State & Local WIC Agencies

Evaluation of the Birth Month Breastfeeding Changes to the WIC Food Packages Study

LWA Interview _P1_10.16.08

State & Local WIC Agencies

OMB: 0584-0551

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Local WIC Agency Survey Items: Pre-Implementation (P1)

OMB Clearance Number: 0584-NEW Expiration Date: xx/xx/2011


According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 60 minutes per response. If you have any comments concerning the accuracy of time estimates or suggestions for improving this form, please contact: U. S. Department of Agriculture, Food and Nutrition Service, Office of Research & Analysis, Room 1014, Alexandria, VA 22302.


Hello, my name is [INTERVIEWER]. I work for Abt Associates Inc., which is conducting a study sponsored by the U.S. Department of Agriculture’s Food and Nutrition Service to learn about the pending changes to the WIC food packages for postpartum women and infants.


You have been invited to participate in a telephone interview for this study to offer your perspective on the WIC food package changes that your State is going to implement in the near future. Your input is important to help us understand the different issues surrounding these changes and how your local agency/clinic is preparing for them.

The interview will take approximately 60 minutes. Your responses will not be attributed to you but will be merged with responses from other interviews we conduct with your State and local agency/clinic to create an overall summary of the implementation plans. Do you have any questions before I begin?



General Site Characteristics

  1. How many staff members work in your agency? How many (if any) clinics do you have and what are the types of communities that they serve?

  2. What are the racial/ethnic characteristics of the WIC participants you serve? (Make sure adds up to 100%) Approximately what proportion are recent immigrants?

  3. What is your policy or general practice about the maximum amount of formula for an infant of a mother who is partially breastfeeding? (Obtain copies of any written materials.)

  4. Are pregnant women routinely given information from WIC staff about breastfeeding prior to delivery? If so, when is this information given? How is it communicated? (Obtain copies of any written materials.)

  5. During certification appointments for pregnant and postpartum women, are food package options typically discussed with WIC participants? (always, often, occasionally, rarely, never). Is this done with all WIC participants or only with certain ones? Please specify.

  6. During follow-up or Nutrition Education Sessions, are food package options typically discussed with the WIC participant? (always, often, occasionally, rarely, never)

  7. During voucher pick-up, are food package options typically discussed? (always, often, occasionally, rarely, never)

  8. How long does a certification appointment usually take for a postpartum woman? For an infant? How much time, if any, is spent discussing food package options for mother and infant?

  9. How often do postpartum women change food packages during the first month? (e.g., from breastfeeding to non-breastfeeding)? (often, occasionally, rarely). How much of an administrative burden does this present?

Breastfeeding Information and Support

  1. What proportion of your staff who sees WIC participants have received a lactation counselor certificate or lactation management training? Which staff receives training? How often do they receive it?

  2. Do you have a lactation consultant on staff? How many FTEs?

  3. Please answer the following questions for the local hospital where WIC participants served by your agency most frequently deliver. (Obtain name of hospital. If two hospitals equally serve WIC participants, obtain information for both).

  1. Has this hospital been designated a Baby-Friendly Hospital, as outlined by UNICEF and the World Health Organizations?

  2. Is there rooming-in for newborns?

  3. Are mothers encouraged to breastfeed within the first hours after birth?

  4. Are breastfeeding infants routinely given any supplementation, including water?

  5. Are formula discharge packs provided?

  6. Are there lactation consultants on staff?

  7. Has hospital staff received training in lactation management in the last 3 years?

  8. Does the hospital have any discharge lactating support programs?

  9. Does WIC staff provide education to newly delivered women in the hospital?

  10. Are WIC certifications of newly delivered women and their infants done while in the hospital?


  1. Does your agency have a Loving Support breastfeeding program or other peer counseling program? If yes, please describe.

  1. How many women do peer counselors contact in the average month?

  2. If you have a grant, what is its size?

  3. Did your agency receive other funding for peer counseling, and if so, how much?


  1. In addition to any peer counseling your agency may offer, does your agency provide other breastfeeding promotion services or programs (e.g. support groups, classes, educational materials) for WIC participants?

  1. If yes, please indicate the breastfeeding promotion activities available to WIC participants in your local agency:

  • Media campaigns and /or posting materials in public places

  • Making lactation consultants and other trained specialists available to WIC participants

  • Support groups or classes

  • Equipment (e.g., pumps)

  • Peer counseling or other counseling to WIC participants that is different than Loving Support peer counseling

  • Special training to nutritionists and other WIC staff, hotline, other.


Implementing Food Package Changes

  1. Please describe how the changes to postpartum food packages will be implemented. What are your biggest logistical concerns? How do you anticipate addressing them?

  2. What systems, if any, are needed to change or be put in place in order to accommodate the Interim Rule? (computers, printers, software, new forms, etc.)

  3. What training, if any, is needed to ensure accurate implementation – for example, directions on “up to” 4 cans, etc?

  4. How long do you expect it will take to fully implement these changes?

  5. What, if any, staffing changes are planned as a result of the implementation of the Interim Rule? (new hires, changes in job descriptions, added job responsibilities, other)

Information on Interim Rule to WIC Participants

  1. Do you anticipate that WIC participants will be informed of the food package changes for partially breastfeeding women and infants? If so, how? (notified by mail, phone, in person, other).

  2. When will WIC participants be informed of the changes? (at certification or follow up appointments? By phone or mail prior to appointments?)

  3. Will the changes for partially breastfeeding women and infants be publicized within WIC clinics? If so, how will they be publicized? (posters, pamphlets, verbally by staff, written on vouchers)

  4. Will written materials explaining the changes be provided to the WIC participants? Will written materials be available in languages other than English? If so, what languages?

  5. Who will prepare the written materials (e.g. the State office or someone in your local agency)?

  6. Who will be responsible for explaining the changes to the WIC participants? (nutritionists, clinic assistants, clerical staff, other)

  7. Other than local WIC agencies, will the food package changes be communicated to other places in the community? If so, where? (local physicians, hospitals, health centers, stores, community or daycare centers, schools, churches, other)

WIC Participants’ Food Packages Choices

  1. Currently, what are the reasons participants give for changing from exclusively breastfeeding to formula packages? To what degree does the content of the food packages affect these decisions?

  2. How well do you think WIC participants understand the different packages?

  3. How soon after the birth do women who choose to fully breastfeed typically come into be certified? How soon do women who choose to partially or fully formula feed?

  4. Currently, on average, how much time passes before a woman who decides to fully breastfeed switches to packages with more formula? (e.g. how many days, weeks/months postpartum)

  5. Do you think that women’s decisions to change to packages with more formula are due to problems with the act of breastfeeding or for other reasons (e.g., returning to work)? If changes are due to problems, what steps do you generally take, if any? (referred to peer counseling or other breastfeeding supports) How effective are these steps?

Effects of Food Package Changes

  1. How do you think the Interim Rule will affect breastfeeding initiation? Duration? Intensity?

  2. Do you think the pending Interim Rule has affected staff attitudes toward breastfeeding? If so, how do you think it will influence package choices? Please explain.

  3. Do you plan to track the effects of postpartum food package changes on breastfeeding outcomes? If yes, please explain how.

  4. Do you currently collect data on initiation, duration or exclusivity of breastfeeding? If so:

  1. How are these data collected? (paper or electronic reports, entered into state or local database, survey sent by state to all LWAs).

  2. How are these data used? (Needs assessment, reporting to State, local evaluation of Loving Support program, other).


  1. Have there been any program changes based on the past data collection efforts?

Abt Associates Inc. Local WIC Agency Interview Questions_P1 4

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