Wednesday, May 14, 2008

Knocking Down Barriers

I've been hard at work trying to finish my powerpoint for the WIC conference in a couple of weeks. (WIC is a government run food program for low income women and children who are nutritionally at risk- the program supplies them with supplemental nutritious foods to round out their diets) The research has been very thought provoking. I've learned so much more about the barriers that have to be overcome for some women to breastfeed. Its amazing. It seems that the babies who would most benefit from being breastfed are the least likely to be. How sad. I hope to have many, many opportunities to give this presentation. From the research, I identified 55 barriers divided into 9 categories ( political, cultural, social, economic, institutional, behavioral, environmental, educational, and relational). I came up with a list of recommendations that cover every level of human intereaction from governmental interventions to community-based, to one-on-one in the workplace. I have still have mixed feelings about this organization. They are an arm of the government, and the largest purchaser of formula. On the other hand they are under federal mandate to increase breastfeeding rates. However, one of the research articles I came across identified being a WIC mom as a factor for being least likely to breastfeed! At least 2 research articles found WIC interventions to boost breastfeeding to be weak or ineffective (though there were other articles that promoted the stregnth of other interventions). In other words, there is much work to be done. This organization has access to the women who need to increase their breastfeeding rates- so this is the organization to join forces with. The idea is to come up with interventions that really work- interventions that truly change peoples beliefs and behaviors. I don't believe that governments lead cultural change, they can only facilitate and encourage that change. Consumers lead cultural change. My desire is to draw consumers to claim and embrace breastfeeding as their own.


Anonymous said...

WIC gives free formula...why bf? I think that's the attitude.


airdriesg said...

I know this is too true, but when faced up against two problems: having to work to make ends meet and needing money to buy the pump and the time to pump, there will continue to be a low breastfeeding rate in the WIC women. I think many of them know it is better, but are stuck in between a rock and hard place. Maybe WIC could start subsidizing pumps or have a loaning program.

KBH said...
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KBH said...

As BOTH a breastfeeding mother and a recipient of WIC I find this very interesting... I recently heard that WIC was no longer able to give out free formula unless the client had a doctors note stating they couldn't breastfeed for medical reasons. I'm not sure if this is completely accurate, but either way I have mixed feelings. I'd really like to see your powerpoint... maybe you could post it on the blog somehow? There's definately a change that needs to happen culturally and in the establishment. I've found so much mis-information and dis-trust (towards me) in the WIC office. I believe that they assumed I was poor and dumb and that maybe it would be easier to track my baby's 'low' weight (but normal for a breastfed baby) so that they could meet their federally mandated standards if I would just formula feed. Then again I wasn't your typical breastfeeding mom or WIC mom.... college educated, lots of family support, married, breastfeeding a toddler, and pregnant AND very up to date on child development.

Laborpayne said...

Interesting comments ladies. I won't post my powerpoint (intellectual property) but I will continue to discuss some of the research I found. KBH, the doctor's note thing is not true (wish it were). Our government continues to be the largest purchaser and purveyer of infant formula. However the mistrust/misinformaion certainly prevails.

doctorjen said...

When I was in residency I did a small survey among mothers who receive WIC about their breastfeeding attitudes and practices. To gather survey recipients, I sat in the WIC office and asked folks to take my survey while they were waiting. I was really disappointed in this particular WIC office's breastfeeding support. (This was an inner city WIC office with a largely AA population, with a <5% other racial backgrounds.) Even the client sign in sheet they used had a formula company logo on the top - and it was simply a photocopied sheet with name and time signed in on it, but they chose to keep photocopying a sheet with a logo on it! The mothers who were breastfeeding were often still badgered into accepting ABM, because "you won't be able to keep it up, and when you run out you need to have formula around"
I was also disappointed to see that having a healthcare provider recommend or encourage breastfeeding seemed to do very little in my study population - most people reported at least one physician encouraging breastfeeding, but it didn't correlate at all with initiation or continuation rates, while having a supportive family member, especially a mother, did.
In my current practice in a more rural/small town setting, the WIC office is more supportive, having a full time IBCLC on staff and offering individualized help if needed, and high risk infant follow up including home visits. Breastfeeding moms often seem to feel more supported here - although some of that may just be timing as it is almost 10 years later.
I'm always interested in the barriers out there to breastfeeding initiation - and I'm especially interested in ways to encourage continuation. I feel like I have a pretty high initiation rate, but still have a huge drop offs well before I'd like. I always wonder why folks will wean over the oddest, least evidence based advice from a doctor, and yet don't stick it out when given supportive, evidence based reasons to continue!