WIC Infant Toddler Feeding Practices Study – 2: Infant Year Report 2017 National WIC Association Annual Education and Training Conference & Exhibits Courtney Paolicelli, USDA FNS Nancy Weinfield, Westat Shannon Whaley, PHFE WIC

Purpose The Feeding My Baby Study (WIC ITFPS-2) addresses: Infants’ and children’s feeding practices Associations between WIC services and: feeding practices Health and nutrition outcomes of children receiving WIC. Infant Year Report Focus: Breastfeeding initiation and duration, and Introduction of complementary foods. Comparisons with the 1997 WIC Infant Feeding Practices Study–1 (WIC IFPS-1).

Methodology Longitudinal study Follows infants enrolled in WIC from birth to age 5 Nationally representative Began Fall 2013

Study Participants Eligibility Requirements Pregnant or infant less than 2.5 months old First time enrolling in WIC for this pregnancy or child At least 16 years old Speaks English or Spanish 3,777 infants in sample for this report

Study States (27) and Sites (80)

Data Collection WIC Site Data Site visits Key Informant Interviews (State and Local Agency) WIC staff survey WIC Participant Data Enrollment on site Follow-up telephone interviews WIC Administrative Data Height/weight data for those off WIC

Data Collection

Infant Data Collection Interviews conducted every 2 months Incentive for completing telephone interview N=3,777 caregivers (completed at least a 1 or 3 month interview) Birth 1 3 5 7 9 11 13

Study Sample

Demographic Characteristics Racial and Ethnic Distributions Hispanic/ Latino 38% Non-Hispanic 62%

Demographic Characteristics Mother’s Age Parity Third or Subsequent born 16-19 years 26+ years First born Second born

Breastfeeding Beliefs and Intentions

Prenatal Views: Benefits of Breastfeeding Maternal Attitudes and Beliefs   Percentage of Mothers Agreeing with Statement WIC IFPS-1 (1994-95) WIC ITFPS-2 (2013-14) Direction of Change Benefits of Breastfeeding Breastfed babies are healthier than formula-fed babies. 61 79.7 ↑ Breastfeeding helps protect the baby from diseases. 77 81.2 Breastfeeding is easier than formula feeding. 50 55.3 Breastfeeding brings a mother closer to her baby. 81 87.9 Breastmilk alone gives a new baby all he/she needs to eat. 71 71.3 Breastfeeding reduces the risk of a child becoming overweight. Not Asked 50.0 -- Breastfeeding helps women lose weight. 53 74.5

Prenatal Views: Barriers to Breastfeeding Maternal Attitudes and Beliefs   Percentage of Mothers Agreeing with Statement WIC IFPS-1 (1994-95) WIC ITFPS-2 (2013-14) Direction of Change Barriers to Breastfeeding Breastfeeding ties you down. 41 17.3 ↓ Breastfeeding takes too much time. 34 14.7 Breastmilk leaking onto your clothes is something that I worry about. 46 27.4 Breastfeeding in public is not something that I want to do. 61 36.9 Breastfeeding is painful. 39 43.6 ↑ Breastfeeding means no one else can feed your baby. 48 50.8 With bottle feeding, the mother knows that the baby is getting enough to eat. 76 67.0

Infant Feeding Intention (IFI) Scale Scores 0-16 point scale composed from five questions Higher scores = stronger intention to breastfeed Nearly ¾ of prenatal WIC participants have a moderate to very strong intention to exclusively breastfeed.

Breastfeeding Behaviors

Breastfeeding Rates Increased Since 1994 NOTE: Similar slopes in trend lines between studies.

Breastfeeding Initiation by Race and Ethnicity NA

Expressing Breastmilk Percentage of Breastfeeding Mothers Who Report Expressing Breastmilk During the Past Week

Rates of Exclusive Breastfeeding and Combination Feeding Healthy People 2020 Goals: 46% exclusively breastfeeding through 3 months; 26% exclusively feeding through 6 months

Top Reasons for Breastfeeding Cessation At 3 months, top reasons why mothers stopped breastfeeding: Breastmilk alone did not satisfy baby (57%) I didn’t produce enough breastmilk (56%) Baby lost interest in nursing (34%)

Moms Not Breastfeeding As Long As They Intended

Introduction of Complementary Foods

Early Introduction of Complementary Foods is Less Prevalent WIC IFPS-1 (1994-95) WIC ITFPS-2 (2013-14)

Complementary Foods Are Being Introduced Later Mean Age (in Months) Infants Were Introduced to Complementary Foods

Caregivers’ Perceptions of WIC

WIC Positively Impacts Breastfeeding Behaviors For > 95% of breastfeeding mothers, WIC played an important role in breastfeeding decision 61% identified the enhanced food package as an important factor in their breastfeeding decision Moms aware of the enhanced food package breastfed for 1.5 months longer

WIC is a Trusted Source of Information on Infant Feeding

Additional Support Provided by WIC Postpartum women who received support calls from WIC were more likely to be breastfeeding exclusively at 1 month

Perceived Influence of WIC on Feeding About 60% of study mothers indicate they made positive changes in feeding practices because of something they learned at WIC. Most common changes at 13 months were: Know how to choose more healthy foods for myself/family (34%) Eat more fruits and vegetables (27%)

Key Findings Breastfeeding rates have risen dramatically over the past 20 years. Early introduction of complementary foods is less prevalent among WIC participants than previously. Caregivers credited WIC with making positive changes in how they feed their infants and themselves. Participants reported extensive support from WIC.

Future Directions

Next Steps Analyzing toddler data through 24 months Currently collecting 36 & 42 month data (48 month data collection starts in late April!)

How You Can Stay Involved Download the full report

How You Can Stay Involved

How You Can Stay Involved

How You Can Stay Involved

How You Can Stay Involved Download the full report Share the infographic You can also check out the fabulous infographic that our partners at Westat created for the Infant Year REport.

How You Can Stay Involved

How You Can Stay Involved Download the full report Check out the infographic Support the study team with final rounds of data collection Of course, if you’re one of the lucky folks who works at a WIC clinic or state agency that is involved in the study, first off, we sincerely THANK YOU for your support and your cooperation, and we encourage you to continue supporting these study activities. As some of you may already be aware, our state agencies and sites help with a number aspects of data collection. Several of them assist us with putting together our IRB packets.

Height/Weight Card Additionally, study participants who are no longer receiving WIC are still eligible to participate in the study. But in order to obtain accurate height/weight data, we send them this card and ask them to go back to their WIC clinic and get this information completed. We truly appreciate the dedication and commitment of staff who help us by getting this info from non-participants. The study will be done with data collection in just a couple years, so we’re almost there! We truly do appreciate the help of our folks on the ground that are making sure we get this data so we can tell the story of how WIC is impacting so many participants.

Courtney.Paolicelli@fns.usda.gov 703.605.4370 Thank you! Courtney.Paolicelli@fns.usda.gov 703.605.4370