Breastfeeding
Improve annual breastfeeding outcomes of Indiana WIC participants through promotion and support of breastfeeding mothers.
Introduction
The Indiana WIC program provides supplemental foods, health care referrals, breastfeeding support, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC promotes breastfeeding as the optimal method of infant nutrition.
Breastfeeding support and promotion continue to be one of the main goals for the Indiana WIC Program. Parents who breastfeed are eligible for a larger food package and longer participation in the program. The Indiana WIC program provides several breastfeeding supports for clients including breastfeeding education, breastfeeding supplies and aids, and access to Peer Counselors and Designated Breastfeeding Experts.
As part of the requirements for administering the WIC program, Indiana WIC reports client breastfeeding data to USDA’s Food & Nutrition Service (FNS), which is included in the Breastfeeding Data by Local Agency (BFDLA) report each year. The BFDLA report compares all local WIC agencies across the country on their client breastfeeding status by certification category, specifically looking at the infants who participated in the program in a given fiscal year.
WIC infant categories include:
– Fully Breastfeeding (IBE)
– Breastfeeding Partial (IBP)
– Fully Formula (IFF)
– Breastfeeding Partial (IBP)
– Fully Formula (IFF)
The goal of WIC Breastfeeding Promotion & Support is to improve the percentage of clients who fall within the Fully and Partial Breastfeeding categories, with an emphasis on improving exclusivity.
This report presents Indiana WIC client breastfeeding data statewide by individual county and agency.
Trends in Breastfeeding 
Figure 1. Indiana WIC Program Trends in Breastfeeding, 2012-2022
The breastfeeding initiation rate among the Indiana WIC Program population has been improving over time, increasing from 67.8% in 2012 to 73.0% in 2022 (Figure 1).
Figure 2. Trends in Breastfeeding Initiation by Race/Ethnicity, 2012-2022
The breastfeeding initiation rate is increasing across almost all racial and ethnic groups (Figure 2). Although the breastfeeding initiation rate remains the lowest among the Black WIC population, this group experienced a consistent rate of increase over the decade, rising by almost 15% from 59.8% in 2012 to 74.7% in 2022.
Prevalence of Breastfeeding
Figure 3. Percentage of Infants Breastfed for at Least 3, 6 And 12 Months by Race and Ethnicity, FY22
Compared to all other races/ethnicities, Asian WIC clients had the highest prevalence of breastfeeding at 3, 6, and 12 months (44.3%, 35.9%, and 27.0% respectively) (Figure 3).
Figure 4. Prevalence of Breastfeeding Duration Among Ever Breastfed Infants, FY22
Nearly 90% of breastfeeding women in the Indiana WIC Program continue breastfeeding to the first week (Figure 4).
Initiation and Duration
TABLE 1. Prevalence of Breastfeeding Initiation and Duration to 3, 6 and 12 Months Among Indiana WIC Infants by Selected Maternal Characteristics, FY22
| Maternal Age | Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
|---|---|---|---|---|
| <15 yrs | 62.8% | 8.1% | 4.8% | 2.3% |
| 15-19 yrs | 74.6% | 22.1% | 12.6% | 5.3% |
| 20-29 yrs | 72.4% | 33.7% | 22.3% | 11.1% |
| 30-39 yrs | 77.5% | 32.0% | 30.0% | 16.6% |
| 39+ yrs | 78.0% | 45.0% | 32.1% | 20.7% |
| Maternal Marital Status |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| Single | 74.2% | 30.5% | 19.1% | 9.1% |
| Married | 81.6% | 37.9% | 32.5% | 20.6% |
| Maternal Education |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| 8th grade and less | 76.6% | 30.3% | 28.1% | 16.4% |
| 9th to 11th grade | 69.1% | 25.1% | 15.5% | 6.7% |
| High school | 75.4% | 31.6% | 20.0% | 9.9% |
