Did changes in WIC packages make you choose exclusive breastfeeding? A new study investigates.

Did you know that over half of American infants receive support from the Women, Infants, and Children (WIC) program each year, at over 9,000 clinic locations?  That the program is the largest purchaser of infant formula in the U.S.?  That there are thousands upon thousands of WIC breastfeeding peer counselors, likely making it the largest system of breastfeeding support in the country?

With reach like that, the impact of the WIC program on breastfeeding in the U.S. can’t be understated.  So when big changes happen in the WIC program, it’s important to pay attention.  A new study out last week assesses what happened when WIC dramatically changed its infant feeding benefits, and I thought it was worth a close look.

Women who receive WIC benefits have for years have had lower breastfeeding rates than other mothers.  The demographics of WIC participants (lower income, younger, etc.) are independently associated with lower breastfeeding rates, but studies have found that even when compared to similar mothers not using WIC, those on WIC have lower breastfeeding rates.  This suggests that WIC itself might have a negative impact on breastfeeding behaviors.

So for years now, WIC has been trying to reverse this connection, turning the program from “the place where you get free formula” into a breastfeeding promotion and support system through efforts like its peer counseling program, Loving Support and Fathers Supporting Breastfeeding breastfeeding promotion campaigns.  But it wasn’t until the last few years that WIC revamped its actual benefit package to encourage mothers to breastfeed, and to do so exclusively.

WIC benefits for infants fall into three “packages:”  a full breastfeeding package with no infant formula, a partial breastfeeding package with some infant formula, and a full formula package.  In addition to infant food, mothers also receive food for themselves.

For years there have been complaints about the way these packages were constructed.  Among the problems:  The value of the fully breastfeeding package was significantly lower than the other packages.  The large amount of formula given to partially breastfeeding mothers was considered an incentive to supplement more.  Formula was given to partially breastfeeding mothers in the first month, which may have hindered the development of their milk supplies.  Infant cereals were given starting at 4 months.

So in 2007, after much study, WIC began to roll out a revised set of food packages, which include:

  • A fully breastfeeding package with the highest and most varied amount of food for the mother for one year, and the highest amount of complementary foods for the baby starting at six months.  Breastfeeding support provided.
  • A partial breastfeeding package with no formula in the first month, with less formula than in previous packages, and a higher amount of food for the mother than the fully formula feeding package, for one year. Mothers requiring more than the amount of formula given in this package (50%)are given the fully formula feeding package.  Breastfeeding support provided.
  • A fully formula feeding package, with an amount of formula dependent upon the needs of the infant, and food for the mother for six months.

These changes brought the value of the fully breastfeeding package closer in line with the value of the other packages, and were intended to provide a strong incentive for moms to choose breastfeeding and exclusive breastfeeding.

So, after reviewing the records for over 200,000 infants aged 0-5 months in 10 states, what did the authors of the recent study say about the effects of these changes?

After implementation of the [new package], fewer WIC mothers were assigned the partial breastfeeding package, whereas more mothers were assigned to the full breastfeeding and full formula packages.  For dyads or partial dyads in whom the infant was in his or her birth month, the percentage of mothers who received the partial breastfeeding package fell from 24.7% to 13.8%. The percentage of mothers who received the full breastfeeding package rose from 9.8% to 17.1%, and the percentage of mothers who received the full  formula package rose from 20.5% to 28.5%. [emphasis mine]

What about breastfeeding initiation?

The breastfeeding initiation rate for WIC participants was essentially unchanged at 65.5% (preimplementation) and 65.1% (postimplementation).   Overall rates of breastfeeding initiation appeared quite stable even as WIC package assignments changed.

And what about exclusivity over time?

In dyads with infants who were 3–5 mo old, the use of the full breastfeeding
package was nearly the same before and after implementation of the change. Thus, the increased use of the full breastfeeding package after implementation was observed for dyads with infants aged 0–2 mo but not for dyads with infants aged 3–5 mo.

So, what might explain these results, especially the shift away from the ‘middle’ option to the fully breastfeeding and fully formula feeding options?

