Breastfeeding patterns of Oregon WIC participants after implementation of the no formula in the first month rule

Background: In August 2009 the Oregon WIC program implemented new food packages for mothers and infants and disallowed giving formula to breastfeeding infants in the first month of life. The purpose of this study was to understand how WIC's policy influenced the progression of mothers' infant feeding decisions from pregnancy through six months postpartum.

Methods: A stratified random sample of 90 postpartum Oregon WIC participants completed a 30 minute telephone interview comprised of open ended questions about plans for breastfeeding while pregnant, breastfeeding advice from WIC, timing and reason for first formula introduction, first formula request to WIC, sources other than WIC for formula, and reasons for continuing breastfeeding.

Results: Almost all participants intended to breastfeed during their pregnancies and felt WIC wanted to them breastfeed as well. Few knew about WIC's no formula policy and none cited it as influencing their feeding choices. One-third reported giving their infant some formula within the first week. After introduction most mothers went to combination feeding rather than all formula. Mothers' perception of infant hunger was the main reason for giving formula. More than three-quarters reported buying formula before or in addition to that from WIC. Almost all started with formula that was not from WIC.

Implications: Mothers who perceive their infant's hunger is not fully satisfied with breast milk turn to formula as a solution. Increasing exclusive breastfeeding requires addressing the underlying issues that drive women to seek formula regardless of the source. WIC programs should improve counseling to partially breastfeeding women.