WIC Infant Toddler Feeding Practices Study 2 Infant

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 1

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). 2

Methodology • Longitudinal study • Follows infants enrolled in WIC from birth to age 5 • Nationally representative • Began Fall 2013 3

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 4

Study States (27) and Sites (80) 5

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 6

Data Collection 7

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 8

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Study Sample 10

Demographic Characteristics Racial and Ethnic Distributions Other 15% White 59% African American or Black 26% Hispanic/ Latino 38% Non. Hispanic 62% 11

Demographic Characteristics Parity Mother’s Age Third or Subsequent born 16 -19 years 26+ years 12% First born 32% 47% 41% 27% 20 -25 years Second born 12

Breastfeeding Beliefs and Intentions 13

Prenatal Views: Benefits of Breastfeeding Maternal Attitudes and Beliefs Benefits of Breastfeeding Breastfed babies are healthier than formula-fed babies. Breastfeeding helps protect the baby from diseases. Percentage of Mothers Agreeing with Statement WIC IFPS-1 WIC ITFPS-2 (1994 -95) (2013 -14) Direction of Change 61 77 79. 7 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. Breastfeeding reduces the risk of a child becoming overweight. Breastfeeding helps women lose weight. 71 71. 3 ↑ Not Asked 50. 0 -- 53 74. 5 ↑ 14

Prenatal Views: Barriers to Breastfeeding Maternal Attitudes and Beliefs Barriers to Breastfeeding ties you down. Percentage of Mothers Agreeing with Statement WIC IFPS-1 WIC ITFPS-2 (1994 -95) (2013 -14) Direction of Change 41 17. 3 ↓ Breastfeeding takes too much time. 34 14. 7 ↓ Breastmilk leaking onto your clothes is something that I worry about. Breastfeeding in public is not something that I want to do. Breastfeeding is painful. 46 27. 4 ↓ 61 36. 9 ↓ 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 ↓ 15

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. 39% 22% 6% 4% IFI Scale score range Very Low (0 -3. 5) Moderate (8 -11. 5) Very Strong (16) Low (4 -7. 5) Strong (12 -15. 5) 16

Breastfeeding Behaviors 17

Breastfeeding Rates Increased Since 1994 83% Breastfeeding Rates by Month 61% 56% WIC ITFPS-2 WIC IFPS-1 42% 33% 26% 22% 18% 21% Initiation Month 1 Month 3 16% 12% 10% Month 5 Month 7 Month 9 Month 12 NOTE: Similar slopes in trend lines between studies. 7% 18

Breastfeeding Initiation by Race and Ethnicity 91% 84% 74% 53% 62% 92% 84% 34% African American or Black White ITFPS-2 76% Other NA IFPS-1 Hispanic/Latino ITFPS-2 Non-Hispanic IFPS-1 19

Expressing Breastmilk Percentage of Breastfeeding Mothers Who Report Expressing Breastmilk During the Past Week 59% 56% 47% 42% 36% 24% NA Month 1 Month 3 ITFPS-2 Month 5 NA Month 7 IFPS-1 20

Rates of Exclusive Breastfeeding and Combination Feeding Healthy People 2020 Goals: 46% exclusively breastfeeding through 3 months; 26% exclusively feeding through 6 months 31% 22% 30% Month 1 16% 12% 20% 16% 15% Month 3 Month 5 Month 7 Exclusively BF Combination Feeding (BF + FF) 21

Top Reasons for Breastfeeding Cessation At 3 months, top reasons why mothers stopped breastfeeding: 1. Breastmilk alone did not satisfy baby (57%) 2. I didn’t produce enough breastmilk (56%) 3. Baby lost interest in nursing (34%) 22

Moms Not Breastfeeding As Long As They Intended Percentage of Breastfeeding Mothers Who Met Their Personal Breastfeeding Goals, by Length of Goal 72% 69% Met goal 28% 31% Did not meet goal 6 months or less More than 6 months Length of breastfeeding goal 23

Introduction of Complementary Foods 24

Early Introduction of Complementary Foods is Less Prevalent WIC IFPS-1 (1994 -95) WIC ITFPS-2 (2013 -14) 38% 62% 20% 80% Introduced complementary foods before 4 months No introduction of complementary foods before 4 months 25

Complementary Foods Are Being Introduced Later Mean Age (in Months) Infants Were Introduced to Complementary Foods 8 6 6 5 3. 5 Infant Cereals 4 Fruits WIC ITFPS-2 (2013 -2014) Vegetables Meats WIC IFPS-1 (1994 -95) 26

Caregivers’ Perceptions of WIC 27

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 28

WIC is a Trusted Source of Information on Infant Feeding Percentage of Caregivers that Received Feeding Information by Source Doctor or health professional 66% 59% WIC office or clinic 56% Family member Internet or parenting websites 34% Husband/boyfriend 32% 25% Books or magazines 23% A friend Mom's group or class 9% 29

Additional Support Provided by WIC • Postpartum women who received support calls from WIC were more likely to be breastfeeding exclusively at 1 month 30

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%) 31

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. 32

Future Directions 33

Next Steps • Analyzing toddler data through 24 months • Currently collecting 36 & 42 month data (48 month data collection starts in late April!) 34

How You Can Stay Involved • Download the full report 35

How You Can Stay Involved 36

How You Can Stay Involved 37

How You Can Stay Involved 38

How You Can Stay Involved • Download the full report • Share the infographic 39

How You Can Stay Involved 40

How You Can Stay Involved • Download the full report • Check out the infographic • Support the study team with final rounds of data collection 41

Height/Weight Card 42

Thank you! Courtney. Paolicelli@fns. usda. gov 703. 605. 4370 43