One, the authors note, is that mothers requiring more formula than is given to partially breastfeeding mothers were reclassified as fully formula feeding mothers.  Another factor, I would guess (and have heard anecdotally), is that mothers intending to breastfeed but not sure if they can do it exclusively might be scared by hearing that they’ll receive no formula in the first month, and opt for the fully formula feeding package.  The authors note that implementation of the changes may have been uneven around the country.  And finally, the authors note that the period of data collection (2009) was a very volatile one for the U.S. economy:  “it is still possible that rapid changes in the US economy in 2009 could have influenced WIC package choices.”

Have you used WIC?  Were the package changes an incentive to breastfeed or breastfeed exclusively?  What do you think of these results?  What other factors could explain them? 




10 thoughts on “Did changes in WIC packages make you choose exclusive breastfeeding? A new study investigates.

  1. I’m on WIC, and exclusively breastfeed. The different packages had no impact on my choice (I went into it intending to BF, and got GREAT support from my local office). But I have been pleasantly surprised by how much I am receiving as a exclusively breastfeeding mother 😀 It has been so helpful since we have a very difficult time financially but not quite enough of a difficult time to receive normal state aid.


  2. I was breastfeeding during the implementation of this change. Even the WIC office during visits that occurred during my pregnancy discussed ways to get formula before the first post-baby appointment. I got no breastfeeding support besides a DVD. I was not given any information about pumping or the availability of pumps. I was told on more than one occasion that I should consider the combo feeding package “just in case”

    I was *NOT* discouraged from nursing in the waiting room though.

    They also insisted on looking at my child’s weight on a CDC chart and did not take into account that she was 80th percentile in length (telling me to worry about her 85th percentile weight at <6 months old)

    At the same time, they got on to me for planning to not introduce solids until 6 months of age.

    I canceled my visit scheduled for 6 months post partum because we weren't going to use the food for the baby (we were using baby led weaning) and since they also didn't support me being dairy free at the time (due to my child's sensitivity) we weren't able to use a lot of what they provided for me.

    I know of at least one other person locally who had similar experiences and left WIC because they didn't support a dairy-free diet.


    1. to clarify: they were suggesting ways to get formula to feed the baby between the hospital discharge and the first WIC appointment for baby, which was often weeks later. Their suggestions included using food stamps, purchasing it, and visiting food banks. One time, they did add, or you could try breastfeeding.


  3. I gave birth to my second son in 2009, the year they changed the food packages. The change didn’t affect my decision to breastfeed exclusively, as this was a choice I made for both my sons. Both my boys had different needs with breastfeeding; my first one would drink from me, a bottle of warmed milk was fine, he even accepted a pacifier that we fazed out after six months. My second son was born with severe sucking blisters, still sucks thumb even now, would only drink from me not a bottle. That made being away from him for a short time very difficult. Unfortunately I went back to work when he was nine months old, there was plenty of stored milk that he barely drank. After his first birthday he weaned himself and stuck to cows milk. My first son went to fourteen months then weaned. We still had a good experience.


  4. I have been a Peer Counselor for about two years now. I really have to say that I don’t think the food packages really sway my mother’s either way…even though I still use it as a “selling” tool. As much as I try to support these mothers and as much as I try to ease whatever concerns they have…some moms will just breastfeed no matter what and some moms will just be 50/50 no matter what I say or whatever kind of foods they will receive. I do believe that the reason breastfeeding is on the rise is BECAUSE of Peer Counselors…if you ever step foot in a WIC office, as Pro Breastfeeding as anyone wants to be…there was no time in the past to sit with a mom, sometimes for over an hour on her concerns…When it IS YOUR job to help that mom to answer any questions she has about breastfeeding and not just dismiss her to move on to the next folder…this has impact..and I think that is why the numbers are rising..To be honest I have had many a mother in my office say…its too much food anyway…I do have a handful of mothers every month that would have chosen formula because they were not educated on the difference between such choices or wean too early if I were not there to help them…Whenever I have a mother in my office crying and thanking me if it weren’t for me she would have quit..I QUICKLY take it from attention on me to them..and say..if it weren’t for your babies you wouldn’t be able to breastfeed…the two of you are doing all the work…Im just on the sidelines cheering you on…


  5. I hear stories from nurses; some suggest to their patients receiving WIC to say that they are formula feeding, otherwise those patients won’t get any formula. So it isn’t only ” that mothers intending to breastfeed but not sure if they can do it exclusively might be scared by hearing that they’ll receive no formula in the first month, and opt for the fully formula feeding package”, it can also be the healthcare professional’s advice in the hospital.

