Hawai'i WIC Electric Breast Pump Loan Program Evaluation

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Hawai'i WIC Electric Breast Pump Loan Program
Evaluation

• Valerie Espinueva, M.P.H.
• Cheryl Prince, Ph.D., M.P.H., M.S.N.
• Sue Uyehara R.D., M.P.H.
• Rosie Li, MD, Ph.D
• Larry Grummer-Strawn, Ph.D
• Hawaii WIC Services Branch
• Hawaii Department of Health

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Breastfeeding Initiation

• Healthy People 2010 target gt75
• Hawaii PRAMS Prevalence 89.6

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Breastfeeding Duration

• Decreases sharply first few weeks after birth
• Hawaii WIC Study (1997) 46 of women introduced
  formula within the first week after delivery
• Contributing factors include returning to work or
  school

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WICs Breastfeeding Goal

• Increase breastfeeding duration to one year

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Breastfeeding Programs

• WIC instituted a number of programs from
  1998-2001, including hiring breastfeeding
  counselors
• and
• loaning Electric Breast Pumps to moms going to
  work or school.

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Electric Pump Loan Program

• The demand for electric pumps was very high among
  WIC participants.
• However, there is limited data to show that
  loaning pumps increased breastfeeding duration.

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Manual Pumpby Medela

• Given to part time workers and students
• Used for transient situations and casual pumping
  needs

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Lactina Electric Pumpby Medela

• Electric pumps saved for exclusively
  breastfeeding women who met specific criteria.

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Electric Pump Loan ProgramStudy Methods

• Women who requested a pump to return to work or
  school were randomized into 2 groups
• Study group Lactina Electric Pump Users
• Control group Manual Pump Users

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Survey Instrument Implementation

• Survey Instrument
• Development Lactation Consultants, WIC
  Nutritionists, Researchers, CDC
• Implementation
• Enrollment July 1, 2002-July 1, 2003
• Surveyed when the infant was 6 months of age and
  at 12 months
• Participating agencies Hilo, Honolulu,
  Kapiolani, Leeward, Maui, Kauai, Kona, Wahiawa,
  Waimanalo

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Survey Analysis

• Chi Square Tests
• Identify statistically significant disparities
  between sociodemographic categories
• Linear Logistic Regression Models
• To predict breastfeeding duration from one or
  more other variables

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Sample Characteristics
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Breastfeeding Duration
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Breastfeeding Duration

• For Electric and Manual Pumps, the median
  duration was 7 months.

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Linear Regression Model

• Dependent Variable Breastfeeding Duration
• Independent Variables Pump Assignment,
  Education, Age, Ethnicity, Marital Status, Parity
• Results
• Women age 30 breastfeed 1.5 months longer than
  younger women (p lt 0.05).
• Native Hawaiian women breastfeed 1.3 months
  longer than women of other ethnicities (p
  0.03).

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Logistic Regression Model

• College educated women were 2.5 times as likely
  to breastfeed to 12 months compared to high
  school educated women when both groups used the
  electric pump (p 0.02).
• No significant difference was found between the
  electric and manual pumps.

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Barriers

• Comparison of significant barriers reported at
  one year vs.
• at 6 months (N135)

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Conclusions

• No significant difference in breastfeeding
  duration between electric and manual pump
• After adjusting for parity and interaction
  between pump use and education, Hawaiian and
  older women breastfed longer than non-Hawaiian
  and younger women.
• The WIC pump loan program assisted women
  breastfeed at least 7 months

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Limitations

• Not all mothers answered both surveys
• Surveys were given to some mothers after the
  infant was over a year old
• Missing breastfeeding duration and demographic
  information for some mothers
• Insufficient sample size to detect less than a
  two fold difference in breastfeeding rates
  between electric and manual pump users

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Further Considerations

• Some women in the manual pump group may have
  acquired an electric pump on their own.
• Some women in the manual pump group may have
  received more breastfeeding support than women in
  the electric pump group.

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Recommendations

• Build relationships with college campuses to
  promote WIC enrollment

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Acknowledgements

• Special thanks to the WIC staff and
  Breastfeeding Coordinators for their hard work
  and commitment to the study and Pratisha
  Budhiraja and Christina Simmons for their
  invaluable contributions.
• The Hawaii WIC Breast Pump Program Evaluation
  was funded by a cooperative agreement from the
  Centers for Disease Control and Prevention and
  the Association of Teachers of Preventive
  Medicine.
• Additional in-kind support came from the Hawaii
  Department of Healths WIC Services contract
  funds.