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When women stop breastfeeding linked to child care options, study shows

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A new study led by Juhee Kim, a professor of kinesiology and community health, found links between mothers’ participation in WIC, use of relatives for child care and shorter breastfeeding duration. Although WIC offers various incentives to mothers to promote breastfeeding, there is also a need for educational programs aimed at relative caregivers, the study indicated.

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3/13/2012 | Sharita Forrest, News Editor | 217-244-1072; slforres@illinois.edu

CHAMPAIGN, lll. — Mothers participating in the Special Supplemental Nutrition program for Women, Infants and Children, known as WIC, are more likely to discontinue breastfeeding their infants before 6 months of age than non-WIC mothers, especially if they rely upon relatives to provide child care, according to a new study by Juhee Kim, a professor of kinesiology and community health at the University of Illinois.

Kim’s study sample included more than 7,500 children 8-14 months of age. About 50 percent of the infants were enrolled in WIC, and 47 percent received child care on a regular basis.

WIC programs provide a number of resources and incentives to promote breastfeeding; however, WIC participants were twice as likely as non-WIC mothers – 41 percent versus 20 percent, respectively – to never initiate breastfeeding.

About 28 percent of the WIC participants used relative child care, and their infants showed a greater prevalence of early introduction of solids (29 percent) and short breastfeeding duration (79 percent).

“Most notably, compared to infants in parental care, infants in relative care had a lower rate of breastfeeding and a higher rate of early introductions of solids with greater weight gain,” Kim and her co-authors wrote. Their study appeared last month in the Journal of Human Lactation.

Researchers have documented numerous short- and long-term health benefits for breastfed infants, including lower incidence of Sudden Infant Death Syndrome, obesity and Type 1 and Type 2 diabetes.

“Breastfeeding not only benefits infants in many ways, it benefits mothers too, causing faster postpartum weight loss and reducing women’s risks for breast and ovarian cancer,” in addition to being more economical than formula feeding, Kim said.

More than half (58 percent) of all infants born in the U.S. during 2008 were covered by WIC, and 47 percent of all newborns participate in some form of nonparental child care during their first year, “meaning we have a good window of opportunity for providing education to promote healthy infant feeding practices,” Kim said.

WIC provides food assistance to pregnant, postpartum and breastfeeding women and children up to age 5. Participants must have incomes at or below 185 percent of the federal poverty level, meet state residency requirements and be determined nutritionally at risk by a health professional.

Mothers who breastfeed can extend their eligibility for WIC benefits from six months to one year, and they are eligible for enhanced food packages, peer counseling and supplies such as breast pumps.

Regardless of WIC status, mothers who used relatives for child care were most likely (80 percent) to not breastfeed for six months, followed by mothers who used center-based day care (78 percent) and mothers who used non-relative care (72 percent).

Infants receiving parental care, which made up about half of the children in the study, were least likely to be introduced to solid food early (20 percent) or have short breastfeeding duration (60 percent).

“WIC has a nutrition education component for mothers, so they have to pay attention to recipients’ child care arrangements,” Kim said. “If women say they are using informal arrangements or relatives for child care, WIC might want to have an educational component for the caregivers as well about the importance of breastfeeding and making sure not to introduce solids before infants are 4 months old.”

The American Academy of Pediatrics currently recommends six months of exclusive breastfeeding and delaying the introduction of complementary foods until infants are 4-6 months old, but only 15 percent of mothers in the U.S. follow those guidelines, oftentimes because they have to go back to work soon after childbirth and place their infants in child care, Kim said.

About 30 percent of all mothers in the study population never initiated breastfeeding, and 67.8 percent of mothers who did breastfeed did so for less than six months.

Because the majority of WIC mothers using relative child care relied on the children’s grandmothers or aunts, the researchers presumed they would have a more supportive environment for breastfeeding duration, but that did not seem to be the case.

WIC mothers using relative care may not have been able to afford adequate child care and extended unpaid maternity leave or may have been employed in workplace environments that were not accommodating to lactation, the researchers wrote.

State agencies, which administer WIC with grant funding from the U.S. Dept. of Agriculture Food and Nutrition Service, reported serving slightly less than 9 million WIC clients monthly for the first eight months of Fiscal Year 2011, according to the WIC website.

Kim’s study used baseline data from the Early Childhood Longitudinal Study-Birth Cohort conducted by the National Center for Education Statistics, which recruited from a nationally representative sample of children born in the U.S. in 2001.

Co-authors on the study were Jae Eun Shim, a professor at Daejeon University, South Korea; and Julie B. Heiniger, a graduate student at the U. of I. at Chicago.

Editor's note: To contact Juhee Kim, , call 217-244-2998 or e-mail juheekim@illinois.edu.
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