Infants, and Children (WIC) program are almost 12% less likely to initiate BF than the general population, and less likely to continue for a year.
To identify barriers to BF in order to recommend guidelines for the WIC population.
A systematic review using the search words WIC and BF was conducted using the CINAHL, PubMed, and Cochrane Library databases. Inclusion criteria were articles studying the WIC population alone and/or relative to other populations. Twenty-four articles from the last 5 years were reviewed and graded according to the Evans' hierarchy of evidence.
Barriers to BF in the WIC population were sorted into five categories: lack of support inside/outside the hospital, returning to work, practical issues, WIC-related issues, and social/cultural barriers. Factors predisposing to lower BF rates include non-Hispanic ethnicity, obesity, depression, younger age, or an incomplete high school education. Interventions trialed with positive outcomes include peer counseling, improved communication between hospital lactation consultants and WIC staff, breast-pump programs, and discouraging routine formula provision in the hospital and by WIC.
Reasons for low BF rates in the WIC population are complex. More research is needed into interventions tailored for WIC participants. Recommendations for clinicians include initiating peer-counseling programs, prenatal/ postpartum education, in-hospital BF support, and changing the focus of WIC from formula to BF promoting.
Objectives:
We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes.
Methods:
We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder.
Results:
Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model.
Conclusions:
Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.
Background:
Low breastfeeding rates persist as a health disparity among high-risk inner-city mothers. We sought to obtain input of community health workers (CHWs) in preparation for a breastfeeding intervention.
Subjects and methods:
We conducted audiotaped focus groups with CHWs of the Cleveland (OH) Department of Public Health's MomsFirst™, a federally funded Healthy Start program, which addressed interest in breastfeeding, positives and negatives of breastfeeding, perceived barriers, and an intervention concept. We used notes-based and tape-based analysis with a previously developed theme code modified for breastfeeding relevance.
Results:
Seventeen (50%) of 34 actively employed CHWs participated in two focus groups. Issues that emerged were as follows: (1) breastfeeding is "hard" for young mothers, with multiple obstacles identified, including lack of support at home, pain with nursing, extra time required, incompatibility with medications and lifestyle, body image concerns, and "no equipment" (breast pumps); (2) expected supports such as postpartum hospital care have not been helpful, and in-home help is needed; (3) many CHWs' personal breastfeeding experiences were difficult; (4) CHWs requested additional breastfeeding education for themselves; and (5) while strongly endorsing "making a difference" in their clients' lives, CHWs worried that additional curricular mandates would create burden that could become a disincentive.
Conclusions:
CHWs who make home visits are in a unique position to impact their clients' breastfeeding decisions. A targeted intervention for high-risk inner-city mothers must meet the educational needs of the teachers (CHWs) while minimizing administrative burden, address issues identified by the clients (mothers), and provide hands-on help within the home.
Improving maternal and child health is a key objective of the United Nations' Millennium Development Goals and the Healthy People goals for improving the health of Americans. Government initiatives are important particularly for reducing disparities that affect disadvantaged populations. Head Start, Healthy Start, WIC and Medicaid are four federal programs that target disparities in maternal and child health outcomes. This paper reviews recent evaluations of these programs to identify outcomes assessed and opportunities for further evaluation of these programs. We conducted a review of recent evaluation studies assessing the impact of four maternal and child health programs on a health or healthcare outcome. Sources for published literature included the PubMed, Academic Search Complete, CINAHL and PsycInfo databases. Titles and abstracts of studies were examined to determine if they met inclusion criteria. Included studies were categorized by type of outcome examined. Twenty peer-reviewed studies published between January 2006 and June 2011 met inclusion criteria. The majority of studies examined infant outcomes (11), followed by breastfeeding/nutrition (4), maternal health (3), and unintended pregnancy (2). Measures used were consistent across studies; however, findings on the impact of programs were mixed reflecting differences in selection of comparison group, data source and statistical methods. The impact of maternal and child health programs may vary by setting and population served, but inconclusive findings remain. Health service researchers can build upon current evaluations to increase our understanding of what works, help target resources, and improve evaluation of programs in the future.
Thirty years ago obesity was rarely seen in children but is now described as a world wide pandemic. Previous research has focused on school age children; however, researchers have now identified critical moments of development during uterine life and early infancy where negative factors or insults could cause permanent changes in the structure and function of tissues and lead to epigenetic changes. Obesity in preschool children can cause premature and long term chronic health problems; has been associated with academic and social difficulties in kindergarten children; difficulty with social relationships; increased feelings of sadness, loneliness and anxiety; and negative self image in children as young as 5 years of age. The importance of identifying children under the age of five with obesity and associated risks is important yet less than half of health professionals intervene in cases of preschool obesity. This paper explores the concerns around antenatal and preschool obesity and the challenges for nurses and midwives in assessing and providing appropriate interventions for children and families in community settings.
