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OBJECTIVE: The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. METHODS: We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. RESULTS: We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10–1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10–1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68–0.89). CONCLUSIONS: A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

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Low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in racial/ethnic and language minority communities.

In December of 2007, the Federal Register published an Interim Rule establishing revised food packages for participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) that was implemented by states in 2009. We analyze changes in breastfeeding among WIC participants from the period before to period after implementation of the new food package We used linear regression to analyze data from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 19 states from 2004 to 2010, the Pediatric Nutrition Surveillance System (PedNSS) in 16 states monthly from January 2007 to October 2010 and the National Immunization Survey (NIS) from all 50 states and the District of Columbia from 2004 to 2010 for evidence of an association between time-series patterns of breastfeeding among women or children who participated in WIC and changes in the new food package. Data from all three sources evidenced steady upward trends in ever breastfed infants on WIC during the study period. In neither PRAMS nor the NIS were trends in breastfeeding after implementation of the new food package statistically different from trends in breastfeeding among low-income women not on WIC. We also uncovered no break in monthly breastfeeding rates by birth cohort associated with new food package in the PedNSS. Rates of ever breastfed children are rising nationally but the increase is not associated with changes in WIC's new food package as evidenced in national and state surveys of postpartum women.