WIC Participants

WIC Birth Month Food Package Evaluation

Participant Survey

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-NEW. The time required to complete this information collection is estimated to average 30 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]. Thank you for taking time today to help us. I’m from Abt Associates Inc. and we are talking to mothers who recently gave birth to learn about their infant feeding practices and their experience receiving services from WIC. [A short time ago, you should have received a letter from your WIC agency about this study, stating that someone would be contacting you to participate in an interview.][A short time ago, I talked to you about the study and you consented to participate in the interview.]¹

The interview will take approximately 30 minutes. Your answers will help (STATE) improve its WIC services for parents and infants. Everything you tell me will be kept strictly confidential. As a way of saying thank you, we will give you a $35 gift card when we are finished.

Your participation in this interview is voluntary. Your benefits will not be affected if you choose not to participate. If you take part, you may refuse to answer any question. If you take part, your answers won’t change any benefits you may receive from any agency. If now is a good time for you and you are willing to participate, I’d like to begin my questions. Do you have any questions before I begin?

Infant Information and Feeding Practices

1. Infant date of birth: ____ / ____ / ________

(mm dd yyyy)

2. Infant birth weight: _________ pounds _________ ounces

3. Did you ever breastfeed or pump breastmilk to feed your baby after delivery?

• Yes

• No (SKIP TO Q6)

4. Are you still breastfeeding or feeding pumped milk to your new baby?

• Yes (GO TO Q5)

• No (ASK Q4a)

4a. How many weeks or months did you breastfeed or pump milk to feed your baby? (SKIP TO Q6)

______ Weeks

______ Months

5. Which of the following best describes the kind of milk you fed your baby in the last 24 hours?

• Breastmilk only (SKIP TO Q8)

• Mostly breastmilk with some formula (GO TO Q5b)

• Breastmilk and formula about equally (GO TO Q5b)

• Mostly formula with some breastmilk (GO TO Q5b)

• Formula only (ASK Q5a)

5a. Earlier you indicated that you were still breastfeeding your baby. Is this correct?

• Yes (ASK Q5b)

• No (GO TO Q6)

5b. Thinking back over the last week, how frequently did you feed your baby breastmilk?

• Usually two times a day or more often

• Usually once a day

• Less than once a day

6. In the past 24 hours, how much formula did your baby drink in total?

__________ Ounces

7. In the last 24 hours, did you feed your baby anything else besides formula or breastmilk?

• Yes (ASK Q7a)

• No (GO TO Q8)

7a. Please indicate what else you fed your baby and approximately how much in the last 24 hours.

	YES	NO	IF YES: How much?
Baby cereal			__________
Cow’s milk or any other milk			__________ Ounces
Plain water			__________ Ounces
Juice/sugar water			__________ Ounces
Table/solid/adult food			__________
Other (SPECIFY): _______________			__________

7b. How old was your baby the first time you fed him or her any of these things?

__________ Weeks

WIC Program Participation

8. Did you receive WIC while you were pregnant with your infant?

• Yes (ASK Q8a AND Q9)

• No (ASK Q8b AND SKIP TO Q10)

8a. How many months pregnant were you when you started getting WIC?

______ Months

8b. When did you get on WIC?

____ / ____ / ________

(mm dd yyyy)

9. When you were pregnant did you take a class from WIC where they talked about breastfeeding?

• Yes (ASK Q9a AND Q9b)

• No (GO TO Q10)

9a. What did they talk about? (CHECK ALL THAT APPLY)

• Proper positioning for breastfeeding

• How to tell if your baby is getting enough breastmilk

• Differences in food packages depending upon whether or not you chose to breastfeed

• Who to call if you had any questions or issues about breastfeeding

• Other (SPECIFY):

9b. How many months pregnant were you when you took the class?

__________ Months

10. Have you or a family member ever participated in WIC previously?

• Yes

• No

11. Were you encouraged to breastfeed by WIC?

• Yes

• No

12. While you were in the hospital for delivery of your baby, did anyone help you with breastfeeding by showing you how or talking to you about breastfeeding?

• Yes

• No

13. When you left the hospital after the delivery of your baby, were you given any formula?

• Yes

• No

14. Did you have any questions or problems when you first tried to breastfeed?

• Yes (ASK Q14a)

• No (GO TO Q15)

14a. Who did you talk to for help? (CHECK ALL THAT APPLY)

• A friend

• A relative

• Someone from WIC

• Someone at my doctor’s office

• Someone at the hospital

• Someone on a helpline

• Other (SPECIFY):

Food Package Choices

15. What are the differences in a mother’s food package if she fully breastfeeds compared to if she chooses to only feed her baby formula? (DO NOT PROMPT. CHECK IF ANY OF THESE RESPONSES ARE GIVEN.)

Breastfeeding mothers get….

