Prevalence of breastfeeding in the United States… What are the influencing factors?

In my research on the topic of breastfeeding, I have discovered the many reasons how women choose to pursue breastfeeding or bottle-feeding. Many of them are social (stigma, embarassment, prominence of one method over another, family and friends) while others have medical or physical justifications (mother or child is unwell, child will not “latch,” etc.). What I aimed to discover over the semester was the various cultural influences that sway new mothers one way or another. The studies and statistics I discovered both on general breastfeeding and the impact of WIC offices revealed some interesting phenomena.

The most prominent trend I discovered in my research was that of a stigma against breastfeeding, both publicly and privately. Based on Nicole’s experience in the Chittenden County WIC office compared Madeline’s discoveries from interviewing passers-by in the UVM Davis Center, it is safe to say that a large population believes is that breastfeeding is weird, especially in public. But when people are educated on the vast nutritional and formative benefits their child receives, the act of breastfeeding is understood as the natural gift it has always been.

A lack of education on the matter proved to be a trend in the many articles I discovered on breastfeeding. However, one study shows that of the first-time mothers that initiated breastfeeding, those still breastfeeding at 13 weeks was more common in women without a high school education (62%) than women with more than a high school education (50%) (Taylor 983). Could socioeconomic status be at play? Generally, women that attain some level of education beyond high school have a higher income than those that never graduate high school. So why is it that those with less formal education seem to be breastfeeding for longer? This is something that could play a role in the social stigma; In the eyes of more affluent women, is breastfeeding for “poor people?”

Another interesting phenomena I discovered was bottle-feeding. In a study that looked at iron levels in infants of mothers involved in WIC, I discovered something of interest: “The WIC Program was initiated in the early 1970s in response to the recognition that… many pregnant and postpartum women as well as infants and preschool-aged children, who were considered nutritionally ‘at risk.'” (Miller 104).  The program has provided infants with iron-fortified formula in an effort to increase nutritional intake but what does that imply for breastfeeding? This, along with the advertising and influence of formula companies, has probably had an impact on the number of women choosing to breastfeed. Bottle-feeding has become a societal norm through ideological shift and lack of education on the matter. In turn, the topic of breastfeeding has become taboo and a big topic of debate and a lack of research on the culture surrounding breastfeeding still remains.

This has been a really interesting topic for me to learn more about because of my interest in global and public health issues. It’s fascinating how different one country is to the next, even one state to the next, as this project has shown. How did the natural, incredible ability to breastfeed become “gross” (as Madeline’s study revealed)? What I have gained from this project is not how various breastfeeding programs work or their effectiveness, but more about the cultural norms that inhibit breastfeeding programs from succeeding. Even with the benefits of natural breastmilk in mind, the majority of mothers choose to bottle-feed with formula at some point during their child’s infancy. As they say, you can lead a horse to water but you can’t make him drink.

WIC is an incredible resource for women who are new to parenting and really care about the health and future of their children. I feel that they have had a great impact on the women that utilize them as a means of education and support. I am proud and enlightened to be a part of this project that provided me some deeper insight into the organization and the impact they have had on the families of the over their 5 decades of work.

Bibliography

Miller, Virginia, Sheldon Swaney, and Amos Deinard. “Impacts of the WIC Program on the Iron Status of Infants.” Pediatrics 75.1 (2001): 100-05. Web.

Taylor, Julie S., Patricia M. Risica, Lauren Geller, Usree Kirtania, and Howard L. Cabral. “Duration of Breastfeeding among First-time Mothers in the United States: Results of a National Survey.” Acta Pediatrica 95 (2006): 980-84. Web.

Peer Counseling Programs and Support: What Is Most Effective?

