Dear Lactnetters:

WIC (The Supplemental Nutrition Program for Women, Infants and Children)
was started in the late 1970's in response to high levels of low birth
weight and anemia among low-income infants.  Given the times (with
breastfeeding rates very low among low-income families and concerns that
human milk had insufficient iron), the program identified iron-fortified
formula as the infant feed of choice.  Unlike other feeding programs,
however, WIC incorporated a strong educational component for mothers to
improve the overall nutrition of themselves and their families.

In the mid-1980's the U.S. Dept. of Health and Human Services got
interested in breastfeeding (remember the Surgeon General's Conferences)
and funded programs to promote breastfeeding beginning in 1985.  These
were separate from WIC, although they were often operated at the State
level in the same or similar branch as the WIC office.  This set of
projects began to identify strengths and difficulites in WIC as well as
methodology to make changes. When DHHS began a second series of
breastfeeding promotion grants in 1990, many more were awarded to state
WIC agencies to address health professional training and direct
education to clients.

Furthermore, the WIC program must be re-authorized by Congress every 5
years.  In 1989, several state WIC directors (and other breastfeeding
promotion people) lobbied to have money set aside in the WIC
authorization to "promote breastfeeding."  In 1989 they requested U.S.
$8 million, which was taken from the Administrative budget.  Ironically,
hunger advocates would not allow promotion monies to come from the food
budget because that would be taking food from babies mouths.  In 1994,
when WIC was next re-authorized, $22 million was set aside. There are
many factors playing into this:
-- Studies in 1992 and 1993 indicated that the WIC money was a catalyst
to improve breastfeeding promotion, and that other public health
programs (especially Maternity programs) were also expending large sums
of money to promote and support breastfeeding.
-- The International Conference on Nutrition had strong statements on
breastfeeding promotion and support.
-- Breastfeeding research had improved significantly, with results that
are too obvious to ignore.
-- Breastfeeding-support constituencies became increasingly vocal
(That's us, folks!)

What has this meant for WIC?
-- Money is power, and you also have to spend it to get it next year.
This gave many WIC managers incentive to promote breastfeeding in order
to keep their budgets up.  Sometimes this just meant buying pumps.  But
many WIC programs have done really creative things to increase
breastfeeding with their clients.
-- WIC nutrition and clerical staff have become better versed in
breastfeeding benefits and lactation management.
-- Breastfeeding initiation rates HAVE increased significantly among WIC
clientele (see the articles by Ryan etc. from the Ross Labs studies).
-- Other public health programs have increased their interest and
ability re: breastfeeding management and support.

The Future for WIC
WIC will again be reauthorized in the next year.  Advocates for
breastfeeding are already examining where the program can be
strengthened to improve breastfeeding incidence and duration.  There are
many issues related to WIC clientele that can impact the program.
-- The impact of Welfare Reform on child health and nutrition.  How will
bf rates be impacted by mothers forced to return quickly to the
workforce or risk losing assistance? (And you thought working and
breastfeeding was tough enough among middle-class white collar workers).
-- Changes in Medicaid eligibility for children and in programs as they
move into a managed care environment.  Can/will Medicaid strengthen its
services to mothers through Maternity programs to include coverage for
lactation consultation and electric pumps.
-- Food Stamp eligibility may increase participation in WIC as families
lose this benefit.  Increased participation among children (which has
been historically low) may decrease ability to spend money on extra
services for infants (although infants will continue to be a higher
priority than children).
-- Overall WIC funding may be increased or decreased depending on
feelings on Capitol Hill about the efficacy of other Welfare Reforms and
their impact on children (especially).

As you can see, WIC has had a tremendous impact on breastfeeding rates
throughout the U.S..  In some areas it has been a catalyst for change.
WICs greatest strength has been to empower those few voices in the
wilderness promoting breastfeeding by putting its money where its mouth
is.  Not every program is the same, but not every area's needs are the
same, either.

As per someone's idea of not allowing WIC participation until a certain
age postpartum:  "Catch them with honey, not vinegar."  Prenatal
contacts through WIC are instrumental, along with coordination with
Maternity and hospital services, to get women thinking and learning
about breastfeeding.  Then, get the moms back into WIC participation
post-partum by building on the rapport established prenatally.  Our
staff tell moms to come in ASA baby is born to get baby enrolled
(although baby status is "inactive"), to help with breastfeeding, and to
get mom on an exclusive bf package.  We also enroll in the hospital in
some situations.  Step 10 is to get moms into support networks post
discharge.  In many areas, WIC is the foundation of this network.

Sure, lots of moms self-select into WIC prenatally because they can get
'free formula.'  But if they weren't in the clinic, you wouldn't have a
chance to tell them the good things about breastfeeding.  You wouldn't
have the chance to tell them on day 3 that they can relieve that
engorgement by putting baby to breast, even if they planned not to
breastfeed.  You wouldn't have the chance to put that breastfed baby's
picture up on the clinic bulletin board of "beautiful breastfed babies."
And you wouldn't be planting the seeds of breastfeeding for the next
time around (whenever that might be).

Comments?  Want to learn more about what you can do to influence WIC
reauthorization?  Email me privately at <[log in to unmask]>

Doraine Bailey, MA
Breastfeeding Support Services
Lexington-Fayette County (KY) Health Department

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