Trends in Breastfeeding Disparities in US Infants by WIC Eligibility and Participation

J Nutr Educ Behav. 2019 Feb;51(2):182-189. doi: 10.1016/j.jneb.2018.10.005. Epub 2018 Dec 1.


Objective: To examine the trends in breastfeeding disparities across Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligibility and participation statuses in the last 2 decades.

Design: Secondary analyses from multiple cross-sectional surveys.

Setting: United States.

Participants: The National Health and Nutrition Examination Survey 1999-2014 included 10,696 children younger than 60 months. Birth cohorts in 4-year increments were created from 1994 to 2014.

Main outcome measures: Ever-breastfed status and breastfed-at-6-months status.

Analysis: The prevalence rates of ever-breastfed and breastfed at 6 months were estimated between WIC-eligible vs non-eligible children and WIC-eligible participants vs eligible nonparticipants. Prevalence rates and their 95% confidence intervals were plotted across birth cohorts. Log-binomial regression was conducted to test the trends of breastfeeding in each subgroup.

Results: Ever-breastfeeding rates increased from 52% (WIC participants) vs 57% (WIC-eligible nonparticipants) in the 1994-1997 birth cohort to 71% vs 77% in the 2010-2014 birth cohort-a 36% vs 34% relative increase for participants vs eligible nonparticipants, respectively (P < .001). Breastfeeding-at-6-month rates increased from 28% (participants) vs 30% (eligible nonparticipants) to 34% vs 49% in the same time period-a 21% vs 66% relative increase, respectively (P < .001).

Conclusion and implications: To meet the Healthy People 2020's goal for breastfeeding at 6 months, sustainable postpartum breastfeeding education and interventions may be needed among WIC participants. Future research focusing on identification of the causal relationship between WIC participation and breastfeeding outcomes is warranted.

Keywords: NHANES; WIC; breastfeeding; disparities; infant.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Breast Feeding / statistics & numerical data*
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Food Assistance / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nutrition Surveys
  • United States