Nicole Jumper, April 16th           

A few months back, I sat in on a presentation that Tricia Cassi gave about the “10 Steps Project:  Empowering Mothers and Nurturing Babies.”  The 10 Steps project is a training project to increase inclusive breastfeeding rates at six months using educational methods to train hospitals in practices that are proven to better support mothers and babies and improve breastfeeding rates.  Recently Vermont’s WIC office received a grant from the federal government for their high breastfeeding outcomes and decided to use it to develop the “10 Steps to Successful Breastfeeding,” in hospitals around the state.
The last of these 10 Steps is to “Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic” (healthvermont.gov).  Research has shown that women are far more likely to sustain breastfeeding and meet their breastfeeding goals with support from health care providers and counselors (Dozier).  It is not a question whether or not counseling is effective (it is!) but how is the best way to implement these types of programs.
I began my search by looking at different states and how their sustained breastfeeding rates differ.  The key word here is ‘sustained’.  It is not difficult to convince a woman to at least try to breastfeed, but to make sure she has the support and resources to continue is a different matter.  The rates are variable.  According to the CDC’s Breastfeeding Report Card, 2012, as a percentage of mothers who still breastfed exclusively after six months, Colorado came in first with a whopping 26.6% (snaps for CO!).  Mississippi, on the other hand, came in at only 7.6%.  But as we’ve learned, there can be many reasons for this discrepancy.
I thought I might compare the programs of the highest and lowest faring states, but this proved unsuccessful.  Very few peer reviewed articles were out there about specific states’ programs.  One thing I did notice, however, is that the states that had more successful programs had what (in my opinion) seemed like websites that contained more information than those with lower rates.  But perhaps it isn’t the website itself that helps women, but the program itself– meaning those with more effective programs tend to make more in depth online pages.  This is speculation on my part, but we must also take into account that the programs themselves (in most cases) are not the causes of high or low breastfeeding rates;  as we have mentioned in many posts, the reason people do or do not breastfeed can be linked to a plethora of different reasons.
So from there I decided to just try to see what information was out there about how to get the most out of peer-counseling programs and what kinds of things work best in helping mothers breastfeed.
The following paragraph is taken from a report titled, “Implementing and Expanding Breastfeeding Peer Counseling Programs” by WIC written in 2006.  This report was really helpful in my research and highlighted certain programs that were effective and innovative.  Here is the list of adequate support for peer-counselors (presumably, to make the program better, an office would go above and beyond these guidelines):

Adequate Program Support of Peer Counselors
o Adequate training and continuing education of peer counselors
o Timely access to breastfeeding coordinators and other lactation experts for assistance with problems outside of peer counselor scope of practice
o Regular, systematic contact with supervisor
o Participation in clinic staff meetings and breastfeeding inservices as part of the WIC team
o Opportunities to meet regularly with other peer counselors

The report goes on to give examples of certain states and programs or initiatives that were effective in breastfeeding promotion:

Washington DC:  Breastfeeding Coalition.  A group of hospitals, and organizations that support the WIC peer counseling program was formed and aids the program by “providing training opportunities to Breastfeeding Peer Counselors, improving knowledge of breastfeeding, WIC and counseling methods among community partners, increasing referrals, increasing recruitment of new Breastfeeding Peer Counselors and improving community perception of WIC as a breastfeeding supporter”

Indiana:  Building Bridge.  A program created to “bring current, evidence based breastfeeding information to the hospital and to inform the hospital of the breastfeeding support services WIC provides”.

Massachusetts:  Community Partnerships.  The ‘Mother to Mother’ peer counseling program was created to enhance the program by allowing in-person consultations with clients at the WIC clinics, email support, in hospital support, and extensive continuing education.  They also used “emotional techniques” rather than fact-based messages” to get points across to clients.  They have used stories and images to convey the importance of breastfeeding, like the ‘Strengthen the Bond,’ a photojournal which documents sessions with counselors and clients using imagery.

Other improvements made in some states were:

• increasing the pay and responsibilities of peer counselors and make them accessible to clients outside the normal “work” hours.

