LAUSR

OBJECTIVE To describe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) site-level breastfeeding support practices and associations with breastfeeding outcomes. DESIGN Secondary analysis of WIC Infant and Toddler Feeding Practices Study-2, including data from interviews with caregivers of infants and interviews and surveys with staff from 27 WIC state agencies and 80 study sites. PARTICIPANTS A total of 1,235 mothers of breastfed infants participating in the WIC Infant and Toddler Feeding Practices Study-2. MAIN OUTCOME MEASURE Any and fully breastfeeding 2, 6, and 12 months postpartum. ANALYSIS Descriptive statistics described WIC site-level breastfeeding supports. Multilevel mixed modeling of breastfeeding at 2, 6, and 12 months, controlling for site- and participant-level characteristics. RESULTS Five WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06-1.12; and odds ratio = 1.26, 95% confidence interval, 1.21-1.31, respectively). CONCLUSIONS AND IMPLICATIONS Positive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports.