National WIC Breastfeeding Promotion Project repositioned the traditional
health benefits of breastfeeding to emphasize a new product benefit - familiar
bonding from birth. The emotional price of breastfeeding was identified as
embarassment and conflicts with active lifestyles. To reduce these prices, a
counseling program was developed to help mothers work through individual
constraints. The place strategy targeted hospital environments as well as homes.
It focussed on key intermediaries such as professional associations. Media as
well as grassroots advocacy comprised the bulk of the promotion strategy with
media stressing a congratulatory tone and communicated through family spokespersons.
Breastfeeding rates in hospitals went from 57.8% to 65.1% after a year of the
Though there has not yet been a national study conducted to evaluate the
results of the National WIC Breastfeeding Promotion Program in each of the ten
pilot states, a summative evaluation of the program's impact in the State of
Iowa was completed, and several other pilot states are currently assessing their
individual campaigns. Preliminary results from the Iowa study show evidence of
the program's success in both breastfeeding rates and changed attitude and
awareness toward breastfeeding. The Iowa evaluation was based on the Ross Six
Months Mothers' Infant Feeding Survey and a separate mail survey of WIC
participants immediately before the campaign and four months afterward.
Increased breastfeeding rates: Based on the data from the Ross
Breastfeeding Survey, there was an observed increase in the rate of breastfeeding
as a result of the WIC Breastfeeding Promotion Project. Prior to the start of the
program, breastfeeding rates for mothers while in the hospital had been at 57.8
percent. Six months after the campaign's start rates increased to 64.4 percent,
and a year after the start they increased to 65.1 percent. The rates for women
still nursing six months after birth also increased. Before the start of the
campaign, women still breastfeeding was aore the start of the
start of the campaign, rates increased to 29.3 percent, and to 32.2 percent a
year after the program's start.
Increased breastfeeding support from relatives and friends: A major
objective of the public information component of the National WIC Breastfeeding
Promotion Project's "Loving Support Campaign" was to encourage the spouses,
relatives, and friends of pregnant women to provide support for breastfeeding.
Results of the survey indicated that support for breastfeeding increased in every
- Support from the pregnant woman's mother increased from 35.2 percent to 53 percent.
- Support from the pregnant woman's husband or boyfriend increased from 47.7 percent to 53 percent.
- Support from the pregnant woman's friends or other relatives increased from 48.8 percent to 51.1 percent.
- Support from the pregnant woman's prenatal health care provider increased from 62.4 percent to 83.8% and from WIC employees from 81.9 percent to 92.5 percent.
The WIC Program
Created in 1972, WIC (the Special Supplemental Nutrition Program for Women,
Infants, and Children), is a federal program under the USDA designed to provide
nutrition education, supplementary foods, and referrals for health and social
services to economically disadvantaged women who are pregnant, postpartum, or
are caring for infants and children under five. Administered in all of the
fifty-five U.S. states and territories and in 33 Indian tribal organizations
(ITOs), the WIC program is credited with reducing infant mortality and morbidity,
improving the health outcomes of its participants, and reducing health care costs.
WIC operates through a network of 88 state agencies and 2,200 local agencies, and
provides services to more than 7.4 million program participants per month in
10,000 clinic locations.
National WIC Breastfeeding Promotion Project
Among its many programs and services, the WIC provides support, education,
and promotion for breastfeeding. In 1989, Congress began designating a specific
portion of each state's WIC budget allocation to be used exclusively for the
promotion and support of breastfeeding among its participants. More than five
years after the government started supporting promotional efforts, however,
breastfeeding rates among participants of the WIC program were found to be
considerably less than segments of the population in higher socio-economic
levels. During this time, 59.7% of infants in the United States were breastfed
at birth and 21.6% at six months postpartum compared to only 46.6% and 12.7%
respectively among infants in the WIC program.