• supplementing PC training with in-depth instruction, bulletin boards, chat rooms, interactive practice sessions and resources

• hiring diverse peer counselors for the ability to reach out and connect to different populations

• work on retention by giving counselors incentives (like a cell phone for example)

• investing in quality training and continuing education

• developing web-based ways of connecting clients and counselors

• allowing participants to call peers at any time, day or night (done in shifts)

• having peers attend WIC staff meetings and clinics and give presentations at local places such as schools or fairs

There are a lot of great ways to improve the existing peer counselor program in Vermont and “beef up” Loving Support .  It will take trial and error, however, because not all populations respond the same to each method.  By looking at what other states have done, it is a great jumping off point to develop the program and make it even more effective for breastfeeding mothers and peer counselors.

REFERENCES:

Benton, Pat, et al. “Evaluation of a Breast-feeding Peer Counselor Program.” Journal of Nutrition Education and Behavior 37 (2005): S64. Academic OneFile. Web. 16 Apr. 2013.

Dozier, Ann M. “Community engagement and dissemination of effective breastfeeding programs.” Breastfeeding Medicine 5.4 (2010): 215+. Academic OneFile. Web. 16 Apr. 2013.

http://healthvermont.gov/wic/food-feeding/breastfeeding/10steps/index.aspx

Implementing and Expanding Breastfeeding Peer Counseling Programs (WIC)

Breastfeeding Report Card—United States, 2012 (CDC)

WIC Utilization Around The United States

Women, Infants and Children was founded in 1973 with a funding of $20 million. A mere 9 years later, the program was authorized for $950 million and maintains that funding today (Yankauer 1101). WIC is a program that attains clients based on eligibility, creating a moral obligation to seek out those in need of advice on all things related to motherhood. Populations are targetted largely based on “nutritional risk” in an effort to educate women and families and make sure kids are getting the nourishment they need. From the start of life, breastfeeding is the best thing you can do for your child to ensure their health into adolescence.

But how can WIC offices promote starting and sustaining breastfeeding? What works, and what doesn’t? I aimed to answer these questions in my research of the success of Women, Infants and Children programs across the country.

A study done at WIC in Sacramento, California aimed to discover whether encouraging formula-feeding caregivers to alter their feeding practices and reduce infant formula intake would have an impact on the rates of formula use and infant weight gain. Despite the positive response from participants, there was no change in bottle feeding behavoir (Kavanagh 244). Why is it that even with education, many women continue to bottle-feed?

Conducted at WIC offices around Georgia, another study found a rate of only 24% initiating breastfeeding and a mere 6% still breastfeeding at 6 months. Interestingly, the data also showed increasing rates of initiation from unmarried mothers (14%) to widowed or divorced mothers (22%) to married mohers (36%) (MacGowan 363). This proves that the role of men in breastfeeding is significant and having a stable partner in parenting makes a positive difference. One interesting topic discussed in this study was that although WIC strongly encourages women to breastfeed, “all WIC programs provide free formula to infants of mothers who partially breastfeed or do not breastfeed” and “some programs allow promotional materials from infant formula companies to be displayed in their clinics” (MacGowan 365). Corporations should not play a role in a woman’s decision to breastfeed, especially if formula feeding is subtly endorsed by some WIC offices.

A subsample of the Fragile Families and Child Wellbeing Study conducted in 1999 in 20 cities around the country found that about half of the studied mothers reported breastfeeding initiation (Chatterji 1324). WIC participation was associated with a statistically significant increased probability of that initiation, however there was no evidence of a correlation between WIC use and breastfeeding duration. The findings of this study do support previous research that WIC participation is associated with healthy behaviors that benefit infants into their adolescent life (Chatterji 1325).

In our collective research and observation, the Chittenden County WIC office located in Burlington has had a substantial positive impact on many women who have and continue to utilize the program. I found surprisingly little information on breastfeeding in Vermont WIC offices and even in Vermont in general. As I previously stated in another post, I look forward to seeing more research being done on breastfeeding culture around the United States and beyond. Being a very taboo topic of conversation, it is no surprise that there are very few studies done on the matter.

