title: A barrier to exclusive breastfeeding for WIC enrollees: limited use of exclusive breastfeeding food package for mothers.
abstract: BACKGROUND
  In the first 2 weeks of life, most breastfeeding mother-infant dyads in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive infant formula from WIC, instead of a larger food package designed for exclusively breastfeeding mothers. This study was designed to explore reasons for high rates of formula supplementation of breastfeeding newborns enrolled in WIC and the limited use of the WIC expanded food package.
  
  
  METHODS
  We conducted in-depth interviews with 29 mothers who either partially or exclusively breastfed for at least 2 months. Interviews were transcribed verbatim, analyzed, coded, and organized into 10 themes.
  
  
  RESULTS
  Participants view the WIC program in a contradictory manner. They see it as highly supportive of breastfeeding, but also as a promoter of infant formula. The expanded food package for mothers is not valued, but free supplemental formula is highly valued. Misinformation about breastfeeding pervades the healthcare system, and exclusive breastfeeding is not promoted as an important health goal. Lack of access to breast pumps, the unacceptability of pumping in the workplace, and difficulties with nursing in public all contribute to formula supplementation.
  
  
  CONCLUSIONS
  The healthcare system, the WIC program, and demands of daily life all contribute to low rates of exclusive breastfeeding in the WIC program. The available expanded food package for mothers who are exclusively breastfeeding is both disliked and underutilized, while free supplemental formula is rarely discouraged.
authors.affiliation: Department of Pediatrics, Concord Hospital, Concord, New Hampshire 03301, USA. aholmes@crhc.org
authors.forename: Alison Volpe
authors.initials: AV
authors.lastname: Holmes
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Chin
authors.forename: Jeffery
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Cindy R
authors.initials: CR
authors.lastname: Howard
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007407:Interviews as Topic; D008019:Life Style; D009035:Mothers / Q000523:psychology*; D009518:New York; D011632:Public Assistance / Q000706:statistics & numerical data*; D014931:Women, Working / Q000523:psychology; D055815:Young Adult