Breastfeeding Initiation Trends by Special Supplemental Nutrition Program for Women, Infants, and Children Participation and Race/Ethnicity Among Medicaid Births

Abstract

Objective: Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity.

Design: Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009.

Participants: Term births with hospital costs covered by Medicaid (N = 6,402,704).

Main outcome measures: Breastfeeding initiation.

Analysis: The descriptive characteristics of WIC participants and WIC-eligible nonparticipants were compared by year and race/ethnicity using the chi-square test of independence or t tests. Adjusted breastfeeding initiation prevalence was estimated using linear regression models with county fixed effects, controlling for sociodemographic and obstetric/health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Differences and P values were assessed using interaction terms between WIC and year.

Results: Breastfeeding initiation increased for WIC participants and nonparticipants. Special Supplemental Nutrition Program for Women, Infants, and Children participants had lower adjusted breastfeeding initiation (2009: 69.0%; 2017: 78.5%) than nonparticipants (2009: 70.8%; 2017: 80.1%) (P < 0.001 per year). Breastfeeding initiation increased more rapidly in WIC participants than in nonparticipants for non-Hispanic Asian/Pacific Islander (21.4% and 8.6%, respectively; P < 0.001) and American Indian/Alaskan Native (13.6% and 8.1%, respectively; P = 0.02)-narrowing the gap between WIC participants and nonparticipants over time.

Conclusions and implications: Annual birth certificate data provide detailed information for monitoring trends and disparities in breastfeeding initiation by prenatal WIC status. These findings can inform WIC and maternal child health program efforts to improve breastfeeding promotion for populations with low-income and racial/ethnic groups.

Keywords: WIC; breastfeeding; racial/ethnic disparities.