So what is it that is keeping so many caregivers from breastfeeding their children, even with the wealth of benefits dictated by WIC staff? It is an ideological, cultural norm that keeps women bottle feeding as opposed to breastfeeding. Over the past decades with the recent controversy surrounding public breastfeeding, bottlefeeding has become something more prominent in public spaces and in the media. This is something that is now engrained in the American psyche cannot be altered with educational classes, but rather a massive paradigm shift.

Bibliography

Yankauer, Alfred, ed. “Is WIC Worthwhile?” American Journal of Public Health 72.10 (1982): 1101 – 103. Web.

Chatterji, Pinka. “WIC Participation, Breastfeeding Practices, and Well-Child Care Among Unmarried, Low-Income Mothers.” American Journal of Public Health 94.8 (2004): 1324-1327. Web.

MacGowan, Robin J., Carol A. MacGowan, Mary K. Serdula, J. Michael Lane, Riduan M. Joesoef, and Frances H. Cook. “Breast-feeding Among Women Attending Women, Infants and Children Clinics in Georgia, 1987.” Pediatrics 87.3 (1991): 361-66. Web.

Kavanagh, Katherine F., Roberta J. Cohen, M. Jane Heinig, and Kathryn G. Dewey. “Educational Intervention to Modify Bottle-feeding Behaviors among Formula-feeding Mothers in the WIC Program: Impact on Infant Formula Intake and Weight Gain.” Journal of Nutrition, Education and Behavior. 40 (2008): 244-50. Web.

WIC’s Peer Counselor Program

Nicole Jumper, April 4th, 2013

For my part of this research project, I decided to look into the peer counseling program at WIC, “loving support”, and find out what about it how it works, what is effective and what isn’t.  To learn about the program in Chittenden County, I interviewed the peer counselors in the Cherry Street about their experience with the program.
So what is it that these peer counselors do?  Peer counselors are former WIC clients that are now employed by WIC who have, themselves, breastfed their baby/babies for a certain amount of time.  Lori Dotolo, in the WIC office on Cherry Street, is the head of the peer counseling office for Chittenden County.  She explained to me that her requirements when hiring are that the potential counselor has breastfed for at least one year, exclusively.  (These requirements vary by state).  These women go through and interview process and if hired, attend training classes on how to be a peer counselor.  They are given a caseload of clients and give information and support to new mothers.  The counseling is usually done by phone, but in the Cherry Street office they are beginning to have the counselors sit in at the WIC clinics.  These jobs are on a part-time basis, and can usually be done from home.
I sat down with the peer counselors a few weeks back during their monthly staff meetings to ask them about their experiences working for WIC.  As I waited in the meeting room (the break-room as it were) the atmosphere was relaxed and friendly.  It appeared most of these women hadn’t seen each other in a long time and were ecstatic at the chance to catch up with one another.  A handful of children were around the room playing, and one mom kicked her feet up and breastfed while we talked.  The mood was pleasant and calm, and everyone seemed pleased to be there.
Their office employs seven breastfeeding peer counselors who work on a part time basis, roughly ten hours per week.  This varies between states and counties.  They recently had had ten counselors but had scaled down.  Lori mentioned that some women found the job too part time, and decided to find work elsewhere.  Others find it the perfect number of hours, allowing them to either hold down another part time job or to spend more time with their kids at home.  What I wanted to find out was if this setup is effective and how the counselors feel about the program and their job.
I began my questions with, “what is a typical day in the life of a peer counselor?”  The first mom piped up and said that she usually making calls on her couch at home, a book at her side, her kids running around the room trying to get attention, and a dog at her feet.  She grinned as she said this and explained that it is a very relaxed setting where she can multitask while counseling.  She can still watch her kids and be at home while doing her work.  She explained that most of the counseling is through short phone calls.  They will have a caseload of about 40 clients and each client is variable about the consistency of contact and the length of time.  Some people don’t answer or call back, and others will be in regular contact and have a rather intimate relationship with their counselor.  Each new mother varies with the degree she uses the resources provided to her.
I then asked about themes of problems women face with breastfeeding and in turn, what they do to counsel these women.  The most common issues they hear are concerns about milk supply, going back to work or school, time constraints, discomfort, or latching issues.  One answer I loved in response to what they tell their moms was “I try to make them feel empowered and good about what they have accomplished so far.  I ask them what makes them concerned, find out specifics, then gather information and give them the facts.”  Another counselor said that it is important to “give them encouragement and validation about what they have already done.  Moms are so frustrated.  Some are really appreciative and sound more confident (after talking to a peer counselor)”.
At this point someone touched briefly on breastfeeding culture, saying that one of her clients lives with her boyfriend and his brothers and feels uncomfortable breastfeeding in her own home.  We talked about breasts being sexualized in our culture and that sustained breastfeeding (past 1-2 years) is considered “abnormal” in the United States.  Someone mentioned “closet nursing”, that being when women nurse in secret, longer than the cultural norm.  We began a talk about personal experiences when breastfeeding has been taboo in their own lives. One women said that her husbands parents are extremely uncomfortable and can’t even say the word “breastfeeding”.  “She will ask, ‘will you be done with that soon?”‘.  They chose to leave the room rather than stay with her while she breastfeeds.  Another counslor laughed and said at Thanksgiving with her husband’s family she can “clear a room” when she begins breastfeeding.  Another piped in saying that when she had her first baby, she and her husband went down to Miami to visit his family.  The family was outraged that she brought her baby out in public and breastfed and his aunt gave them an especially hard time, but that her husband stepped up to the plate and supported her.
I ended the conversation by asking what types of things were lacking in the peer counselor program at WIC and what kind of improvements could be made.  Here are some of their suggestions:

