Indiana WIC Breastfeeding Program

As part of its continuing efforts to promote breastfeeding, the Indiana
Women, Infants, and Children (WIC) program began building an improved
breastfeeding support network for WIC mothers in 2000.  This network
includes additional training in breastfeeding promotion and support to WIC
certifiers, hiring peer counselors, and encouraging qualified employees to
obtain the IBCLC credential.  WIC has expanded coordination with private
and community based services.

At the promotion level, we identified the need to use the Loving Support
program.  All staff, clerical and professional are trained in the Loving
Support 3-Step Counseling method.  We found it impossible to keep everyone
trained by the local breastfeeding coordinator, who often is budgeted only
1-2 hours per week in breastfeeding duties.  To sustain the training
program, we have assigned this duty to Regional Breastfeeding Centers
(described below).

At a more intensive level of promotion and basic support, we have funded
peer counselors since 1991. Peer counselor training was the responsibility
of the local WIC breastfeeding coordinator until 2003.  Currently, the
Regional Breastfeeding Support Center Personnel train new peer counselors
and serve as consultants.  Peer counselors are trained to refer lactation
issues to the IBCLC when the issue exceeds the peer counselor job
description.

In 2002, there were 44,740 prenatal women enrolled in Indiana WIC, and
23,430 initiated breastfeeding.  Approximately 15% breastfed at least six
months (WIC statistics closely match the Ross Survey figures -2002).  Our
preliminary statistics show that the WIC’s program’s 2005 caseload in
Indiana will be approximately 8% higher than 2002 and breastfeeding rates
continue to increase, thus increasing the breastfeeding workload for staff.

WIC does see complicated breastfeeding cases on a daily basis and there is
a need for on-going assistance to WIC mothers.  WIC works closely with
hospitals, physicians, and local La Leche Leagues.  Due to lack of
insurance reimbursement for private IBCLCs, WIC participants usually
cannot afford private services.  In 2001/2002, a grant was received from
USDA, United States Department of Agriculture, to provide an Intensive
Breastfeeding Management Course for professional staff. The first course
was offered to persons who worked in WIC and who self-identified enough
experience and interest to sit for the IBCLE exam.  WIC has subsequently
offered the course three additional years.  As a result, the number of
lactation consultants in Indiana increased from six in 2000 to 50 in
2004.  Training and taking the exam is voluntary.  No staff in Indiana is
reimbursed from WIC funds for exam costs and no staff receives additional
salary for IBCLC duties.  One large urban WIC program has a goal of
sending all professional staff through the Lactaction Mangement Course due
to a need to place staff at hospitals and the large number of clinic sites.

In 2003, the Indiana WIC program developed nine statewide regional
lactation centers to improve access to breastfeeding information.  These
centers are staffed with a least one international board certified
lactation consultant.  Additional funding to support the regional centers
has been added to existing WIC local agency budgets.

Staff at the regional lactation centers are responsible for providing
consistent and timely training, for evaluating WIC clinics for
breastfeeding friendliness, and for ordering and distributing education
materials, breast pumps, and other breastfeeding supplies.  WIC
breastfeeding supplies include breast shells, breast shields, nursing
supplementers (SNS), flanges, feeding cups, and spoons.  All WIC
professional staff receive breast pump training.  This training includes
protocols for what type of pump to distribute.  Starting in 2004, regional
center staff arranged hospital-based trainings entitled “Bridging the
Gap.”  This training, which will continue in 2005, helps identify
procedures to ensure seamless services between local WIC programs and
hospitals.

The Indiana WIC program also works with the Indiana Perinatal Network to
promote breastfeeding, including supporting breastfeeding-friendly
legislation, creating a Breastfeeding Resource Book, developing the
Indiana’s Strategic Breastfeeding Plan, and providing an Indiana unique
Breastfeeding Promotion Campaign scheduled for March 2005.  The campaign
will be a joint effort with state dietetic coalitions for National
Breastfeeding Month.  The Indiana WIC program also sponsored a conference
in November 2004, along with local partners, to showcase breastfeeding
initiatives and to recognize community leaders for their efforts to
support breastfeeding in Indiana.

In an effort to improve breastfeeding among minority populations, the
Indiana WIC Program provided a speaker at a variety of baby health
information events hosted by the Office of Minority Health, Indiana State
Department of Health, in 2004. The events included Fathers' Support
Groups, Baby Showers, and Grandmothers’ Teas.

Currently WIC and the MCH Division are co-sponsoring an Intensive
Lactation Management Course available to any health professional in
Indiana.

Finally, with funding for 2004/2005 available to State WIC programs,
Indiana WIC is enhancing the Peer Counselor program in Indiana.  Two pilot
projects have been developed to provide additional services in a large
urban area and an 11 county rural area that includes 11 rural hospitals.
The Indiana WIC Program is working cooperatively with the AAP
Breastfeeding representative physician for Indiana on various projects.

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