• More juice

• More milk

• More eggs

• More money for fruits and vegetables

• Canned fish

• Peanut butter

15a. How did you learn about the differences between the food packages that you would get for yourself, as a new mother, depending upon whether you feed your baby breastmilk and no formula, breastmilk and some formula, or no breastmilk and only formula? From… (CHECK ALL THAT APPLY)

• WIC (ASK Q15b)

• Friend (GO TO Q16)

• Family (GO TO Q16)

• Other (SPECIFY): (GO TO Q16)

15b. Did you receive anything in writing from WIC about what was in the packages, like a brochure or pamphlet?

• Yes (ASK Q15c)

• No (GO TO Q16)

15c. When did you get information about these different packages?

• During pregnancy (IF YES: Which trimester? ___________)

• After the baby was born

16. What is the difference between the full and partial formula amounts in the baby’s first month? (DO NOT PROMPT. CHECK IF ANY OF THESE RESPONSES ARE GIVEN.)

• Only a small amount of formula is available for the partial formula option

• Only powder formula is available for the partial option

• Much more formula is given for the full formula option

16a. What is the difference between the full and partial formula amounts in the baby’s months two through five? (DO NOT PROMPT. CHECK IF ANSWER IS GIVEN.)

• Half as much formula is given for the partial formula option than the full formula option

16b. How did you learn about the differences in the amount of formula your infant would receive depending upon whether you choose to feed your baby both breastmilk and formula or feed your baby formula and not feed your baby breastmilk? From… (CHECK ALL THAT APPLY)

• WIC (ASK Q16c)

• Friend (GO TO Q17)

• Family (GO TO Q17)

• Other (SPECIFY): (GO TO Q17)

16c. Did you receive anything in writing from WIC about what was in the packages, like a brochure or pamphlet?

• Yes (ASK 16d)

• No (GO TO Q17)

16d. When did you first hear about these different packages?

• When I was pregnant (IF YES: Which trimester? ___________)

• After I gave birth

17. How important were the differences in the food packages for you and for your infant in your decisions about breastfeeding?

• Extremely important

• Very important

• Somewhat important

• Somewhat unimportant

• Not very important

• Not important at all

18. (ASK IF ADMINISTRATIVE DATA INDICATE THAT WOMAN IS RECEIVING FULL- OR PARTIAL-FORMULA INFANT PACKAGES) Our records indicate you received [amount] of formula from WIC this month to feed your baby. Is this correct?

• Yes (ASK Q18a)

• No (ASK Q18d)

• Don’t know (ASK Q18d)

18a. This month, did you have the right amount, too little, or too much formula for your baby?

• The right amount (SKIP TO Q19)

• Too much (ASK Q18b)

• Too little (GO TO Q18c)

18b. What did you do with the extra formula? (CHECK ALL THAT APPLY)

• Saved it for later

• Gave it to someone who needed it

• Traded it for something else that I needed

• Sell it

18c. What did you do to feed your baby this month since you did not get enough formula from WIC? (CHECK ALL THAT APPLY)

• Used formula that I had from a previous month

• Added water to the formula I have

• Fed my baby (more) breastmilk

• Fed my baby other things as well as formula, such as cows’ milk, juice or cereal

• Borrowed or was given formula from someone else

• Bought more formula

• Other (SPECIFY):

18d. How much formula did you receive this month?

• No formula from WIC (GO TO Q19)

• [Amount equal to partial formula package] (ASK 18a)

• [Amount equal to full formula package] (ASK 18a)

Breastfeeding History, Knowledge About, Attitudes Towards, Decisions

19. Please indicate if the following information is true, false, or you don’t know:

	True	False	Don’t know
You should follow a strict schedule for feeding the baby when breastfeeding			
Giving a baby solid food helps him/her sleep through the night			
A baby should eat as many different types of food as soon as possible			
Newborns need to be breastfed often (day and night)			
Breastfeeding babies have fewer illnesses			
You feed your baby solid food with a spoon only			
Breastfeeding even one week is better than not at all			
Breastfeeding provides complete nourishment for a baby			

20. When did you decide what to first feed your baby?

• Before birth

• At hospital

• After arriving home from hospital

21. How important were the following in your decision about whether to breastfeed? Use a four-point scale where 1 = not at all important and 4 = very important.

	Not at all important			Very important
	1	2	3	4
My own past experiences with breastfeeding				
Information and advice from family members				
Information and advice from friends				
Information and advice from my doctor or a nurse at my doctor’s office				
Information and advice from someone at WIC				

22. For each of the following items, please indicate how important they were when you made your decision about how you feed your baby. Would you say it was extremely important, very important, somewhat important, somewhat unimportant, not very important, or not important at all?

