Maternal Health| Volume 29, ISSUE 6, P513-521, November 2019

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Determinants of Breastfeeding Initiation and Duration Among African American DC WIC Recipients: Perspectives of Recent Mothers

Published:August 10, 2019DOI:



      In Washington, DC, African American women receiving the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits have the lowest breastfeeding rates compared with other WIC-eligible populations.


      The purpose of this research was to use the social cognitive theory and elements of social support as a guiding framework to better understand the factors affecting breastfeeding initiation and duration among African American WIC recipients in low-income areas of Washington, DC.


      Semistructured interviews were conducted with 24 women receiving WIC services in DC to learn about their infant feeding practices and decisions. Using a pragmatic approach, an integrated inductive and deductive coding strategy was used.


      Breastfeeding experiences were influenced by barriers at multiple levels: community (i.e., perceptions of breastfeeding in one's network), interpersonal (i.e., few supportive providers), and individual constraints (i.e., pain, supply, and latching issues) as well as environmental difficulties of finding resources to help overcome these challenges. Social support from a close family member, friend, or partner often helped to minimize many of these barriers and facilitated breastfeeding.


      Social support seems to bolster efficacy and help women to overcome various barriers to breastfeeding in their immediate environment; however, social support from providers was limited. WIC offers recipients in DC many helpful breastfeeding resources. Although several respondents were aware of these resources, overall use in the sample was low. Continued outreach may help further facilitate breastfeeding in African American mothers by providing additional sources of social support.
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      Jennifer Schindler-Ruwisch, DrPH, is currently an Assistant Professor at Fairfield University. She has special interest in nutrition-related diseases, smoking cessation, and maternal/child health. She is passionate about decreasing health disparities and social/environmental determinants of health.


      Amira Roess, PhD, is an Associate Professor at the George Washington University Milken Institute School of Public Health. She is engaged in mixed-methods to conduct emerging infectious and zoonotic disease research, emergency preparedness and response, HIV/AIDS research, and mHealth technology integration and evaluation.


      Rebecca C. Robert, PhD, is an Assistant Professor in the Conway School of Nursing, The Catholic University of America. She focuses on community-based research to improve infant and young child feeding and nutrition in the U.S. and globally.


      Melissa Napolitano, PhD, is a Professor at the George Washington University Milken Institute School of Public Health. She adapts face-to-face treatment content for dissemination via different delivery channels. Her work specifically focuses on physical activity promotion, weight loss, and prevention of weight gain.


      Emily Woody, MPH, RDN, IBCLC, is a Registered Dietician and Certified Lactation Consultant. Ms. Woody is currently the Breastfeeding Coordinator for the WIC State Agency for the District of Columbia WIC State Agency, District of Columbia Department of Health (DOH).


      Paulette Thompson, MSN, RDN, is a Registered Dietitian and a Certified Lactation Specialist. Ms. Thompson was a Supervisory Public Health Nutrition/Nutrition Education Coordinator for the WIC State Agency for the District of Columbia Department of Health (DOH). She retired from the DC Government in 2018.


      Vinu Ilakkuvan, DrPH, is Founder and Principal Consultant of PoP Health, LLC, a consulting practice focused on strengthening multi-sector community partnerships that address social determinants of health. She is also a Professorial Lecturer at the George Washington University Milken Institute School of Public Health.