Strategy. WIC Food Package Change
Approach. Enhance the number of families participating in the fully-breastfed WIC food package change
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Overview. There is preliminary evidence to suggest that family leave, workplace policies, and state laws such as the WIC food package change could contribute to increased breastfeeding rates. The goal of the food packages is to better promote and support the establishment of successful, long-term breastfeeding, provide WIC participants with a wider variety of foods including fruits, vegetables, and whole grains, and provide WIC state agencies greater flexibility in prescribing food packages to accommodate the cultural food preferences of WIC participants.[1] Although steady upward trends in breastfeeding have been reported due to the new food package,[2] more research is needed for conclusive results.
Evidence. Emerging Evidence.
Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").
Access the peer-reviewed evidence
through the MCH Digital Library or related evidence source.
(Read more about understanding evidence ratings).
Source. Peer-Reviewed Literature
Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):
- Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
- Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
- Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.
Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).
Intervention Level. Community-Focused
Examples from the Field.
Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of WIC staff trained on promoting the fully-breastfed food package. (Measures workforce capacity building to support the initiative.)
- Number of promotional materials distributed to WIC participants about the fully-breastfed food package. (Quantifies outreach efforts to raise awareness of the package.)
- Number of community partners engaged to promote the fully-breastfed food package (e.g., healthcare providers, breastfeeding coalitions). (Tracks multi-sector collaboration.)
- Number of WIC participants who receive education about the fully-breastfed food package. (Measures the reach of educational interventions.)
- Number of WIC participants who enroll in the fully-breastfed food package. (Tracks the primary outcome of interest, i.e., package enrollment.)
- Number of WIC participants who receive referrals to breastfeeding support services in conjunction with the fully-breastfed package. (Assesses linkages to wraparound supports.)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of WIC clinics that consistently offer and promote the fully-breastfed food package. (Measures the consistency and quality of package promotion across sites.)
- Percent of WIC staff who report high confidence in educating participants about the fully-breastfed package. (Assesses the effectiveness of staff training efforts.)
- Percent of fully-breastfed food package education that is provided in participants' preferred language. (Tracks the language accessibility and cultural relevance of education.)
- Percent of WIC infants receiving the fully-breastfed package at 3, 6, and 12 months of age. (Measures breastfeeding exclusivity and duration among package recipients.)
- Percent of mothers on the fully-breastfed package who report high satisfaction with the food items provided. (Assesses participant experience and perceived value of the package.)
- Percent of fully-breastfed package participants who achieve their self-identified breastfeeding goals. (Captures the package's impact on personalized breastfeeding outcomes.)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of WIC state agencies that have implemented the fully-breastfed package. (Tracks large-scale adoption and standardization of the package.)
- Number of stores and vendors that stock and promote WIC fully-breastfed package items. (Measures retail-level support and normalization of the package.)
- Number of healthcare providers who actively recommend the fully-breastfed package to eligible patients. (Assesses provider buy-in and promotion of the package.)
- Number of WIC participants who transition from the partially-breastfed to fully-breastfed package. (Captures the package's influence on exclusive breastfeeding.)
- Number of WIC agencies that see an increase in breastfeeding initiation and duration after fully-breastfed package implementation. (Measures agency-level breastfeeding outcomes.)
- Number of WIC participants on the fully-breastfed package who delay introduction of complementary foods until recommended. (Assesses the package's impact on infant feeding practices.)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- - Percent of fully-breastfed package promotion efforts targeted to WIC populations with lower breastfeeding rates. (Assesses strategic outreach to address breastfeeding disparities.)
- - Percent of WIC vendors in underserved communities that actively promote the fully-breastfed package. (Measures equitable promotion and access to the package.)
- - Percent of WIC participants who receive culturally-tailored education on the fully-breastfed package. (Tracks the cultural responsiveness of package promotion efforts.)
- - Percent increase in fully-breastfed package enrollment among WIC participants from historically marginalized communities. (Measures the package's impact on breastfeeding equity.)
- - Percent of all WIC infants statewide/jurisdiction-wide who are enrolled in the fully-breastfed package. (Assesses population-level uptake of the package.)
- - Percent reduction in WIC infant formula costs after implementation of the fully-breastfed food package. (Captures the package's financial impact and return on investment.)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
