Abstract
H
The Special Supplemental Food Program for Women, Infants and Children, commonly known as WIC, is the target of the “Speaking Out” piece by Shafai et al. 1 Most have long forgotten the history that when WIC was enacted in 1972, it was limited to breastfeeding mothers and their children. In 1974 the doors, however, were opened to formula-feeding mothers, and it was not long until WIC became primarily a formula distribution program. This federal program cost almost $1,000 for each formula-fed infant while spending zero dollars for the breastfeeding infant. The authors suggest that political and business leaders need education on the economic benefits of breastfeeding, not just the breastfeeding family but for the community and the nation. It is suggested by the authors that WIC can play a huge role in improving breastfeeding.
Low-income women have the lowest rates of breastfeeding in the United States! Gurka et al. 2 confronted this fact as they explored the issues among 520 low-income women in the Commonwealth of Virginia as part of the Prenatal Education Video Study (PEVS). PEVS is a multisite, randomized, controlled intervention trial conducted at the University of Virginia Health System. The mothers were interviewed at from 24 to 41 weeks of gestation while enrolling in the prenatal program. The authors report some surprising results, such as the fact that the mother's choice of feeding method was not correlated with plans to return to work. Personal preference and perceived convenience were common influences in feeding choice. The authors suggest that intervention earlier in pregnancy and repeatedly with culturally sensitive materials could change women's intentions to breastfeed.
A third discussion by Ware et al. 3 that targets an African American population in Shelby County, Tennessee, is reported as well. Focus groups were used by the authors to identify the perceived barriers and to seek possible solutions to the abysmal breastfeeding rates. Although they found the barriers to breastfeeding in Shelby County (Memphis) were similar to those in the rest of the country, there was a significant concern about the importance of sexuality and partying as an obstacle to breastfeeding. The recommendations to improve promotion efforts reflected these concerns.
Improving breastfeeding rates among these populations of low-income minorities across the country could potentially save over $13 billion in reduced pediatric illnesses per year, according to Bartick and Reinhold. 4 An additional $17.4 billion cost reduction that would result from reduced maternal premature death nationally has been estimated by Bartick et al. 5 These estimations are based on having 90% of U.S. infants breastfed exclusively for the first 6 months of life each year.
As we continue to try to understand the lack of breastfeeding among low-income and minority racial groups, the work of Brownell et al. 6 presents significant findings. They looked at donor human milk consent in a Level IV neonatal intensive care unit. Mothers who did not consent to the use of donor human milk for their fragile premature infants were primarily African American or another minority group. Unmarried mothers were also more likely to refuse. The investigators found no other demographic parameter associated with the mothers consenting to donor milk.
Educating the minority woman and her family on the value of human milk may be the first step in reversing the trend of choosing not to breastfeed in minority communities. Real change will not happen until all children grow up knowing that breastfeeding is the norm. Only then will breastfeeding become part of the culture.