Promotion of Exclusive Breastfeeding in Low-Income Families by Improving the WIC Food Package for Breastfeeding Mothers

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was formally created by an amendment to Section 17 of the Child Nutrition Act on September 26, 1972. The legislation (P.L. 92-433) was sponsored by Senator Hubert Humphrey of Minnesota and established the WIC program as a 2-year pilot project. Eligibility was limited to children up to 4 years of age and excluded non-breastfeeding mothers. By the end of 1974 WIC was established as a permanent program (P.L. 94-105). The eligibility was extended to non-breastfeeding mothers (up to 6 months postpartum) and children up to 5 years of age.

WIC is the major single purchaser of infant formula in the United States, and numerous interventions to increase breastfeeding rates in the WIC population have not been effective.

There is clear evidence that our nation suffers from serious health disparities. This is especially true and troublesome about breastfeeding rates, which remain lower by socioeconomic characteristics.

The rates of initiation and maintenance of exclusive breastfeeding vary greatly by race, ethnicity, parents' income, parents' education, and family and community support. In the United States the current rate of exclusive breastfeeding at 6 months stands at 16%, with a sharp divide between different racial and income groups. Mothers with an income of six times above the poverty line are at 21%, those between two and four times are at 20%, and those below the poverty line are at 12%. Among the racial groups, whites are at 19%, Hispanics at 16%, and African Americans are at 9%. ¹

There is clear and convincing evidence that formula feeding contributes to childhood obesity, lower scholastic achievement, and higher rates of neurodevelopmental disorders. Furthermore, formula feeding contributes to maternal obesity and subsequent development of type 2 diabetes and cardiovascular disorders. ²

Currently the WIC program provides formula for non-breastfed infants, at an average retail value of $150/month for the first 3 months and $165/month from 3 to 6 months. The average retail value of formula for non-breastfed infants for the first 6 months totals $945. The average food package per person for breastfeeding and formula-feeding mothers in 2012 was $44.98, although fully breastfeeding mothers receive additional food items, which include canned fish and additional fruit juice. Both breastfeeding and formula-feeding mothers receive $6 of fresh vegetable and fruits per month.

At the inception of WIC the U.S. breastfeeding rates were at their lowest; therefore, WIC provided some needed food items for breastfeeding mothers and their children. Physicians were instrumental and lobbied for the enactment of this legislation, realizing that some of their patients, especially pregnant and breastfeeding mothers and their children, lacked adequate nutrition. During the first 2 years of operation as a pilot project, WIC achieved some of its goals in reducing nutritional deficiencies in the participating mothers and their children. Therefore WIC was established as a permanent program, and it was extended to formula-feeding infants.

The majority of the mothers who are enrolled in WIC do not breastfeed their infants, and if they initiate breastfeeding in the hospital, they frequently wean in a few days or weeks. ¹ Therefore it is no surprise that most of the expenditures of WIC are for the purchase of infant formula. This is with the full knowledge of the benefits of long-term breastfeeding to mothers and infants. There have been some improvements in the WIC food package, which was recommended by the Institute of Medicine to address nutritional deficiencies in breastfeeding mothers by adding more eggs, fruit juice, and 30 ounces of canned fish per month. However, the breastfeeding mothers' food package remains grossly inadequate in fresh foods, fruits, vegetables, and meat.

WIC is a popular program and has bipartisan support in the U.S. Congress. However, there has been criticism of the program by physicians who promote breastfeeding, because of the distribution of infant formula to 90% of infants on the program. Additionally, WIC has been criticized by organizations advocating welfare reform. ³ One may ask, isn't it more prudent if some of the funds spent to purchase fruit juice, canned food, and infant formula was transferred to provide fresh vegetable, fruits, and meat for breastfeeding mothers? If more first-time mothers exclusively breastfeed for 6 months, not only would WIC save $945 per infant (the retail value of formula), there will be substantial savings in eliminating medical expenses associated with formula feeding. ⁴

Many WIC recipients are employed in low-paying jobs, frequently have to return to work early, and may not have workplace lactation support. Additionally, many of the breastfeeding mothers may be single parents. Exclusive breastfeeding is time consuming and economically costly to the mothers; therefore we see a sharp decline in exclusive breastfeeding after 2–3 months among WIC recipients. Therefore promotion of exclusive breastfeeding in the WIC population requires strategies to share maternal lactation costs.^5,6 This may be achieved by improving the WIC food package for first-time mothers who are exclusively breastfeeding their infants. Eliminating sugary juices, canned food, canned fish, and formula for the first 6 months would more than compensate for $100 per month of fresh vegetables, fruits, and meat as a healthy alternative. The mother would receive basic breastfeeding education prenatally and lactation support in the birthing hospital and for the next 6 months. Additionally, she will receive a $100 voucher per month for the next 6 month for fresh food, meat, vegetables, and fruits.

Furthermore, both mother and infant should receive health monitoring by WIC staff and medical providers with optimal training in the area of breastfeeding medicine. We should encourage family and community support for the breastfeeding mothers and to educate our political and business leaders on the economic benefits of breastfeeding for the breastfeeding family, the community, and the entire nation.