	Extremely important	Very important	Somewhat important	Somewhat unimportant	Not important at all
How convenient it is					
How close it makes you feel to your baby					
How much it helps you lose weight					
How important it is for the baby’s health					
How much it allows the baby‘s father or other family member to be involved in feeding the baby					
How much it makes you feel embarrassed when in public					
How easy it is to go out socially					
How easy it is to go to work or school					
How trouble free it is					
How it allows you to see exactly how much the baby has eaten					
How much you have to watch what you eat or drink					

23. (ask if stopped breastfeeding or are partially breastfeeding—Q4 and q5) How important were each of these issues in your decision to [stop breastfeeding/ supplement breastfeeding with formula]? Use a four-point scale where 1 = not at all important and 4 = very important.

	Not at all important			Very important
	1	2	3	4
My baby (has) had trouble sucking/latching on				
My baby is old enough so the difference between breastmilk and formula no longer mattered				
Breastmilk alone did not satisfy my baby				
My baby was not gaining enough weight				
I didn’t have enough milk				
Breastfeeding was too painful or uncomfortable				
Breastfeeding was too inconvenient				
I started a job or returned to work				
Although I didn’t return to work I needed to leave my baby for several hours at a time				
I wanted someone else to feed my baby too				

24. Have you breastfed any babies before this infant?

• Yes (ASK Q24A AND Q24b)

• No (GO TO Q25)

24a. How many other babies did you breastfeed? __________

24b. How long did you breastfeed each baby? ___________

25. On a scale of 1 (very uncomfortable) to 5 (very comfortable), how would you rate the following situations?

	Very un-comfortable				Very comfortable
	1	2	3	4	5
A woman breastfeeding her baby in the presence of close women friends					
A woman breastfeeding her baby in the presence of men and women who are close friends					
A woman breastfeeding her baby in the presence of men and women who are not close friends (such as at a shopping mall or restaurant)					
A woman breastfeeding her baby in the presence of family members					

26. How do your friends and family feed their babies? (CHECK ALL THAT APPLY)

• Breastfeed from breast

• Breastfeed from bottle (pumped or expressed milk)

• Formula feed

Employment

27. Did you work for pay outside of the home in the past 4 weeks?

• Yes

• No (SKIP TO Q32)

28. Are you currently employed?

• Yes

• No

29. What is the average number of hours you work per week?

____________ Hours per week

30. In your opinion, how supportive of breastfeeding is your current [or last if no longer working—Q28] place of employment?

• Not at all supportive

• Not too supportive

• Somewhat supportive

• Very supportive

31. (ASK ONLY IF BREASTFEEDING—Q4 AND Q5) Which of the following circumstances describe your situation during the past 4 weeks?

• I breastfeed my baby during my work day

• I pump milk during my work day and (CHECK ONE)
   dump it OR
   save it for my baby to drink later

• I neither pump nor breastfeed during my work day

Childcare

32. Did someone other than you care for your baby for more than 3 hours last week?

• Yes (ASK Q32a)

• No (SKIP TO Q35)

32a. Does the person who took care of your baby do so on a regular basis? This could be for work or non-work related reasons (for example, you had classes or other activities).

• Yes

• No (SKIP TO Q35)

33. How many days in the last week was your baby cared for by someone else?

____________________ Days per week

34. On an average day when someone else was caring for your baby, how many hours was he or she with a care provider?

____________________ Hours per day

Demographic Characteristics

35. How many people are living in your household?

___________ People

36. How many children do you have under 18 including your baby?

_____________ Children

37. What is your current marital status?

• Never married

• Married/living with partner

• Divorced

• Legally separated

• Widowed

• Refused/NA

38. What was the highest grade/level of school you completed?

• Did not graduate high school

• High school graduate or GED

• Some college or 2-year degree

• 4-year college graduate

• More than 4-year college degree

39. Please choose one or more categories to describe your race.

• American Indian or Alaskan Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

40. What is your ethnic background? Are you…

• Hispanic or Latino

• Not Hispanic or Latino

41. Where were you born?

• One of the 50 US states or the District of Columbia

• One of the US Territories (PROBE: Puerto Rico, Guam, American Samoa, US Virgin Islands, Mariana Islands, or Solomon Islands)

• Some other country (SPECIFY):

42. When were you born?

____ / ____ / ________

(mm dd yyyy)

43. Please indicate your total household income.

• Less than $10,000

• Between $10,001 – $15,000

• Between $15,001 - $20,000

• Between $20,001 – $25,000

• Between $25,001 - $30,000

• Between $30,001 – $35,000

• Between $35,001 - $40,000

• More than $40,000

44. Do you receive any of the following? (CHECK ALL THAT APPLY)

• Food stamps

• TANF or cash assistance

• Medicaid

• Welfare

1 Some of the WIC participants will be sent a letter by their local agency indicating that unless they otherwise object, they will be contacted and asked to participate in the study. Others will be recruited in the WIC clinics by field staff, who will be responsible for conducting the interview.

Abt Associates Inc. 12