In the United States, most mothers who initiate breastfeeding will either stop or begin supplementing with formula before their infants are 3 months old. Routine breastfeeding education and support following hospital discharge are critical to breastfeeding success. The purpose of this article is to identify this critical period for supporting and reinforcing breastfeeding.
We will use data from participants enrolled in the Maryland State Program of the U.S. Department of Agriculture's Supplemental Nutrition Program for Women, Infants, and Children (WIC). This cross-sectional study will explore whether breastfeeding patterns during the period between birth and postnatal WIC certification differ by participation in a local WIC agency that provides breastfeeding peer counselor support (PC) versus two comparison groups, the lactation consultant (LC) and standard care (SC) groups.
During 2007, 33,582 infants were enrolled in the Maryland State WIC program. Infant breastfeeding status was categorized as exclusively breastfeeding, partially breastfeeding, or not breastfeeding. At certification, 30.4% of infants were breastfeeding, 25.3% had been breastfed but had stopped before certification in WIC, and 44.3% never breastfed. The breastfeeding initiation rate was higher for the PC group compared with the LC and SC groups (61.6% vs. 54.4% and 47.6%, respectively; p < 0.001). Participants in the PC group were more likely to certify as exclusively and partially breastfeeding compared with the LC and SC groups (36.0% vs. 24.8% and 25.3%, respectively; p < 0.001).
Our analysis identifies a window of opportunity during which targeted contact with breastfeeding mothers could enhance longer-term breastfeeding rates.
Pregnancy-related weight retention can contribute to obesity, and breastfeeding may facilitate postpartum weight loss. We investigated the effect of breastfeeding on long-term postpartum weight retention.
Using data from the North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 1996-2004), weight retention was assessed in women aged 18 years or older who had more than one pregnancy available for analysis (n=32,920). Using multivariable linear regression, the relationship between duration of breastfeeding after the first pregnancy and change in pre-pregnancy weight from the first pregnancy to the second pregnancy was estimated, controlling for demographic and weight-related covariates.
Mean time between pregnancies was 2.8 years (standard deviation (SD) 1.5), and mean weight retention from the first to the second pregnancy was 4.9kg (SD 8.7). In covariate-adjusted analyses, breastfeeding for 20 weeks or more resulted in 0.39kg (standard error (SE) 0.18) less weight retention at the beginning of the second pregnancy relative to no breastfeeding (p=0.025).
In this large, racially diverse sample of low-income women, long-term weight retention was lower among those who breastfed for at least 20 weeks.
The dramatic increase in the prevalence of childhood overweight and its resultant comorbidities are associated with significant health and financial burdens, warranting strong and comprehensive prevention efforts. This statement proposes strategies for early identification of excessive weight gain by using body mass index, for dietary and physical activity interventions during health supervision encounters, and for advocacy and research.
This study was designed to analyze the relationship between breast-feeding and mental development at 24 months of age, independently of the influence of other factors. A total of 238 babies born between October 1995 and February 1998 were enrolled in an observational prospective cohort study. Cognitive development was assessed using the Bayley Infant Development Scale. The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development.
We set out to compare rates of breastfeeding between women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with those of non-WIC mothers from 1978 to 2003.
The Ross Laboratories Mothers Survey is a national survey designed to determine patterns of milk feeding during infancy. Mothers were asked to recall the type of milk fed to their infant in the hospital and during each month of age. Rates of breastfeeding in the hospital and at 6 months of age were evaluated. Logistic regression analyses identified significant predictors of breastfeeding in 2003.
From 1978 through 2003, rates for the initiation of breastfeeding among WIC participants lagged behind those of non-WIC mothers by an average of 23.6 +/- 4.4 percentage points. At 6 months of age, the gap between WIC participants and non-WIC mothers (mean: 16.3 +/- 3.1 percentage points) steadily increased from 1978 through 2003 and exceeded 20% by 1999. Demographic factors that were significant and positive predictors of breastfeeding initiation in 2003 included some college education, living in the western region of the United States, not participating in the WIC program, having an infant of normal birth weight, primipary, and not working outside the home. For mothers of infants 6 months of age, WIC status was the strongest determinant of breastfeeding: mothers who were not enrolled in the WIC program were more than twice as likely to breastfeed at 6 months of age than mothers who participated in the WIC program.
Breastfeeding rates among WIC participants have lagged behind those of non-WIC mothers for the last 25 years. The Healthy People 2010 goals for breastfeeding will not be reached without intervention. Food package and programmatic changes are needed to make the incentives for breastfeeding greater for WIC participants.
This study examined the association between participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and adherence to 4 American Academy of Pediatrics recommendations on infant feeding.
We used data from the Early Childhood Longitudinal Study-Birth Cohort, which is nationally representative of children born in 2001. We estimated regression models to assess relationships between program participation and adherence to American Academy of Pediatrics recommendations on exclusive breastfeeding and the introduction of infant formula, cow's milk, and solid foods.
