1. Fielding Graduate University, School of Psychology
Breastfeeding Duration: Comparison of Women, Infants, and Children (WIC) and Non-WIC Supported Families
Leah G. Kenyon-George, MA, Jessica E. Emick, PhD, Joseph P. Bush, PhD, Susan Kim, MA, Erica A. Davies, MA
Fielding Graduate University, School of Psychology
Introduction
Objective
Results
Discussion
Much is known about the benefits of breastfeeding broadly, such as physical benefits for mothers and infants, and cognitive/ developmental benefits for infants (Gartner et al., 2012). However, less is known about the value of breastfeeding duration, particularly in developed countries. It is important to understand potential benefits associated with longer breastfeeding duration for children from low income families. Women among low income groups may experience additional barriers to breastfeeding, including limited financial resources, the need to return to work sooner, and less support and access to coaching (Rippeyoung & Noonan, 2012).
In the United States, the Special Supplemental Nutrition Program is a federally-funded, national program that supports Women, Infants, and Children (WIC) who are low-income or nutritionally at risk by providing supplemental nutritious foods and nutritional counseling as well as links to other services. The relationship between WIC participation and duration of breastfeeding is complex because WIC programs both promote breastfeeding and provide infant formula in food packages, which would seem to encourage non-breastfeeding. Lower breastfeeding duration in women receiving WIC than in those not receiving WIC persists even following efforts by WIC to support breastfeeding. As 53% of children born in the United States are supported by WIC, their programs and policies are far-reaching.
The goal of this study was to better understand the relationship between WIC participation and breastfeeding duration. Breastfeeding duration was examined among low income families participating in WIC (n=5159) and those who were eligible for WIC but did not participate (n= 9369), in order to evaluate the association of WIC with breastfeeding.
An independent-samples t-test showed a significant difference in mean breastfeeding time on the basis of the WIC group, t(9) = 7.101, p < A significantly higher mean was indicated among respondents who replied with “no” for WIC (M = ) as compared with those who responded “yes” (M = ). Next, Levene’s test for the equality of variances was found to achieve statistical significance, W(3, 25999) = , p < .001, which prompted use of the Games-Howell post-hoc test. With respect to the ANOVA itself, statistically significant mean differences were found in breastfeeding time on the basis of race, F(3, 25999) = , p < Following this, a general linear model was tested focusing on the main effects of WIC, respondent race, and the interaction between these two main effects. The between-subjects effects were statistically significant with respect to WIC, F(1, ) = , p < .001, respondent race, F(3, ) = , p < .001, and the interaction between WIC and respondent race, F(3, ) = , p < Next, separate analyses were conducted comparing races on the basis of WIC. Results of the ANOVA indicated a significant mean difference for race, F(3, 14201) = , p < A second ANOVA was conducted focusing on respondents who responded with “yes” to WIC. Results indicated significant differences with respect to race among these respondents, F(3, 6566) = , p < .001.
The findings of this study demonstrated significant differences in breastfeeding duration between WIC and non-WIC groups across all racial/ethnic groups, suggesting that the presence of WIC services may negatively impact breastfeeding duration. Additionally, looking more specifically within each of the ethnic/racial groups, it is clear that the presence of WIC was more strongly negatively associated with breastfeeding duration for Caucasian and Multi-Racial/Other, Non-Hispanic groups as compared to Black or Hispanic groups. While acknowledging the multiple complex and nuanced factors that impact breastfeeding, the findings of this study may have important implications for policy makers, researchers, and clinicians as we start to consider the need for culturally responsive strategies and programs to support breastfeeding duration and consider the role that receiving services from WIC or similar organizations may play in that process.
Methods
Data from the 2011 National Survey of Children’s Health, a nationally representative cross-sectional survey, were analyzed. Analyses were conducted on families who were at least 400% below Federal Poverty Level with children aged 6 months to 5 years old for whom breastfeeding data were available.
The problem of missing data not at random was addressed using multiple imputations. An independent-samples t-test was conducted in order to determine whether a significant difference in mean breastfeeding time was present on the basis of WIC group. Following this, a one-way ANOVA was conducted in order to determine whether significant mean differences in breastfeeding time existed on the basis of respondent race. Following this, a general linear model was tested focusing upon the main effects of WIC, respondent race, as well as the interaction between these two main effects. Next, a second ANOVA was conducted focusing on respondents who responded with “yes” to WIC. Following this, additional analyses were conducted in order to determine whether the measures identified as potential covariates had significant associations with WIC.
Limitations and Future Directions
The current study had several limitations inherent to the data set including missing data not at random. Multiple imputation was used in an attempt to ameliorate this problem. Previous research has suggested that parental retrospective self-report of breastfeeding duration is less accurate than other measures and may result in over-reporting. As the data were collected in 2011/2012, there were some additional initiatives and programs through WIC at both national and state levels to support breastfeeding that may have impacted duration. Finally, there is a lack of specificity in how the various racial and ethnic groups are defined within the current study. Of note, there is no specific Asian category. Despite these limitations, the results of the study are a good starting point for further conversation and evaluation.
ACKNOWLEDGEMENTS
Data were provided by: 2011/12 National Survey of Children’s Health. Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. 2011/12 NSCH SPSS Indicator Data Set prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative.  
Contact
For further information, please contact Jessica Emick at
ANOVA with Race: Games-Howell Multiple Comparisons
Group Group Mean Difference (1-2)
Hispanic White, non-Hisp ***
Black, non-Hisp ***
Multi-racial/Other, non-Hisp ***
White, non-Hisp Hispanic ***
Black, non-Hisp ***
Multi-racial/Other, non-Hisp
Black, non-Hisp Hispanic ***
White, non-Hisp ***
Multi-racial/Other, non-Hisp ***
Multi-racial/Other, non-Hisp Hispanic ***
White, non-Hisp
Black, non-Hisp ***
Note. *p<.05, **p<.01, ***p<.001.
References
Gartner, L.M., Morton, J., Lawrence, R.A., Naylor, A.J., O’Hare, D., Schanler, R.J., Eidelman, A.I. & American Academy of Pediatrics Section on Breastfeeding (2005). Breastfeeding and the use of human milk. Pediatrics 115, 496–596. DOI: /peds
Rippeyoung, P.L.F., & Noonan, M.C. (2012). Is breastfeeding truly cost free? Income
consequences of breastfeeding for women. American Sociological Review, 77 (2), DOI: /
United States Department of Agriculture Food and Nutrition Service. (2015). Women Infants and Children (WIC): About WIC- WIC at a Glance. Retrieved from