WIC Breastfeeding Support at Risk

I cannot tell you how important it is for you and your colleagues to weigh in and tell your elected representatives in government how essential the safety net programs, nutrition programs, and programs for people in need are to you, your communities, and your colleagues. As president and chief executive officer of the National WIC Association, I am part of a small group of people who sent a letter asking the President, the Vice President, and leaders in Congress to leave these programs alone. We are calling ourselves a “circle of protection,” and we are faith-community leaders and people engaged in the support of safety net programs.

We are in danger. Senator Harkin touched on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) and mentioned the U.S. House of Representatives' $733 million in cuts to the Program. ¹ The U.S. Department of Agriculture estimates that as many as 750,000 mothers and young children could be cut from the program. Such a cut would have a devastating impact on a lot of people's lives.

I thank the Academy of Breastfeeding Medicine for issuing a statement on the importance of the WIC Program during the Program's funding debates on the floor of the House of Representatives. There, Representative Virginia Foxx, Republican of North Carolina, brought an amendment to the floor to eliminate funding for WIC breastfeeding peer counseling and for breastfeeding performance bonuses—a tremendous incentive tool used by WIC to encourage state and local agencies to promote and support exclusive breastfeeding. One of her statements on the floor of the House was that “Women have been breastfeeding for millions of years and shouldn't need any help.” Her statement shows a total absence of understanding of the challenges facing breastfeeding mothers and women who want to breastfeed. We were astonished by her remarks, but perhaps we shouldn't be surprised given the political and economic climate that we are now in.

However, with the help of many in the breastfeeding community, we defeated Rep. Foxx's amendment to the Fiscal Year 2012 Agriculture Appropriations bill by 306 votes, including strong bipartisan support. Nevertheless, that does not mean that Virginia Foxx and her colleagues will not take steps to repeat this effort to eliminate peer counseling support for breastfeeding from the WIC Program.

I recently went to the Upper Cardozo Health Clinic in the Columbia Heights neighborhood of the District of Columbia. The Upper Cardozo clinic has midwives who collaborate very closely with the local WIC office, which has been working hard to raise breastfeeding rates at the clinic. The two women with whom I met, and one member of the WIC staff, have volunteered to meet with me and with Rep. Foxx, which we hope to do as her schedule allows.

A couple of years ago I stood before the Summit on Breastfeeding and said that “Many of you may feel that WIC is the formula go-to program. Well, we are hell-bent and determined to make WIC the breastfeeding go-to program.” This year, we published our National Strategic Plan ² for promoting breastfeeding, which has now been broadly circulated and well received, and the Six Steps to Achieve Breastfeeding Goals for WIC Clinics. ³ Both are now available to all of our local agency programs and WIC clinics. As a result, a great many people in our community are committed to making a fast-track effort to support and promote breastfeeding wherever the opportunity arises in the WIC clinic setting.

We have challenges. We understand and appreciate the data that Dr. Robert Drago, the Research Director of the Institute for Women's Policy Research, presented at the Summit on the WIC food packages. They included the datum that more infants are being fed with the exclusively formula-fed food package and less than 20% are being fed with the exclusively breastfed food package. ⁴ We know that the retail value of the exclusively formula-fed package is almost as great as that of the exclusively breastfed package for mothers and infants in the age range of 6–11.9 months but is greater for mothers and younger infants. ⁴ We recognize that this may present a challenge for mothers who perceive a better economic value to the former package.

At a recent past Summit I suggested that I would love to see mothers incentivized for breastfeeding by receiving a check or cash value voucher. We now give cash-value vouchers to support the inclusion of fruits and vegetables in the WIC program. A short time ago, breastfeeding women had a slight advantage over other women participating in the WIC program when it came to their fruit and vegetable cash value voucher ($10 vs. $8). Currently, however, the playing field in terms of fruit and vegetable vouchers is a level field, and it is our goal to increase the value of those vouchers for fully breastfeeding mothers. So, why can't we give breastfeeding moms a small check or cash value voucher to support their breastfeeding efforts, which offsets the cost of infant formula? It would make the breastfeeding package a much more attractive food package to expectant mothers.

