Breastfeeding Promotion Among WIC-Participating Women in North Carolina.Abstract, Executive Summary of Dissertation

摘要

There is an urgent need to develop breastfeeding promotion programs for low-income mothers and to evaluate effects of nursery formula discharge packs upon breastfeeding. We used integrated qualitative-quantitative methods among North Carolina WIC-participating women to elicit barriers to breastfeeding, teaching opportunities, timing of the infant-feeding decision, and components of hospital discharge packs conducive to breastfeeding. We developed and tested the effectiveness of low cost innovative nonformula nursery discharge packs and teaching strategies and instruments for prenatal WIC breastfeeding promotion using a 2x2 factorial randomized controlled trial in 6 North Carolina WIC clinics. Results showed that most WIC mothers made their feeding decision prior to or early in pregnancy. Testing caused significant improvements in knowledge, attitudes and plans for exclusive breastfeeding and a trend to improved social support. Teaching and discharge pack interventions had no effects upon breastfeeding incidence. However there were modest but not statistically significant effects of both interventions on breastfeeding duration. Exploratory analyses suggested marked intervention effects upon breastfeeding among subgroups of mothers. These results suggest prenatal teaching improves knowledge, attitudes and plans for exclusive breastfeeding and that formula discharge packs may be related to decrease breastfeeding. These findings have important policy implications for WIC and local and national health decisionmakers.