• more awareness for mothers about the program, outreach improvement

• a way to get moms together with one another in the community so that they can get to know each other and have additional support

• meeting face to face, or meeting the counselor beforehand at the WIC clinic might make them more inclined to answer the phone and be receptive to help

It had been shown that support from family, friends, and community are some of the most important factors in successful breastfeeding.  It sounds like this program is doing a great job of helping breastfeeding mothers so far.  For my next part of this research project I will be looking at other states to see how their programs differ from Vermont and if there are other methods of success in reaching out and supporting breastfeeding moms.

http://healthvermont.gov/wic/food-feeding/breastfeeding/youcandoit/index.aspx
http://www.nal.usda.gov/wicworks/Learning_Center/loving_support.html

The High Life of a WIC Breastfeeding Peer Counselor

Breastfeeding in the Media

Madeleine: March 18, 2013

The media has a powerful influence over what society deems normative.  Given the incredible benefits for both baby and mother, it would make sense that media outlets would encourage breastfeeding, that for every baby formula commercial  there would be a nice ad explaining how incredible women and their mammary glands really are!  However, mainstream media has done otherwise, despite the medical establishment’s promotion of breastfeeding.

Negative Representations of Breastfeeding in the Media

• According to Brown and Peuchaud, there are two fundamental facts about U.S. media that drive negative breastfeeding coverage: 1) The media are increasingly profit-driven conglomerates and 2) They are not in the business of health education (1).
• It is no surprise that a majority of adverstisements push formula on mothers.  Artificial formula can be marketed and sold; breast milk cannot.  One analysis showed a dramtic increase in the numbers of ads promoting infant formula and related products in Parents magazine between 1972 and 1999, as the percentage of women initiating breastfeeding declined (1)
• An analysis of 615 articles published between 1997 and 2003 from seven popular parenting, general women’s and African American magazines in the U.S. found the following (2):  More information was provided on breastfeeding than formula feeding; Responsibility for infant feeding was placed primarily on the mother.  The social benefits of partner, family, peer and/or other support were seldom mentioned;  African American magazines presented more breastfeeding benefits, and general women’s magazines contained the least infant-feeding info; Bottle-feeding images were nearly as common as breastfeeding images
• The “dangers” of breastfeeding have garnered national interest numerous times.  In 1994, the Wall Street Journal covered a story on white mothers suffering from “insufficient milk syndrome,” depicting their babies as the victims of medical institutions that encouraged breastfeeding at all costs.  In striking racist contrast, Tabitha Walrond, a young black mother, was convicted of negligent infant homicide in 1997.  She was blamed for “failing to live up to her responsibilities as a mother” when her two-month-old son died from malnutrition.  Walrond had never been told that her breast reduction surgery might result in insufficient breast milk production yet was pegged as a failed, negligent breastfeeding mother instead of a victim like the white mothers (1).