Regression results indicated that WIC participation was associated with a 5.9-percentage point decrease in the likelihood of exclusive breastfeeding for > or = 4 months and a 1.9-percentage point decrease in the likelihood of exclusive breastfeeding for > or = 6 months. Program mothers were 8.5 percentage points less likely than nonparticipants to adhere to the American Academy of Pediatrics recommendation to delay introduction of infant formula until month 6. Program mothers were 2.5 percentage points more likely than nonparticipants to delay the introduction of cow's milk until month 8. Program participants were 4.5 percentage points less likely than nonparticipants to delay the introduction of solid foods for > or = 4 months. However, the difference between participants and nonparticipants disappeared by month 6.
Results suggest that, although program participants are less likely to breastfeed exclusively than eligible nonparticipants, program-provided infant formula is an important option for mothers who do not breastfeed exclusively. The program faces the challenge to encourage breastfeeding without undermining incentives to follow other recommended infant feeding practices. Recent changes proposed to the food packages by the US Department of Agriculture Food and Nutrition Service are consistent with the goal of increasing adherence to recommended infant feeding practices among participants.
Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates.
The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months.
More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months.
Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.
Contemporary research on union formation in the United States largely focuses on how economic deprivation impinges upon union formation decisions by race. Union formation among specific Latino subgroups, particularly Mexican Americans, is relatively understudied. Mexican Americans are of special interest because they exhibit marriage behavior similar to that of non-Latino Whites, and have a relatively precarious economic existence. This directs attention to the normative foundations of marriage. Using the 1987-88 National Survey of Families and Households, this research examines normative beliefs about marriage and cohabitation among non-Latino Whites, Mexican Americans, and mainland Puerto Ricans. The results indicate that Mexican Americans tend to be more pronuptial than non-Latino Whites. They evaluate marriage more positively relative to singlehood, and marriage intentions significantly boost their approval of cohabitation. The former is particularly evident among the foreign born. Such differences cannot be explained fully by socioeconomic background or beliefs about nonmarital sex and childbearing. Puerto Ricans are least disapproving of cohabitation in the absence of plans to marry, primarily because of their beliefs about nonmarital sex and childbearing.
Current research on the retreat from marriage emphasizes the economic underpinnings of family formation, especially among disadvantaged minorities. The paradox of Mexican American nuptiality is that first marriage rates among Mexican Americans are similar to those among Anglos, despite economic circumstances that closely approximate those of African Americans. Using event histories constructed from the National Longitudinal Survey of Youth, this study extends previous analyses by investigating the roles of both structural (e.g., pool of marriageable men) and cultural (e.g., familism) factors in the marriage transitions of 3,853 Mexican American, African American, and Anglo women. The results support three main conclusions. First, similarities are outweighed by differences in the marriage process across these groups. Second, cultural indicators do not explain group differences. Third, the unique aspects of the marriage process among Mexican Americans cannot be fully understood without taking their generational heterogeneity into account.
We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants. Of the 242 women with complete data, 48% initiated breastfeeding, but only 31% were still breastfeeding at 7-10 days. Initiation was associated with cesarean delivery, infant feeding instruction, no artificial milk discharge pack, attending the peer counselor only-intervention site, and intention to breastfeed. Continuation was influenced by infant feeding instruction, no artificial milk discharge pack, and intention to breastfeed. Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.
To assess the relations between breast feeding and infant illness in the first two years of life with particular reference to gastrointestinal disease.
Prospective observational study of mothers and babies followed up for 24 months after birth.
Community setting in Dundee.
750 pairs of mothers and infants, 76 of whom were excluded because the babies were preterm (less than 38 weeks), low birth weight (less than 2500 g), or treated in special care for more than 48 hours. Of the remaining cohort of 674, 618 were followed up for two years.
Detailed observations of infant feeding and illness were made at two weeks, and one, two, three, four, five, six, nine, 12, 15, 18, 21, and 24 months by health visitors.
The prevalence of gastrointestinal disease in infants during follow up.
After confounding variables were corrected for babies who were breast fed for 13 weeks or more (227) had significantly less gastrointestinal illness than those who were bottle fed from birth (267) at ages 0-13 weeks (p less than 0.01; 95% confidence interval for reduction in incidence 6.6% to 16.8%), 14-26 weeks (p less than 0.01), 27-39 weeks (p less than 0.05), and 40-52 weeks (p less than 0.05). This reduction in illness was found whether or not supplements were introduced before 13 weeks, was maintained beyond the period of breast feeding itself, and was accompanied by a reduction in the rate of hospital admission. By contrast, babies who were breast fed for less than 13 weeks (180) had rates of gastrointestinal illness similar to those observed in bottle fed babies. Smaller reductions in the rates of respiratory illness were observed at ages 0-13 and 40-52 weeks (p less than 0.05) in babies who were breast fed for more than 13 weeks. There was no consistent protective effect of breast feeding against ear, eye, mouth, or skin infections, infantile colic, eczema, or nappy rash.
Breast feeding during the first 13 weeks of life confers protection against gastrointestinal illness that persists beyond the period of breast feeding itself.