In September of 1995, Best Start Social Marketing, a non-profit social
marketing organization based in Tampa, Florida, submitted an unsolicited
proposal to the United States Department of Agriculture's Food and Nutrition
Service (FNS) to request funding and assistance in developing a comprehensive,
national breastfeeding promotional campaign through the WIC.
During the fall of that year, Best Start staff, together with representatives
of the FNS and members of the WIC's breastfeeding promotion consortium,
instituted the National WIC Breastfeeding Promotion Project and outlined
the program's objectives, targeted populations, and pilot locations. The four
goals that were established for the program included: increasing breastfeeding
initiation rates; increasing the rate of breastfeeding duration among WIC
participants; increasing referrals to the WIC program for breastfeeding support;
and increasing the general public's knowledge and support for breastfeeding.
In order to maximize the impact for each of the program's objectives, the
targeted population for the campaign was organized into three separate audiences.
The primary target audience was composed of pregnant Anglo, African, and
Hispanic American women who were either enrolled as WIC participants or who met
the income eligibility requirements (annual income below 185% of the US poverty
guidelines). The secondary audience consisted of individuals who might influence
the primary target population, such as the mothers, husbands and boyfriends of
pregnant women, prenatal health care providers, and WIC staff. The general public
was also included as the tertiary audience in order to affect change in the
established social norms and prevailing public perception regarding breastfeeding.
The campaign planners chose ten pilot states to conduct research and
demonstrate the initial WIC Breastfeeding Promotion Project. The selected
states included: Arkansas, California, the Chickasaw Nation, Iowa, Mississippi,
Nevada, New Jersey, New York, Ohio, and West Virginia.
With the parameters of the program established, formal development of the
campaign began with the collection of consumer information needed to segment
the population, identify important factors limiting breastfeeding, and to
define the methodology to effectively promote breastfeeding. Some of the
important research objectives included: (1) identifying the perception of
breastfeeding and bottle-feeding held by the primary and secondary target
groups; (2) identifying the factors that motivate and deter the primary target
group from breastfeeding and the secondary and tertiary target groups from
encouraging women to breastfeed; and (3) identifying effective information
channels and spokespersons for promoting breastfeeding among WIC participants.
Between December of 1995 and May of 1996 qualitative and quantitative
research data was collected from the ten pilot states through a series of
observations, interviews (personal and telephone), surveys, and focus groups
using the primary and secondary target audiences. The qualitative data that
was collected was then used to identify other potential research areas and to
help develop a comprehensive survey instrument. This 53-item questionnaire was
administered to 292 WIC participants in twelve prenatal clinics representing a
diverse group of ethnicities, a variety of caseload sizes, and a mixture of
urban, suburban, and rural communities.
Marketing Plan Development
Results from the formative research that was conducted were used to
develop a marketing plan for the WIC Breastfeeding Promotion Program. With
the broad set of data collected from the surveys and interviews, program
strategists established detailed objectives and goals for the project, the
specific audiences and behaviors to be targeted, and the strategies for
addressing the factors associated with promoting breastfeeding. The marketing
plan was created using the conceptual framework of the 4 Ps (product, price,
place, and promotion), and included a specific strategy for each area to
distinguish the product (breastfeeding) from its competition (formula
The "product strategy" defined breastfeeding by describing both the health
and the emotional benefits, and by emphasizing the special, loving bond the
mother will share with her child. In contrast to the traditional public health
approach of addressing breastfeeding as a medical health decision,
breastfeeding was repositioned as a way for a family to establish a special
relationship with their child from the very onset of its life. With the slogan
"Loving Support Makes Breastfeeding Work," program materials were created to
explain the supportive role family members and friends can play in encouraging
a new mother to breastfeed.
Another key component of the marketing plan was its "pricing strategy," which
entailed minimizing or eliminating the deterrents or "perceived costs" of
breastfeeding for new and prospective mothers. The strategy called for
targeting the women who doubted their breastfeeding ability or who felt
breastfeeding was embarrassing or conflicted with their active lives and
relationships. To address these perceived costs, public education materials
were created for each targeted group of women, and a counseling program was
developed for health care providers to assist them in identifying common
misperceptions and helping mothers work through them.
