Randomized Controlled Trial of a Telephone Peer Counseling Program to Support Breastfeeding among WIC Participants

 

Objective: The U.S. Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants and Children (WIC).  As of 2008, 50 percent of WIC clients received services from local WIC agencies that offered peer counseling.  Little is known as to the effectiveness of these peer counseling programs.  Randomized controlled trials of peer counseling interventions among low-income women in the U.S. showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC clients nationally.   We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration and exclusivity.

Methods: We randomly assigned 1,948 WIC clients recruited during pregnancy who intended or were considering breastfeeding to three study arms: standard care, 4 telephone contacts and 8 telephone contacts.

Results:  We combined the two treatment arms because there was no difference in distribution of peer contacts. Non-exclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted RR=1.23; 95% CI:  1.02, 1.32) but greater at 6 months for Spanish-speaking clients only (adjusted RR=1.39; 95% CI: 1.17, 1.65). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted OR=0.71; 95% CI: 0.59-0.86).

Conclusion: A telephone peer counseling program achieved gains in non-exclusive breastfeeding among a population in which over 90 percent of women initiate breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.