This study examined the effect of support from trained peer counselors on breastfeeding initiation, duration, and exclusivity among low-income urban women. Training of counselors, under the supervision of a registered nurse certified in lactation, adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues. The study compared infant feeding practices of women who planned to breastfeed and received support from counselors (counselor group, N = 59) to women who requested counselors but, owing to inadequate numbers of trained counselors, did not have a counselor (No-counselor group, N = 43). Women in the counselor group had significantly greater (p < .05) breastfeeding initiation (93 percent vs. 70 percent), exclusivity (77 percent vs. 40 percent), and duration (mean of 15 weeks vs. mean of 8 weeks) than women in the no-counselor group. The findings suggest that peer counselors, well-trained, and with on-going supervision, can have a positive effect on breastfeeding practices among low-income urban women who intend to breastfeed.
To determine whether breast-feeding is protective against infection in relatively affluent populations, morbidity data were collected by weekly monitoring during the first 2 years of life from matched cohorts of infants who were either breast fed (BF) (N = 46) or formula fed (FF) (N = 41) until at least 12 months of age. Cohorts were matched for characteristics such as birth weight and parental socioeconomic status, and we controlled for use of day care in data analysis. Mean maternal educational level was high (16 years) in both groups. In the first year of life the incidence of diarrheal illness among BF infants was half that of FF infants; the percentage with any otitis media was 19% lower and with prolonged episodes (> 10 days) was 80% lower in BF compared with FF infants. There were no significant differences in rates of respiratory illness; nearly all cases were mild upper respiratory infections. Morbidity rates did not differ significantly between groups in the second year of life, but the mean duration of episodes of otitis media was longer in FF than BF infants (8.8 +/- 5.3 vs 5.9 +/- 3.5 days, respectively; p = 0.01). These results indicate that the reduction in morbidity associated with breast-feeding is of sufficient magnitude to be of public health significance.
Using qualitative methods, this case study of an inner-city family practice explores how a group of eight minority women and their families decided whether to breast-feed or bottle-feed their infants and how the office and hospital settings affected this decision-making process.
The methods included depth interviews, a focus group interview, and participant observation.
Five key themes emerged from the data: 1) knowledge alone does not ensure any particular decision, 2) support is primarily from family networks in this group, with health care providers in a secondary role, 3) mothers and their families want to provide their infants with quantifiably sufficient nourishment, 4) physical and psychosocial satisfaction with the feeding method chosen is important, and 5) breast-feeding in public is not acceptable.
If the nutritional and bonding advantages do not outweigh the social embarrassment, inconvenience, and insecurity of breast-feeding, then bottle-feeding is chosen as the preferred method of infant feeding in this case study. Timely interventions in the postpartum period by providers often play a critical role in the initial success of breast-feeding.
Peterkin and Walker published in 1976 a cost estimate of feeding a baby in the U.S. At that time, they found there was little difference in cost between breast-feeding and formula feeding. Since then, however, the cost of formula has risen drastically--more than 150% during the 1980s. One researcher estimated that food and feeding equipment cost $855 in the first year. Whereas the cost of formula is quite apparent when a family buys it, the cost of breast-feeding is hidden.
To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California.
Cost-savings analysis.
Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal.
Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%.
Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from 4,944 (4% discount) to 6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between 659 (4% discount) and 808 (0% discount) per family.
Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.
The purpose of this study was to determine whether breast-feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants.
The association between breast-feeding dose and illnesses in the first 6 months of life was analyzed with generalized estimating equations regression for 7092 infants from the National Maternal and Infant Health Survey. Breast-feeding dose (ratio of breast-feedings to other feedings) was categorized as full, most, equal, less, or no breast-feeding.
Compared with no breast-feeding, full breast-feeding infants had lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean ratios of illness months and sick baby medical visits. Most breast-feeding infants had lower odds ratios of diarrhea and cough or wheeze, and equal breast-feeding infants had lower odds ratios of cough or wheeze. Full, most, and equal breast-feeding infants without siblings had lower odds ratios of ear infections and certain other illnesses, but those with siblings did not. Less breast-feeding infants had no reduced odds ratios of illness. Findings did not vary by income.
Full breast-feeding was associated with the lowest illness rates. Minimal (less) breast-feeding was not protective. Breast-feeding conferred similar health benefits in all economic groups.
To examine how individuals within a woman's life influence her infant feeding intention, we interviewed 441 African-American women on the breastfeeding attitudes and experiences of their friends, relatives, mother, and the baby's father. Women were interviewed at entry into prenatal care at clinics associated with one of four Baltimore WIC clinics chosen for a breastfeeding promotion project. Qualitative data were also collected among 80 women. Friends and "other" relatives were not influential. Grandmothers' opinions and experiences were important, but their influence was reduced after considering the opinion of the baby's father. The opinion of the woman's doctor was an independent predictor of infant feeding intention. Breastfeeding promotion programs should recognize the separate influence of fathers, health providers, and grandmothers in women's infant feeding decisions.