• How often have you seen a healthy, comfortable woman breastfeeding her baby on the news or in a television show?  Were those around her supportive and offered words of encouragement?
• Articles and images depicting happy breastfeeding woman cause controversy   Complaints are launched that these images are too radical, intimate, provocative, erotic, disgraceful and unacceptable.  Check out the following articles for great examples!

Breast-Feeding In Uniform: Brave or Brazen?

Breastfeeding Images Turn Heads at Any Age

Breastfeeding Flash Mob (seen above)

The Terror Management Theory (TMT)

Developed from a relatively new psychological inquiry, TMT, could provide insight into why breastfeeding is rarely seen in the media and why public breastfeeding evokes such heated controversy   To put it simply, TMT says that humans have a “deep-seated aversion to reminders of the physical, animal nature of humanity” because it reminds us of our mortality.  A study found that thinking about death made people respond more negatively to a public breastfeeding scenario and made then avoid a potential task partner that was described as breastfeeding in another room.  Images of women posing with babies were not found to evoke such negative feelings.  Is it possible the media realizes this and deems breast-feeding a money loser?  Or is this just an excuse for a society’s inability (and immaturity) to handle boobs and babies? (1)

Positives in the Media

Fortunately, the Internet is a great place to find alternative media that embraces a positive breastfeeding culture, but also respects the individual needs of each mother and child.  In response to discrimination against nursing mothers, many have rallied together to provide accurate information and even take to the streets in protest (see “Lactivists” in action).  The following websites offer great information and updates on breastfeeding in the media:  WIC, Nursing Freedom, Womens Health, CDC, La Leche League, 50 Best BF Resources

Ways to Change the Media’s Dangerous Depiction of Breastfeeding

In lieu of my research, I think the following would be beneficial in creating a breastfeeding-positive media:

• Become a lactivist   The organization of all people—not just women—around breastfeeding and positive BF images in the media can help educate an ill-informed public
• Increased representation of women in positions of power in the media.  Historically, men have had control over what makes it through the wires and onto our newspapers and televisions.  What if we had more women as directors, advertisers, TV CEOs, etc. that talked about issues relevant to women’s health?  The development of partnerships between BF advocacy groups with media outlets (1) could also be beneficial and create positive portrayals.
• Call on federal and local public health organizations to create concise media campaigns that inform the public on breastfeeding as a healthy and normal part of life.
• Know your rights!  All states except for Idaho and W. Virginia protect a woman’s right to breastfeed in public.

Sources

(1) Brown, J. & Peuchaud, S. Media and Breastfeeding: Friend or foe? 2008;3:15 Int. Breastfeed J. [NCBI]

(2) Frerichs L, Andsager JL, Campo S, Aquilino M, Dyer CS. Framing breastfeeding and formula-feeding messages in popular U.S. magazines. Women Health. 2006;44:95–118. doi: 10.1300/J013v44n01_06. [PubMed] [Cross Ref]