| Some college | 82.5% | 42.3% | 29.7% | 15.7% |
| College graduate | 83.0% | 43.2% | 36.3% | 26.2% |
| Smoking During Pregnancy |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| No | 78.4% | 36.0% | 22.6% | 12.2% |
| Yes | 65.3% | 22.2% | 10.0% | 4.0% |
| Household Smoking During Pregnancy |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| No | 75.4% | 36.1% | 20.9% | 12.1% |
| Yes | 68.2% | 18.0% | 9.9% | 4.3% |
| Anemia During Pregnancy |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| No | 76.5% | 32.2% | 24.2% | 11.4% |
| Yes | 82.0% | 27.5% | 12.1% | 2.5% |
| Trimester at Enrollment |
Ever Breastfed | BF 3 Mo. | BF 6 Mo. | BF 12 Mo. |
| 1st Trimester | 75.3% | 36.6% | 25.1% | 12.8% |
| 2nd Trimester | 76.8% | 32.5% | 24.1% | 11.4% |
| 3rd Trimester | 72.4% | 31.1% | 20.0% | 7.6% |
TABLE 2. Prevalence of Fully* Breastfeeding Rates at 3 and 6 Months Among Indiana WIC Fully Breastfed Infants by Selected Maternal Characteristics, FY22
| Maternal Age | Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
|---|---|---|
| <15 yrs | 0.0% | 0.0% |
| 15-19 yrs | 43.3% | 39.2% |
| 20-29 yrs | 54.3% | 54.3% |
| 30-39 yrs | 61.0% | 54.2% |
| 39+ yrs | 75.3% | 66.3% |
| Maternal Marital Status |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| Single | 60.8% | 50.7% |
| Married | 73.3% | 57.8% |
| Maternal Education |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| 8th grade and less | 52.0% | 49.0% |
| 9th to 11th grade | 55.3% | 43.4% |
| High school | 61.5% | 52.5% |
| Some college | 66.9% | 61.7% |
| College graduate | 77.7% | 72.2% |
| Smoking During Pregnancy |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| No | 64.2% | 51.0% |
| Yes | 53.1% | 36.1% |
| Household Smoking During Pregnancy |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| No | 64.1% | 50.4% |
| Yes | 50.1% | 36.0% |
| Anemia During Pregnancy |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| No | 63.1% | 50.0% |
| Yes | 43.7% | 40.2% |
| Trimester at Enrollment |
Fully Breastfed 3 Mo. | Fully Breastfed 6 Mo. |
| 1st Trimester | 64.0% | 51.1% |
| 2nd Trimester | 63.1% | 49.7% |
| 3rd Trimester | 62.0% | 46.2% |
*Fully Breastfeeding is defined as WIC clients who are breastfeeding their babies and do not receive infant formula from WIC.
Clients enrolled in the first trimester of pregnancy have higher rates of breastfeeding compared to those enrolled during the second and third trimesters.
Total infants served that were breastfed increased from
29.0%
in FY21
<
32.3%
in FY22
Governor Holcomb has challenged Indiana to reduce the rate of infant deaths and be the “best in the Midwest” for infant mortality by 2024.
Breastfed babies have a 21% lower risk of death in their first year compared with babies never breastfed, and risk reduction increases with breastfeeding duration of three months or more.
One local agency, Whitley County WIC Program, has exceeded the Healthy People 2020 objective to increase the proportion of ever breastfed infants to 81.9%.
TABLE 3. Prevalence of Breastfeeding Initiation and Breastfeeding Duration to 3, 6 and 12 Months in Top Five Indiana WIC Local Agencies, FY22
Highest Prevalence of Breastfeeding Initiation
1
PORTER
82.8%
2
MONROE
82.7%
3
BROWN
82.7%
4
ADAMS
81.8%
5
ELKHART
81.7%
Highest Prevalence of Breastfeeding to 3 Months
1
HANCOCK
43.7%
2
STEUBEN
43.4%
3
WHITLEY
41.3%
4
MONROE
41.1%
5
MARTIN
40.6%
Highest Prevalence of Breastfeeding to 6 Months
1
LAGRANGE
35.9%
2
OWEN
33.3%
3
STEUBEN
33.2%
4
HENDRICKS
32.0%
5
MARTIN
31.1%
Highest Prevalence of Breastfeeding to 12 Months
1
BROWN
30.7%
2
HANCOCK
19.4%
3
LAGRANGE
19.1%
4
WHITLEY
18.3%
5
STEUBEN
18.1%
TABLE 3. Prevalence of Breastfeeding Initiation and Breastfeeding Duration to 3, 6 and 12 Months in Top Five Indiana WIC Local Agencies, FY22