This study evaluates the effectiveness of a peer counseling program at increasing breastfeeding by participants in the Mississippi Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
Data from the 1989-1993 Pediatric Nutrition Surveillance System were analyzed to compare breastfeeding rates in clinics with and without peer counseling programs. A questionnaire completed by program staff to describe the program in greater detail helped identify characteristics associated with greater success.
The incidence of breastfeeding rose from 12.3% to 19.9% in those clinics with peer counseling programs, but only from 9.2% to 10.7% in clinics without a program. Clinics that started a program earlier showed greater changes in breastfeeding incidence. However, the presence of lactation specialists or consultants in the clinic appeared to be more important than the presence of less-trained peer counselors. Peer counselors who spent more than 45 minutes per participant were more effective than those spending less time.
The peer counseling program significantly increased the incidence of breastfeeding, particularly in clinics with lactation specialists and consultants. Success can be enhanced by ensuring that peer counselors spend a great deal of time with the participants.
The objective of this article is to review the literature regarding the risk of sudden infant death syndrome (SIDS) in bottle-fed infants compared to those that are breastfed. A meta-analysis and qualitative literature review were performed. Cohort and case-control studies were included if they met a minimum SIDS definition and presented data allowing calculation of an odds ratio (OR). Twenty-three studies were included in the meta-analysis. The studies were heterogeneous, and a majority (14) were of "fair" or "poor" quality. Crude ORs from 19 individual studies favored breastfeeding as protective against SIDS. The combined analysis indicated that bottle-fed infants were twice as likely to die from SIDS (pooled OR = 2.11; 95% CI 1.66-2.68). The results of the analysis show that there is an association between bottle-feeding and SIDS, but this may be related to confounding variables.
Most mothers stop breast-feeding before the recommended 6 months post partum. A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum. We conducted a randomized controlled trial to evaluate the effect of peer (mother-to-mother) support on breast-feeding duration among first-time breast-feeding mothers.
We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and randomly assigned them to a control group (conventional care) or a peer support group (conventional care plus telephone-based support, initiated within 48 hours after hospital discharge, from a woman experienced with breast-feeding who attended a 2.5-hour orientation session). Follow-up of breast-feeding duration, maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4, 8 and 12 weeks post partum.
Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum (81.1% v. 66.9%, p = 0.01) and did so exclusively (56.8% v. 40.3%, p = 0.01). Breast-feeding rates at 4, 8 and 12 weeks post partum were 92.4%, 84.8% and 81.1% respectively among the mothers in the peer support group, as compared with 83.9%, 75.0% and 66.9% among those in the control group (p < or = 0.05 for all time periods). The corresponding relative risks were 1.10 (95% confidence interval [CI] 1.01-2.72) at 4 weeks, 1.13 (95% CI 1.00-1.28) at 8 weeks and 1.21 (95% CI 1.04-1.41) at 12 weeks post partum. In addition, when asked for an overall rating of their feeding experience, significantly fewer mothers in the peer support group than in the control group were dissatisfied (1.5% v. 10.5%) (p = 0.02). Of the 130 mothers who evaluated the peer support intervention, 81.6% were satisfied with their peer volunteer experience and 100% felt that all new breast-feeding mothers should be offered this peer support intervention.
The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience. The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs, in conjunction with professional health services, are effective.
To gain perspective on breastfeeding initiation and duration among poor women in the southeastern United States, the authors interviewed a random sample of 150 mothers (93% African American) at a county health clinic in Birmingham, Alabama. Forty-one percent of women initiated breastfeeding, 24% breastfed for at least 1 month, and 8.3% breastfed for 3 months or more. Initiation of breastfeeding was positively associated with the mother having been breastfed herself and having breastfed a previous infant, and negatively associated with premature delivery. Breastfeeding at 1 month was more likely among older women and women with close relatives who breastfed. Duration of breastfeeding beyond 1 month was associated only with the mother having been breastfed and having breastfed a previous infant. Maternal and familial breastfeeding experiences eliminated the effect of more distal factors, such as income or education, on some feeding decisions. The strong influence of breastfeeding experiences must be considered in infant feeding interventions.
To evaluate the relative effects introducing motivational videotapes and/or peer counseling in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics serving African-American women have on breast-feeding duration.
Experimental intervention study. Pregnant women were enrolled at or before 24 weeks gestation and were followed up until postpartum week 16. Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks postpartum. SUNJECTS/SETTING: One hundred fifteen African-American WIC participants who initiated breast-feeding and who had been enrolled in 1 of 4 clinics.
Two-by-two factorial design, in which 4 clinics were randomly assigned to receive either no intervention, a motivational video package intervention, a peer-counseling intervention, or both interventions.
Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum.
Contingency table analysis, including chi2 tests and log-rank tests; multivariate analysis using Cox proportional hazards regression analysis.
A higher proportion of women were breast-feeding at 8 and 16 weeks postpartum in the intervention clinics than in the control clinic. The proportion of women reporting breast-feeding declined at 8 and 16 weeks postpartum, but the rate of decline was slower in the 3 intervention clinics than in the control clinic. Being younger than 19 years of age or older than 25 years of age, having a male infant, and returning to work or school all negatively affected breastfeeding duration, whereas previous breast-feeding experience positively influenced breast-feeding duration.