We have worked hard in the House of Representatives to get an appropriation that would include an additional $2 in fruit and vegetable vouchers for breastfeeding women, but failed in that, and we are now working on the same proposal in the Senate.

Although the administrative costs for WIC actually average less than 10% of a state agency's overall grant, the House of Representatives said in report language accompanying their Fiscal Year 2012 Agriculture Appropriations bill that WIC's overhead was more than 40%. They did this by quoting the results of a Brookings Institute study that incorrectly lumped everything that was not a part of the food grant into program administrative costs. Among the elements of the Program that the House labeled as “overhead” were nutrition education, referrals for pediatric and prenatal care, and breastfeeding support. These are key mission responsibilities of WIC. They are not real estate and lights—traditional administrative categories. What this unfortunate situation has signaled to our community is that in the present political and economic climate, there is little or no desire to provide additional resources to WIC that would support something like additional funding for fruit and vegetable vouchers for breastfeeding women. It is likely to be called too radical, and accomplishing it will take a sea change in the political climate of Congress.

Another challenge that we in the WIC community face is with hospitals. I get reports from local agencies around the country advising that mothers under these agencies' purview have signed papers requesting that they be allowed to breastfeed when they deliver their babies, but that they then get to the hospital only to have their good intentions fall apart as a result of unfortunate hospital protocols or procedures. We are working with Senator Harkin and some others to try and get hospitals to turn the corner on that. The Affordable Care Act contains provisions that should support Baby-Friendly hospitals. ⁵ However, making this a reality will require negotiations, diplomacy, and encouragement with hospitals. It will also take work with formula manufacturers to pull back their efforts to distribute infant formula in hospitals.

The National WIC Association is about to come out with a statement on Baby-Friendly hospitals. We hope that our WIC clinic settings will encourage and support the statement and work with their hospital and pediatrics partners to make Baby-Friendly hospitals a reality. We want to make a difference in this area.

As someone whose work includes that of a hospital chaplain, I have visited many mothers in maternity units that are only now beginning to initiate breastfeeding as an available option. Mothers have candidly shared how difficult it is to breastfeed and the challenges they experience with their intentions to breastfeed in the hospital. We clearly have a lot of educating to do to help mothers stand firm in their commitment, to bring hospitals on board as Baby-Friendly facilities, and to help policymakers understand why supporting breastfeeding is critical.

Several weeks ago I was at the Children's National Medical Center in Washington, DC, with some members of the House appropriations staff whom I took to visit the hospital's WIC clinic. When we went into the WIC clinic we saw a big poster about the benefits of breastfeeding, including issues such as breastfeeding being the front line of immunization defense and its impact on asthma and diabetes. A young man who was formerly on the staff of Senator John McCain, but who now does public relations work for the Hospital and who was accompanying us that day, saw the poster. He turned and said to us, “My wife and I have a 3-month-old child. I didn't realize until someone here in the WIC clinic told me that breastfeeding is the first line of immunization defense.”

I said to him, “I want you to go back to Senator McCain the next time you drop by his office on Capitol Hill and tell him why it's so important for him to support breastfeeding, and encourage him to speak to his colleagues too,” because that kind of relationship-building is what helps to make WIC a priority for policymakers.

Never in my wildest imagination did I think there would be tax incentives to support breastfeeding in the workplace, but now that there are, and as policymakers struggle with revising the tax code, it would be my preference that we get rid of the tax deductions for corporate jets and keep those breastfeeding workplace incentives in place.

Although WIC provides infant formula, we are trying to up the ante on breastfeeding, and we want you to weigh in on our behalf on Capitol Hill because we are at risk. In our current political and economic climate I am not certain that when the Senate goes to mark up their WIC funding legislation they will be able to put an adequate amount of funding to fully support the WIC program.

Reach out to your senators, speak to colleagues and encourage them to reach out to their senators, ask them to spare the safety net programs, and not to balance the nation's budget on the backs of poor people.