Highest Prevalence of Breastfeeding Initiation
1
PORTER
I.D. 22
82.8%
2
MONROE
I.D. 25
82.7%
3
BROWN
I.D. 58
82.7%
4
ADAMS
I.D. 12
81.8%
5
ELKHART
I.D. 8
81.7%
Highest Prevalence of Breastfeeding to 3 Months
1
HANCOCK
I.D. 11
43.7%
2
STEUBEN
I.D. 50
43.4%
3
WHITLEY
I.D. 1
41.3%
4
MONROE
I.D. 25
41.1%
5
MARTIN I.D. 62
40.6%
Highest Prevalence of Breastfeeding to 6 Months
1
LAGRANGE
I.D. 49
35.9%
2
OWEN
I.D. 17
33.3%
3
STEUBEN
I.D. 50
33.2%
4
HENDRICKS
I.D. 32
32.0%
5
MARTIN
I.D. 62
31.1%
Highest Prevalence of Breastfeeding to 12 Months
1
BROWN
I.D. 58
30.7%
2
HANCOCK
I.D. 11
19.4%
3
LAGRANGE
I.D. 49
19.1%
4
WHITLEY
I.D. 1
18.3%
5
STEUBEN I.D. 50
18.1%
Breastfeeding Statistics by County
Indiana WIC Breastfeeding Initiation by County, FY2021
Indiana WIC Breastfeeding Initiation by County, FY2022
Indiana WIC Prevalence of Breastfeeding at 3 Months by County, FY2021
Indiana WIC Prevalence of Breastfeeding at 3 Months by County, FY2022
Indiana WIC Prevalence of Breastfeeding at 6 Months by County, FY2021
Indiana WIC Prevalence of Breastfeeding at 6 Months by County, FY2022
Indiana WIC Prevalence of Breastfeeding at 12 Months by County, FY2021
Indiana WIC Prevalence of Breastfeeding at 12 Months by County, FY2022
Breastfeeding Cessation
Figure 5. Reasons for Breastfeeding Cessation, FY22
Biggest Changes from FY2020
Reasons for discontinuing breastfeeding:
Since 2018 10% increase in clients reporting that they met their breastfeeding goal.
Fewer women reporting stopping due to:
- "Not Enough Milk"
- "Advised to Stop by Health Care Provider"
- "Baby Refused/Prefers Bottle"
- "Just Did Not Like Breastfeeding"
- "Lack of Workplace Support"
+5.8%
increase in women meeting their breastfeeding goal
-5.2%
decrease in reporting that they did not have enough milk
Biggest Changes from FY2020
Since 2018, Indiana WIC has seen a 10% increase in clients reporting that they met their breastfeeding goal.
Reasons for discontinuing breastfeeding:
Fewer women reporting stopping due to:
- "Not Enough Milk"
- "Advised to Stop by Health Care Provider"
- "Baby Refused/Prefers Bottle"
- "Just Did Not Like Breastfeeding"
- "Lack of Workplace Support"
+5.8%
increase in women meeting their breastfeeding goal
-5.2%
decrease in reporting that they did not have enough milk
Breastfeeding Support & Training
Breastfeeding support is prioritized in our Annual State and Nutrition Education Plans. We ensure quality staff training so that clients are provided current, evidence-based education to make informed decisions around their infant feeding goals. We develop tools and trainings for new clinic staff that ensure staff education and training is consistent around the state.
FY22 Lactation Education Opportunities:
66
staff
attended
Diversity, Equity, and Inclusion training
25
staff
attended
A Certified Lactation Specialist course
50
staff
attended
The Advanced Course in Clinical Lactation
These trainings, provided by Lactation Education Consultants (LEC), allow staff to gain advanced lactation skills, feel more confident helping breastfeeding clients, and improve breastfeeding outcomes around the state.
298
staff attended a WIC Breastfeeding Support Curriculum Training with Cathy Carothers to strengthen their skills in supporting breastfeeding families.
Peer Counselor Support
WIC Peer Counselors are paraprofessionals who provide breastfeeding promotion, education and support to WIC participants. Peer Counselors are mothers from WIC’s target population who have similar racial/ethnic backgrounds to the mothers they support. Peer Counselors have experience breastfeeding at least one baby and are accessible to WIC clients during and outside usual clinic hours, as well as in or outside of the WIC clinic environment.