WIC-based peer counselor support and motivational videos can positively affect the duration of breast-feeding among African-American women. WIC nutritionists and other health professionals in contact with this population should expand their efforts toward promoting increased duration of breast-feeding.
Asthma prevalence has increased dramatically in recent years, especially among children. Breast-feeding might protect children against asthma and related conditions (recurrent wheeze), and this protective effect might depend on the duration and exclusivity of the breast-feeding regimen.
We sought to determine whether there is an association between breast-feeding and asthma, recurrent wheeze, or both in children up to 72 months of age and whether the duration and exclusivity of breast-feeding affect this association.
Data were from the third National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey conducted from 1988 to 1994. We tested for significant associations between breast-feeding and physician-diagnosed asthma and recurrent wheeze (> or =3 episodes in the past 12 months) before and after adjusting for potential confounders.
Crude analyses showed that breast-feeding was associated with significantly reduced risks for asthma and recurrent wheeze in children 2 to 71 months of age, but after adjusting for potential confounders, these overall protective associations attenuated and were no longer statistically significant. However, 2 new and important associations were revealed after adjusting for confounders: (1) compared with never breast-fed children, ever breast-fed children had significantly reduced odds of being diagnosed with asthma and of having recurrent wheeze before 24 months of age, and (2) among children 2 to 71 months of age who had been exposed to environmental tobacco smoke, those who had ever been breast-fed had significantly reduced risks of asthma and wheeze compared with those who had never been breast-fed.
Breast-feeding might delay the onset of or actively protect children less than 24 months of age against asthma and recurrent wheeze. Breast-feeding might reduce the prevalence of asthma and recurrent wheeze in children exposed to environmental tobacco smoke.
A close examination of the WHO/UNICEF (2001) Ten Steps to Successful Breastfeeding reveals a central theme: that of keeping mothers and babies together. Two of the steps, in particular, emphasise that close contact is maintained: step four--skin contact and the initiation of breastfeeding, and step seven--rooming-in. The reason for this is that separation interferes with the establishment of breastfeeding and increases the likelihood of complications. This article considers the impact separation of mother and baby may have and asks whether it is any coincidence that breastfeeding relies on the togetherness of mother and baby.
Numerous studies have reported associations between the type of feeding during infancy and subsequent cardiovascular risk factors. Only 2 studies have evaluated the relation between having been breastfed and the risk of adult cardiovascular events.
We examined this association among 87,252 female participants of the longitudinal Nurses' Health Study. Participants (all born between 1921 and 1946) reported in 1992 whether and for how long they were breastfed. During 8 years of follow up, there were 1099 cases of coronary heart disease and 940 strokes among women who knew whether they had been breastfed. We used proportional hazards models to estimate hazard ratios for cardiovascular events, adjusting for changing adult risk factors.
Compared with women who were never breastfed, women who were breastfed had hazard ratios of 0.92 (95% confidence interval = 0.80-1.05) for coronary heart disease and 0.91 (0.79-1.06) for stroke, after adjustment for age, birthweight, and smoking. When body mass index was also included in the model, the results were similar. Looking within subgroups of stroke, hazard ratios were 0.86 (0.70-1.07) for ischemic stroke and 1.01 (0.70-1.46) for hemorrhagic stroke. Comparing women who were breastfed at least 9 months with those who were not breastfed, the hazard ratios were 0.84 (0.69-1.03) for coronary heart disease and 1.00 (0.81-1.23) for stroke. Breastfeeding history was not associated with high blood pressure in adulthood.
These data suggest, but cannot establish, that breastfeeding in infancy may be associated with a small reduction in risk of ischemic cardiovascular disease in adulthood.
Breastfeeding peer counseling has improved breastfeeding rates in developing countries; however, its impact in this country has not been adequately evaluated.
To evaluate the effectiveness of an existing, breastfeeding peer counseling program within the United States.
Randomized, prospective, controlled trial in which participants were recruited prenatally and randomly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling.
An urban hospital serving a large population of low-income Latinas.
Pregnant women (< or =26 weeks' gestation) were recruited from the hospital's prenatal clinic. Inclusion criteria specified that participants be low income, be considering breastfeeding, have delivered a healthy, full-term singleton, and have access to a telephone. Intervention Breastfeeding peer counseling services included 1 prenatal home visit, daily perinatal visits, 3 postpartum home visits, and telephone contact as needed.
Breastfeeding rates at birth and 1, 3, and 6 months postpartum.
The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls (8/90 [9%] vs 17/75 [23%]; relative risk, 0.39; 95% confidence interval, 0.18-0.86). The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month (36% vs 49%; relative risk, 0.72; 95% confidence interval, 0.50-1.05) and 3 months (56% vs 71%; relative risk, 0.78; 95% confidence interval, 0.61-1.00).