Placement and Promotion Strategy
"Placement strategy" for the program focused on reaching the various
environments in which mothers and their friends and relatives obtain infant
care information. Education materials were developed to reach mothers and
relatives in their homes; and together with the World Health Organization and
the UN Children's Fund, Best Start program staff took steps to make hospital
environments more supportive of breastfeeding mothers. Partnerships with other
breastfeeding promotion organizations and professional associations were
established through the FNS' Breastfeeding Promotion Consortium to further
institutionalize and disseminate the program.
The program's "Promotion Strategy" entailed promoting the WIC breastfeeding
project using a variety of methods and through a broad range of outlets,
including: legislative, policy, and organizational development; media and
grassroots advocacy; professional training and education, peer counselor
programs, and direct marketing and advertising. The strategy also called for
developing a campaign message that would use emotional appeal, convey a
positive, congratulatory tone, and would be communicated through family
Program Launch and Implementation
During the summer and fall of 1996, Best Start brought together the
campaign's strategies and concepts, contracted with an advertising agency, and
finalized the structuring of the program. Pretesting of all of the campaign's
messages and materials was also conducted in several pilot states during this
time to determine which marketing concepts were most effective in reaching the
target audiences. When the program and campaign strategies were finalized, the
initial set of marketing and media materials were developed and included: three
bilingual (English and Spanish) television commercials, three bilingual radio
commercials, outdoor billboards, nine bilingual posters, nine bilingual
educational pamphlets, and several information and resource guides and WIC
To ensure effective coordination and implementation of the program's many
elements at the state and local levels, a comprehensive training conference
was held for WIC staff members from the 10 pilot states. The conference sessions
included presentations and seminars covering a broad range of topics including:
research results and their implications for breastfeeding promotion; working
with the media and utilizing the marketing/media package; community and team
building; and nontraditional communication methods. Additional breakout sessions
allowed for skill development and team planning; and by the conclusion of the
conference, WIC staff attendees had developed detailed implementation plans for
each of their respective states.
The National WIC Breastfeeding Promotion Project was officially launched in
Washington, DC with a national press conference during World Breastfeeding Week
(August 1-7, 1997). As part of the program's implementation plan, Best Start
Social Marketing worked closely with the 10 pilot states during the campaign's
first 18 months by providing technical assistance with marketing and team and
||Pilot states include: Iowa, Arkansas, Nevada, California, New Jersey,
West Virginia, Ohio, New York, Mississippi, and the Chickasaw Indian
||Primary target audience included: Pregnant Anglo American,
African American, Hispanic, and Native American women who were enrolled
in the WIC program or were income eligible. Secondary target audience
included: mothers, husbands, and boyfriends of pregnant women,
WIC nutritionists and clerical staff, and prenatal health care providers.
Tertiary audience included: the general public.
||The WIC Breastfeeding Promotion Project was initiated to:
||1. Increase the number of breastfeeding women.
||2. Increase the average duration of breastfeeding among WIC program
||3. Increase the number of referrals to WIC for breastfeeding
support and technical assistance.
||4. Increase acceptance and support for breastfeeding among
the general public.
||Television and radio advertisements, billboards, posters,
educational pamphlets, information booklets, and staff support kits
with resource information and promotional materials.
||Special Supplemental Nutritional Program for Women, Infants, and
Children (WIC), Best Start Social Marketing, Inc., and the USDA Food
and Nutrition Service (FNS).
||August 1997 to August 2000 under initial funding. Program to
continue indefinitely thereafter.
||Jim Lindenberger, Director
Best Start Social Marketing
3500 E. Fletcher Avenue, Suite 519
Tampa, Florida 33613, USA
Telephone: (813) 971-2119
Printed with permission by The Social Marketing Institute