Master's Project Title:

The Effects of Peer Counseling and Parity on Breastfeeding Initiation and Duration: an Analysis of Minnesota Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

MCH Student:

Marcia McCoy

Date of Defense:

January 12, 2015


Objective: Breastfeeding Peer Counseling (PC) Programs have been found to be effective in  increasing both initiation and duration of breastfeeding. Our objective was to explore the  association between program participation and breastfeeding outcomes in a low – income  population, and to assess whether there is a differential response to peer counseling between  first-time (primiparous) mothers and mothers with previous children (multiparous women).  Outcomes include breastfeeding initiation and duration of any breastfeeding.

Design: Secondary analysis of cross – sectional administrative data from the Minnesota Special  Supplemental Nutrition Program for Women, Infants, and Children (WIC) program’s HuBERT  database. Multivariable logistic regression models were used to assess associations between any  peer contact and initiation of breastfeeding. Multivariable Cox proportional hazard models were  used to assess associations between peer contact and duration of any breastfeeding. Population:  Mothers who gave birth to infants in 2012 and who enrolled in the WIC program in  Minnesota during pregnancy (n=16,487).

Results: Among mothers who accepted PC referral while pregnant (n=2219), odds of  breastfeeding initiation were significantly higher among those who had at least one contact with  PC services, after adjustment for maternal and infant characteristics (adjusted OR = 2.58; 95%  CI 1.98, 3.37). Primiparous women were more likely than multiparous women to initiate  breastfeeding, although the odds did not reach statistical significance (adjusted OR = 1.31; 95%  CI 0.99, 1.73). There was no evidence of a differential impact of PC contact by parity. Mothers  who were non – English – speaking (OR = 2.75; 95% CI 1.51, 4.99), older (OR=1.07; 95% CI 1.04,  1.10), and non – smokers (OR=1.56, 96% CI 1.18, 2.07) had significantly higher odds of  breastfeeding initiation than English – speakers, younger mothers, and smokers. Among women  who accepted PC referral and initiated breastfeeding (n=2814), those who had any PC contact  had a significantly decreased hazard of weaning compared to women who accepted referral but did not receive contact (HR = 0.53; 95% CI 0.41, 0.69). Non – English – speaking mothers  (HR=0.81; 95% CI 0.72, 0.92), older mothers (per year of age, HR=0.97; 95% CI 0.97, 0.98),  mothers whose infants weighed less at birth (per 100 gram increment, HR=.99, 95 % CI 0.99,  0.999), and mothers who participated in WIC for 3 or more months while pregnant (HR=0.88;  95% CI 0.80, 0.97) had a lower hazard ratio for breastfeeding cessation, while women who  smoked prenatally (HR=1.44; 95% CI 1.31, 1.60), women with higher  BMIs (per unit increment,  HR=1.02; 95% CI 1.01, 1.02), and mothers of male infants (HR=1.12; 95% CI 1.03, 1.21), had  increased hazard ratios for breastfeeding cessation.

Conclusions: Contact with a peer counselor was significantly associated with increased rates of  initiation of breastfeeding and with longer duration of any breastfeeding among WIC program  participants in Minnesota in 2012. The association between PC contact and breastfeeding  outcomes did not differ between primiparous and multiparous women.