These findings demonstrate that, in the United States, peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum.
Randomized trials conducted in developing countries have demonstrated that breastfeeding peer counseling increases rates of breastfeeding initiation and improves the duration of breastfeeding (Morrow et al. 1999; Haider et al. 2000). We are conducting a randomized community trial, designed to evaluate the effectiveness of an existing community-based breastfeeding peer counseling program serving mostly low income Latinas (i.e., women from Spanish-speaking countries in Latin America or the Caribbean) in Hartford, CT. Preliminary data from this on-going study previously have shown that subjects randomized to receive breastfeeding peer counseling have a median breastfeeding duration one month greater than their counterparts who did not receive breastfeeding peer counseling (1.75 mo vs. 0.8 mo, P<0.05) (Chapman et al. 2002). The objectives of this analysis are to: a) report on a process evaluation of the program, focusing on actual coverage of pre-, peri-, and postnatal services; and b) determine if differences in the degree and timing of the exposure to breastfeeding peer counseling services are associated with breastfeeding duration.
The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices.
Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done.
Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae.
The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident.
Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.
The influence of breastfeeding on blood pressure in later life is uncertain. The authors conducted a systematic review of published studies from which estimates of a mean difference (standard error) in blood pressure between breastfed and bottle-fed subjects could be derived. They searched MEDLINE and Excerpta Medica (EMBASE) bibliographic databases, which was supplemented by manual searches of reference lists. Fifteen studies (17 observations) including 17,503 subjects were summarized. Systolic blood pressure was lower in breastfed compared with bottle-fed infants (pooled difference: -1.4 mmHg, 95% confidence interval (CI): -2.2, -0.6), but evidence of heterogeneity between study estimates was evident (chi(2)(16) = 42.0, p < 0.001). A lesser effect of breastfeeding on systolic blood pressure was observed in larger (n > or = 1,000) studies (-0.6 mmHg, 95% CI: -1.2, 0.02) compared with smaller (n < 1,000) studies (-2.3 mmHg, 95% CI: -3.7, -0.9) (p for difference in pooled estimates = 0.02). A small reduction in diastolic blood pressure was associated with breastfeeding (pooled difference: -0.5 mmHg, 95% CI: -0.9, -0.04), which was independent of study size. If causal, the small reduction in blood pressure associated with breastfeeding could confer important benefits on cardiovascular health at a population level. Understanding the mechanism underlying this association may provide insights into pathways linking early life exposures with health in adulthood.
Breastfeeding is the optimal method of infant feeding. Breast milk provides almost all the necessary nutrients, growth factors and immunological components a healthy term infant needs, Other advantages of breastfeeding include reduction of incidences and severity of infections; prevention of allergies; possible enhancement of cognitive development; and prevention of obesity, hypertension and insulin-dependent diabetes mellitus. Health gains for breastfeeding mothers include lactation amenorrhea, early involution of the uterus, enhanced bonding between the mother and the infant, and reduction in incidence of ovarian and breast cancer. From the economic perspective, breastfeeding is less expensive than formula feeding. In most cases, maternal ingestion of medications and maternal infections are not contraindications to breastfeeding. Breastfeeding, however, is contraindicated in infants with galactosemia. The management of common breastfeeding issues, such as breast engorgement, sore nipples, mastitis and insufficient milk, is discussed. Breastfeeding should be initiated as soon after delivery as possible. To promote, protect and support breastfeeding, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed the Baby-Friendly Hospital Initiative (BFHI) 10 Steps to Successful Breastfeeding. Healthcare professionals have an important role to play in promoting and protecting breastfeeding.
This article reports on breastfeeding intentions of Hispanic and black women by country of origin (continental US born or foreign born) in a low-income population that has experienced demographic shifts. Data were derived from prenatal interviews with 382 women from 2 community clinics. Primary outcome measures were intentions to formula feed, breastfeed, or formula and breastfeed. Foreign-born women were significantly more likely to intend to only breastfeed (42% vs 24% for continental US born, P < .05). In multivariate analyses, country of origin and having breastfed a previous child were the only significant predictors of breastfeeding intention. In contrast to previous work, black (non-Hispanic) and Hispanic women's breastfeeding plans were similar. This finding coincides with dramatic increases in the numbers of blacks from West Indian countries-where breastfeeding is the norm-in the study locale.
To assess the efficacy of peer counseling to promote exclusive breastfeeding (EBF) among low-income inner-city women in Hartford, Conn.
Participants recruited prenatally were randomly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support (peer counseling group [PC]) or only conventional breastfeeding support (control group [CG]) and followed through 3 months post partum.
Low-income predominantly Latina community.
Expectant mothers, less than 32 weeks gestation and considering breastfeeding (N = 162). Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits, daily perinatal visits, 9 postpartum home visits, and telephone counseling as needed.
Exclusive breastfeeding rates at hospital discharge, 1, 2, and 3 months post partum (n = 135).