    Nearly every new mother is worried about her milk supply; it is a normal fear, part of the passage from pregnancy to motherhood. When postpartum practices separate mothers from their newborns (as still happens in a majority of US hospitals), this fear is magnified. When hospital staff are uneducated about breastfeeding, they are also worried about the sufficiency of breastfeeding and want to be sure that babies will be fed. Fear is a powerful and contagious energy. Aggressive formula marketing preys on fear.

    However, the good news is that national organizations like Joint Commission, and the CDC (via its NICHQ and mPINC projects) are putting money and energy behind breastfeeding. In Pennsylvania, the WIC program has given $65,000 grants to birth hospitals in Philadelphia to promote skin to skin care and other hospital practices to increase breastfeeding. More and more, the healthcare system is working to make important changes. This is good news for breastfeeding.


  6. We receive WIC and I’m exclusively breastfeeding (for 5 months now) and I have to say that the extra food didn’t sway my opinion, but I love having it. It’s been a real life saver. I do also have to say that I love the peer counselors. The one at my office is awesome. She calls and checks up on me every few weeks to see how breastfeeding is going – even now, even after all this time, she didn’t just drop out on me. That has been very cool and super helpful. They also gave me a hand pump at WIC which I didn’t think I would want originally but now that I need to be away from my little guy for a little bit is coming in extremely handy. I would probably still breastfeed without WIC, but the support has certainly helped me. Not that I would have stopped without it, but I probably would have felt more discouraged about it. Oh and at my WIC I had a whole breastfeeding class, with lots of showing and telling and helping and I know that I can call them at any time and get help with breastfeeding – my peer counselor even gave me her cell number. I feel truly supported there in my decision to breastfeed.


  7. We receive WIC, and my daughter, nearly 12 months old, has never had formula! There are many reasons the changes in the food packages did not drastically change breastfeeding rates. When I said that I wanted to breastfeed, I received a small booklet about breastfeeding that was very incomplete in its information. I also was told that I could receive a pump. During the first month, I used a friend’s pump until I was allowed my own pump from WIC. It was a struggle to get my peer counsellor at the time to drop off my pump. I have faced many challenges while breastfeeding, including two nursing strikes, mastitis, innumerable clogged ducts, and a post-stomach-virus plummeting milk supply. Every time I dealt with a problem, I found that contacting my hospital’s free lactation consultant phone line was far more helpful than speaking with my peer counselor. I did not have to take any breastfeeding class from WIC until my daughter was three months old! At that point, I was the only woman in the room who had managed to avoid giving formula. Better pre-delivery breastfeeding training really needs to be initiated!

    Finally, WIC forgot to give me vouchers for baby food at six months, and I am glad. The baby food they provide far exceeds the needs of any normally developing baby. By eight months of age, my daughter was preferentially eating finger foods, and now she eats “baby” versions of what we eat. I have provided three other parents with baby cereal for their babies, and I still have extra boxes (I use it as bread crumbs when I cook)! I’ve also inundated friends with jarred meats to the point where they requested I not bring them any more meat. I cook with the jarred veggies and fruits. I now give extra meat for babies to a friend who has cats. Effective incentivizing would take into account baby development and allow increases in the produce voucher while decreasing the baby-specific food.


    1. Megan,

      Sounds like your WIC office has a ways to go in breastfeeding support!

      And I’ve heard the comment about receiving too much jarred food from other moms, too. I wonder if it would be better to increase the moms’ benefit and decrease the solids in order to protect breastfeeding after six months.



  8. I chose to breastfeed BECAUSE of the price of formula. Breastfeeding is EXTREMELY stressful for me, so when I had the option to have free formula, you bet I weaned! I’ll bet there are a lot of mothers out there like me. Also, people who can’t afford formula are typically those who also need to work to support the family, so breastfeeding exclusively isn’t always a viable option. I’m sure these are factors in why changing the plans hasn’t affected the statistics of how many women on the program breastfeed.


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