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Background 

The Special Supplemental Nutrition Program for 

Women, Infants, and Children (WIC) has been 

providing nutritious foods, nutrition education, 

breastfeeding support, and health referral 

services to low-income mothers and their 

children for over 30 years. In 2006 the Food and 

Nutrition Service (FNS) asked the Institute of 

Medicine (IOM) to review the WIC food 

packages. The IOM proposed major changes to 

improve nutrition and encourage breastfeeding 

but also expressed the concern that changes 

related to partial breastfeeding may have 

unintended consequences. The IOM 

recommended that FNS conduct an impact study 

evaluating the birth month breastfeeding 

changes to the WIC food packages. This study 

responds to that recommendation. 

Research Questions 

The study’s research questions examine whether 

there were changes in breastfeeding initiation, 

duration or intensity following implementation 

of the rule.1

 The study measured changes in 

WIC participation, demographic and economic 

characteristics of participants, and the 

percentage of participants receiving each WIC 

food package. 

Methodology 

This study used a pre/post research design, and 

data collection was supported by a two-stage 

design. The first stage sampled 17 Local WIC 

Agencies (LWAs) out of 1,885 LWAs in the 

United States. The second stage collected 

administrative data on approximately 300,000 

participants within those agencies and collected 

 

1

 On December 6, 2007, an Interim Final Rule 

changed the composition and quantities of prescribed 

foods in the WIC food packages (72 Federal Register 

68965-69032). State agencies were required to 

implement these changes by October 1, 2009. 

survey data on 1617 mother-infant dyads. Data 

collection began in April 2009 and was 

completed in May 2010. 

Findings/Summary

Program participation and demographics did 

not change. No significant pre/post differences 

were observed in WIC program participation 

patterns among mothers and infants or among 

mothers receiving WIC during pregnancy whose 

infants were enrolled after birth. 

The percentage of mothers selecting the partial 

breastfeeding package declined. Nearly onefourth of WIC mothers were assigned the partial 

breastfeeding package prior to implementation, 

about one-eighth received it afterwards. 

The percentage of mothers selecting the full 

breastfeeding package or the full formula 

package both increased. Exhibit 1 shows that 

selection of the full breastfeeding package 

increased from 9.8 percent (pre) to 17.1 percent 

(post). Selection of the full formula package 

likewise increased from 20.5 to 28.5 percent. 

Infant formula amounts also changed, moving 

away from intermediate WIC packages and 

toward the two extremes (full breastfeeding or 

full formula feeding). Among mothers with 

infants in the birth month, the percentage where 

the infant received no formula increased from 

12.2 to 19.7 percent, which is a favorable 

outcome. However, the proportion where the 

infant received the maximum or nearly the 

maximum formula amount also increased, from 

49.4 to 56.4 percent, which is a less favorable 

outcome. 

Breastfeeding initiation rates did not change.

As measured in administrative records, the 

breastfeeding initiation rate for WIC participants 

EVALUATION OF THE BIRTH MONTH BREASTFEEDING 

CHANGES TO THE WIC FOOD PACKAGES STUDY 

SUMMARY

Office of Research and Analysis December 2011 
was essentially unchanged: 65.6 percent (pre) 

and 65.2 percent (post). 

Breastfeeding duration had a slight increase. 

The average probability of a mother reaching 4 

weeks duration was 76.3 percent (pre) and 77.2 

percent (post). 

Breastfeeding intensity did not change. Based 

on the participant survey data, there was no 

change after implementation in the percentage of 

mothers exclusively breastfeeding (among 

mothers who had initiated breastfeeding). 

The study findings address the IOM concern that 

the partial breastfeeding changes had no 

unintended adverse consequences. Following the 

food package changes, there was no decrease in 

participation, no change in breastfeeding 

initiation rates, and a slight increase in duration. 

Exhibit 1: Food Package Issued to New Mothers, by Infant Age 

Download full report at http://www.fns.usda.gov/ora/menu/Published/WIC/WIC.htm 

Download public use data files at http://www.fns.usda.gov/ora/menu/Published/WIC/WIC.htm 

U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, Evaluation of the Birth Month 

Breastfeeding Changes to the WIC Food Packages by Parke Wilde, Anne Wolf, Meena Fernandes, Ann Collins; 

Project Officer, Dr. Joseph F. Robare. Alexandria, VA: December 2011. 

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