WIC Services Reach a Majority of California Infants
The WIC Program (Women, Infants and Children Supplemental Nutrition Program) has promoted the health of low to moderate income families (enrolled in Medi-Cal or Food Stamps and/or income less than $35,798 for a family of four) throughout the United States for over 30 years by providing nutrition education, supplemental food, referrals for needed services and promotion of regular health care. Nationally, the program reaches over 7.5 million pregnant, breastfeeding, and post-partum women and children under age five who have nutrition and health-related risks.

In California, over 1.3 million participants monthly attend classes and counseling support for healthy family meals, active lifestyles, breastfeeding, as well as other topics; and afterward receive their monthly "checks" for nutritious foods that are high in protein, Vitamin C and/or iron. The specific nutritious foods provided to participants include peanut butter, beans, milk, cheese, eggs, iron-fortified cereal, juices, and iron-fortified infant formula for infants not breastfed. In 1999, 62 percent of all infants born in California participated in WIC , giving WIC the potential to influence a significant number of parents on the feeding options for their young children.

Private, non-profit health organizations and local health departments operate 82 local WIC programs in over 640 offices located in all 58 California counties. Staff serve immigrants from around the world in up to twenty-five languages, as families work and adapt to American foods, health care and way of life, as well as teen mothers, college students, newly unemployed parents of young children and others.

WIC Support for Breastfeeding
Since its inception in 1972, the WIC program has included breastfeeding women as a category for program eligibility and has provided a food package to meet their nutritional needs. However, it was discouraging to note in the 1998 Maternal and Infant Health Survey that, compared with the breastfeeding initiation rates of in-come-eligible non-participants, the initiation rates of WIC participants were lower only among those who did not receive breastfeeding advice (1). A more recent study has found a positive association between WIC participation and breastfeeding initiation but no effect on duration (2). More recently, Congress has allocated specific funds for WIC programs to develop and implement breastfeeding peer counseling programs, given the evidence this model works to increase breastfeeding initiation, duration and exclusivity rates (3).

Following a review of the WIC food packages in 1988, a special food package for exclusively breastfeeding women was introduced as an incentive to encourage mothers to breastfeed. Still, in 2002, just 41.7 percent of California women who initiated breastfeeding in the hospital were fully or partially breastfeeding six months later, according to the Maternal and Infant Health Assessment in 2003. Similar assessments of WIC mothers indicate that breastfeeding initiation and duration rates for WIC participants continue to lag behind the national average, despite a significant increase in WIC breastfeeding rates since 1990. (4) As other researchers have noted, "the WIC program faces a difficult challenge in encouraging low-income mothers to breastfeed while also providing formula." (2).

Institute of Medicine Study & Recommendations on the WIC Food Package
Faced with mounting pressure from the WIC and health communities to revise the content of the WIC food packages, and given the rising concern about obesity in the American population and the realization that the WIC food package no longer meets the health needs of its target population, the U.S. Department of Agriculture (USDA) commissioned a study of the issue from the Institute of Medicine (IOM) in 2003. The report of the committee was released in April of this year (5) and by law, USDA must publish final regulations on revised food package regulations no later than October 2006.

The committee's research concluded, "WIC participants need at least as much, if not more, breastfeeding advice and support than higher-income women." In addition, the current enhanced food package for exclusively breastfeeding women is not attractive enough compared to packages for partially breastfeeding mother and infant. The committee, therefore, recommended a comprehensive approach that involves:

• Enhanced food packages-including an double the amount of eggs, cheese and baby fruits and vegetables and the addition of baby meats for infants over six months-for the fully breastfeeding mother and her infant;
• Reduced maximum amount of formula provided to partially breastfed infants as well as to formula-fed infants 6 months and older;
• A policy change of not routinely providing formula in the first month of life to breastfed infants;
• A policy change of not providing complementary foods before 6 months of age; and Provision of breastfeeding counseling to breastfeeding mothers who request formula in the first month postpartum.

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