50,897 in FY21
52,135 in FY22
Peer Counselor Referrals for New WIC Clients
272,451 in FY21
281,412 in FY22
Contacts Made by Peer Counselors for Support
100+
Peer Counselors Support Clients Across the State
WIC breastfeeding clients are more likely to continue breastfeeding at 6 and 12 months if they have been contacted by a peer counselor.
WIC Support During the Pandemic
Indiana WIC remains committed to serving families and continuing daily operations during the COVID-19 pandemic. Local agency staff have adapted services during the pandemic to provide flexibility and easy access to WIC participants. The information below tells the story of how WIC staff have stepped up to the plate during the pandemic.
Peer Counselors have followed safety guidelines by wearing PPE masks for home and in-person visits.
Local agencies set new highs in prevalence of breastfeeding in 3 Month, 6 Month and 12 Month categories from 2019!
Indiana WIC remains committed to serving families and continuing daily operations during the COVID-19 pandemic.
Local agencies have offered virtual classes and phone support by call or text and added more breastfeeding content to the WIC Nutrition Education app.
An additional 69,953 contacts were made by Peer Counselors for support compared to 2019.
Local agencies increased the issuance of breast pumps to mothers.
International Board Certified Lactation Consultant pilot expanded into two agencies, Tippecanoe and New Hope Services.
Breastfeeding Cessation
Figure 5. Reasons for Breastfeeding Cessation, FY22
Biggest Changes from FY2020
Reasons for discontinuing breastfeeding:
Since 2018 10% increase in clients reporting that they met their breastfeeding goal.
Fewer women reporting stopping due to:
- "Not Enough Milk"
- "Advised to Stop by Health Care Provider"
- "Baby Refused/Prefers Bottle"
- "Just Did Not Like Breastfeeding"
- "Lack of Workplace Support"
+5.8%
increase in women meeting their breastfeeding goal
-5.2%
decrease in reporting that they did not have enough milk
Awards
USDA FNS established the Loving Support Award of Excellence in 2014 “to recognize local WIC agencies that have provided exemplary breastfeeding promotion and support activities.” The intent is to provide models and motivate local agencies to strengthen their breastfeeding promotion and support activities and ultimately increase breastfeeding initiation, exclusivity and duration rates among WIC participants.
The award is given at three levels of performance that build on one another:
Gold · Gold Premiere · Gold elite
This approach recognizes three groups of agencies that include those that are demonstrating model practices, as well as those who are at varying stages of implementing exemplary breastfeeding promotion and support practices.
WIC Breastfeeding Award of Excellence Winners
Gold
Premiere
Award
Premiere
Award
- Interlocal Community Action Program (2022)
- IU Health Bloomington (2019)
- Johnson County (2021)
- Johnson Nichols (2022)
- Neighborhood Health Clinics (2020)
- St. Joseph County (2021)
- Tippecanoe County (2020)
- Whitley County (2020)
The Gold Premiere and Gold Elite Awards require local agencies to submit an additional application to be considered, in addition to achieving a Fully Breastfeeding category of at least 15% for Premiere and 40% for Elite.
Gold
Award
Award
- Arc of Greater Boone County (2021)
- Community Action Program of Western Indiana (2020)
- Community & Family Services (2020)
- Elkhart County (2019)
- Interlocal Community Action Program (2022 Premiere, 2019 Gold)
- IU Health Bloomington (2019)
- IU Health Morgan County (2020)
- Johnson County (2021 Premiere, 2019 Gold)
- Johnson Nichols Health Clinic (2022 Premiere, 2021 Gold)
- Marion County (2021, 2017)
- Neighborhood Health Clinics (2020 Premiere, 2018 Gold)
- New Hope Services (2019)
- Northwest Indiana Community Action Corporation (2020)
- Open Door Health Services (2021)
- Pace Community Action Agency (2021) *Merged into another agency
- St. Joseph County (2021 Premiere, 2020 Gold)
- Tippecanoe County (2020)
- Western Indiana Community Action Agency (2020)
- Whitley County (Premiere 2020, Gold 2019)
To receive the Gold Award, local WIC agencies must complete an application which evaluates the policies and procedures surrounding breastfeeding promotion and support, the Breastfeeding Peer Counselor program and partnerships with local hospitals and other organizations working toward similar breastfeeding goals.
This institution is an equal opportunity provider.
