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

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.