National WIC Breastfeeding Promotion Project - United States

Media as well as grassroots advocacy comprised the bulk of the promotion strategy, with media adopting a congratulatory tone and communicating through family spokespersons. The programme promoted the WIC breastfeeding project using a variety of methods and a broad range of outlets, including: legislative, policy, and organisational development; media and grassroots advocacy; professional training and education; peer counselor programmes; and direct marketing and advertising. Carrying the slogan "Loving Support Makes Breastfeeding Work," programme materials explained the supportive role family members and friends can play in encouraging a new mother to breastfeed. Another key component of the marketing plan was its strategy of minimising or eliminating the deterrents or perceived costs of breastfeeding for new and prospective mothers. The campaign tried to reach women who doubted their breastfeeding ability or who felt that breastfeeding was embarrassing or conflicted with their active lives and relationships. To address these perceived costs, public education materials were created for each group of women, and a counseling programme was developed for health care providers to assist them in identifying common misperceptions and helping mothers work through them.

Programme materials included three bilingual (English and Spanish) television commercials, three bilingual radio commercials, outdoor billboards, nine bilingual posters, nine bilingual educational pamphlets, and several information and resource guides and WIC staff kits.To ensure effective coordination and implementation of the programme's elements at the state and local levels, a comprehensive training conference was held for WIC staff members from the ten pilot states. The conference sessions included presentations and seminars covering a broad range of topics, including research results and their implications for breastfeeding promotion; working with the media and utilising the marketing/media package; community and team building; and nontraditional communication methods. Additional breakout sessions allowed for skill development and team planning; by the conclusion of the conference, WIC staff attendees had developed detailed implementation plans for each of their respective states.

Placement strategy for the programme focused on reaching the various environments in which mothers and their friends and relatives obtain infant care information. Educational materials were developed to reach mothers and relatives in their homes; together with the World Health Organization and the UN Children's Fund, Best Start programme staff took steps to make hospital environments more supportive of breastfeeding mothers. Partnerships with other breastfeeding promotion organisations and professional associations were established through the USDA Food and Nutrition Service's (FNS's) Breastfeeding Promotion Consortium to further institutionalise and disseminate the programme.

Health, Children, Women, Nutrition.

Created in 1972, WIC is a federal programme under the USDA designed to provide nutrition education, supplementary foods, and referrals for health and social services to economically disadvantaged women who are pregnant, postpartum, or are caring for infants and children under the age of five. Administered in all of the fifty-five U.S. states and territories and in 33 Indian tribal organisations (ITOs), the WIC programme is credited with reducing infant mortality and morbidity, improving the health outcomes of its participants, and reducing health care costs. WIC operates through a network of 88 state agencies and 2,200 local agencies, and provides services to more than 7.4 million programme participants per month in 10,000 clinic locations. In 1989, Congress began designating a specific portion of each state's WIC budget allocation to be used exclusively for the promotion and support of breastfeeding among its participants. Accordingly, among its many programmes and services, WIC provides support, education, and promotion for breastfeeding. More than five years after the government started supporting promotional efforts, however, breastfeeding rates among participants of the WIC programme were found to be considerably less than segments of the population in higher socio-economic levels. During this time, 59.7% of infants in the United States were breastfed at birth and 21.6% at six months postpartum compared to only 46.6% and 12.7% respectively among infants in the WIC programme.

In September of 1995, Best Start Social Marketing, a non-profit social marketing organisation based in Tampa, Florida, submitted an unsolicited proposal to the FNS to request funding and assistance in developing a comprehensive national breastfeeding promotional campaign through WIC. Campaign planners selected ten states in which to conduct research on how best to structure the programme. These states included: Arkansas, California, the Chickasaw Nation, Iowa, Mississippi, Nevada, New Jersey, New York, Ohio, and West Virginia. In these states, planners collected consumer information needed to segment the population, identified important factors limiting breastfeeding, and defined the methodology to effectively promote breastfeeding. They collected qualitative and quantitative research data through a series of observations, interviews (personal and telephone), surveys, and focus groups. Results from this research were used to develop a marketing plan.

Breastfeeding rates in hospitals went from 57.8% to 65.1% after a year of the programme's operation.