At hospital discharge, 24% in the CG compared with 9% in the PC had not initiated breastfeeding, with 56% and 41%, respectively, nonexclusively breastfeeding. At 3 months, 97% in the CG and 73% in the PC had not exclusively breastfed (relative risk [RR] = 1.33; 95% CI, 1.14-1.56) during the previous 24 hours. The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC (99% vs 79%; RR = 1.24; 95% CI, 1.09-1.41). Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months (33% vs 52%; RR = 0.64; 95% CI, 0.43-0.95). The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC (18% vs 38%; RR = 2.15; 95% CI, 1.16-3.97).
Well-structured, intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income, inner-city women in the United States.
To determine whether an individualized, prenatal and postnatal, lactation consultant intervention resulted in increased cumulative intensity of breastfeeding up to 52 weeks.
The randomized, nonblinded, controlled trial recruited women from prenatal care. Baseline prenatal interviews covered demographic data and breastfeeding experience, intention, and knowledge. Interviews at 1, 2, 3, 4, 6, 8, 10, and 12 months after birth collected data on weekly feeding patterns, infant illness, and infant health care use.
Two community health centers serving low-income, primarily Hispanic and/or black women.
The analytic sample included 304 women (intervention: n = 145; control: n = 159) with > or = 1 postnatal interview.
Study lactation consultants attempted 2 prenatal meetings, a postpartum hospital visit, and/or home visits and telephone calls. Control subjects received the standard of care.
Cumulative breastfeeding intensity at 13 and 52 weeks, based on self-reports of weekly feeding, on a 7-level scale.
The intervention group was more likely to breastfeed through week 20 (53.0% vs 39.3%). Exclusive breastfeeding rates were low and did not differ according to group. In multivariate analyses, control subjects had lower breastfeeding intensity at 13 weeks (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.13-3.20) and 52 weeks (OR: 2.50; 95% CI: 1.48-4.21). US-born control subjects had lowest breastfeeding intensity at 13 weeks (OR: 5.22; 95% CI: 2.43-11.22) and 52 weeks (OR: 5.25; 95% CI: 2.44-11.29). There were no significant differences in breastfeeding intensity among the US-born intervention, foreign-born intervention, and foreign-born control groups.
This "best-practices" intervention was effective in increasing breastfeeding duration and intensity. Breastfeeding promotion should focus on US-born women and exclusive breastfeeding.
The authors analyzed data from a trial assessing the efficacy of breastfeeding peer counseling (PC) for increasing exclusive breastfeeding (EBF) to (1) examine whether different ethnic groups responded differently to the intervention and (2) document the determinants of EBF. At 2 months postpartum, the prevalence of EBF in the intervention group was 11.4% among Puerto Ricans compared to 44.4% among non-Puerto Ricans (P = .008). Multivariate logistic regression analyses showed that women who had the intention prenatally to engage in EBF were more likely to do so and those whose mothers lived in the United States were less likely to engage in EBF at hospital discharge. At 2 months postpartum, mothers who were breastfed as children were more likely to engage in EBF, whereas non-Puerto Ricans had a significantly greater response to the intervention than Puerto Ricans (odds ratio, 6.40; 95% confidence interval, 1.45-28.33). There is a need for further studies to determine why different ethnic groups respond differently to EBF promotion interventions.
The Breastfeeding Initiative program is a collaboration between the Michigan Department of Community Health (Women, Infants, and Children Division) and Michigan State University Extension. It aims to increase breastfeeding rates among low-income women through the use of peer counselors. The study's purpose was to identify the program's strengths, operation procedures, and improvement areas from participants' and peer counselors' perspectives. Six focus groups were conducted: 3 of peer counselors and 3 of program participants. Findings revealed that peer counselors and participants were satisfied with the quality of services due to emotional and practical assistance and breast pumps provided by peer counselors. Peer counselors' job satisfaction was explained positively by the intrinsic rewards of helping others and negatively by perceived inadequate resources and recognition. Operating procedures varied greatly. Possible improvements include expanding services, providing peer counselors with additional support, and standardizing peer counselor operating procedures. The peer counselor model can effectively support low-income breastfeeding women.
Traditionally, women have relied upon the wisdom and experience of other women to learn about mothering and breastfeeding. In the United States, however, this once-standard mother-to-mother interaction was almost nonexistent by the mid-20th century. Recent advances in the understanding of the benefits of breastfeeding for maternal and child health have led most professional organizations to advocate breastfeeding as the norm of infant feeding. Promotional breastfeeding efforts over the past 3 decades include strategies to strengthen support for breastfeeding in the health care system and in the community. Breastfeeding peer counseling represents a model of mother-to-mother support which emerged in the 1980s as a community-based resource to provide mothers with the support and assistance needed to establish and maintain breastfeeding in the early weeks and months postpartum. This article describes the role, training, and effectiveness of breastfeeding peer counselors and discusses ways that mothers and peer counselors might benefit from the connection and relationship that develops between the breastfeeding mother and her peer counselor. An exemplar of a breastfeeding peer counseling program is presented.
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