This document summarizes a research project on how staff at the Women, Infants, and Children (WIC) program perceive breastfeeding and their clients. The author conducted participant observation and interviews at a local WIC office. Through this research, the author found that WIC staff see breastfeeding as the healthiest option for mothers and infants. However, they also recognize many clients lack confidence in breastfeeding. Therefore, WIC staff provide education and support to encourage breastfeeding while still respecting other feeding choices. This research provides insight into how WIC staff view their clients and how their work promotes breastfeeding to address low rates, especially among low-income families.

1. The Women, Infants, and Children Program and Breastfeeding: How Staff Perceive
Breastfeeding and Their Clients
Kate Daugherty
Advisor: Mary Tuominen
A project completed as part of the requirements of the Field Research Methods Course (SA 350)
Department of Sociology/Anthropology
Denison University
Spring 2015

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INTRODUCTION
“Breastfeeding Wall of Fame! Breastfeed for at least one year.” This enthusiastic and
brightly-colored bulletin board was my first sign that the Women, Infants, and Children program
(WIC) is more fixated on breastfeeding than the average health organization. I was surprised that
any mother would be able to handle a year of breastfeeding, let alone enough mothers to fill an
entire bulletin board in a local county WIC program’s waiting room. As I observed the rest of the
room, I realized that most of the other boards and posters were also about breastfeeding. Good
Lord, I thought to myself. What’s the big deal?
As I spent more time at WIC, staff members brought up breastfeeding time and time
again; and it seemed to me that there was a much higher focus on the practice than was normal.
Perhaps such a high focus was normal, and I had just never noticed. In any case, I wanted to
know more. I decided to concentrate my research on breastfeeding, and more specifically,
breastfeeding at WIC. I knew there had to be a reason such a widespread organization would put
so much emphasis on a behavior I had previously believed to be both common sense and
expected. But if it was a behavior that almost all women engaged in with as little prompting as I
had assumed, why would WIC go out of their way to make sure clients were doing it?
Once I understood that many women, especially women who are clients at WIC, do not
actually breastfeed exclusively or for very long (Langellier et al. 2014:S112), it became clear that
the promotional materials that plastered WIC’s walls and the championing of breastfeeding by
the staff were parts of a concentrated effort to further improve the health of clients. I wanted to
know why, if breastfeeding is so obviously beneficial, the majority of mothers (both in WIC and
in general) do not engage in breastfeeding for very long or without formula supplementation.

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The official mission of WIC is “to safeguard the health of low-income women, infants,
and children up to age five who are at nutrition risk by providing nutritious foods to supplement
diets, information on healthy eating, and referrals to health care” (U.S. Department of
Agriculture 2015). Although breastfeeding is not mentioned, the promotion of breastfeeding I
saw at the local WIC office is in line with their goals; breastfeeding has been shown to be very
healthy for both infants and their mothers, in addition to being a cheaper option than formula
(Rippeyoung 2013:69).
Through investigating breastfeeding at a local WIC office, I have discovered that by
providing education and support to their clients, WIC staff address the lack of confidence they
perceive in their clients and give them the tools they need in order to successfully and
comfortably breastfeed. In addition, breastfeeding is seen as the best choice for new mothers and
infants, because it is the healthiest option and it promotes an emotional bond between mother and
baby. However, although the staff at WIC do all they can to encourage breastfeeding, they also
emphasize supporting women if they do not choose to breastfeed.
These findings are significant because they show how staff see their clients in their
breastfeeding choices, and how WIC’s work actively seeks to rectify an issue that they’re aware
of beyond the food needs of low-income families. The findings also show how breastfeeding is
perceived by the staff, and how this perception influences how the staff educate clients in order
to sway mothers into breastfeeding.
BACKGROUND
The Women, Infants, and Children program was founded in 1972 under the Department
of Agriculture in order to address the nutritional needs of low-income Americans (U.S.
Department of Agriculture 2015). WIC helps families that do not make enough money to provide

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their children, pregnant women, and post-partum mothers with healthy food options; in order to
receive WIC benefits, a family must meet the income and residency requirements in addition to
having an identifiable health risk (such as smoke exposure). WIC has been proven to increase the
physical health outcomes of its clients, along with the unintentional (but welcomed) side effect
of improving mental health outcomes (Dell’Antonia 2012).
As I noticed during my first observation session, WIC has a strong breastfeeding support
policy. Although WIC has always encouraged breastfeeding, in 2009 the packages were
revamped in order to incentivize clients to breastfeed and to breastfeed longer; mothers who
choose to breastfeed are given more food for a longer period of time, while mothers who
breastfeed partially or not at all get less formula and less food than in the past (Whaley et al.
2012:2269). This same policy change commenced the beginning of the breastfeeding peer
program, which allows for a former WIC client who has breastfed all her children to provide
counselling and support to breastfeeding clients.
The county that this particular local WIC office serves is the third largest in the state, and
is mostly rural with one small city and several smaller towns and villages (Dow 2015). Early in
the twentieth century, the city was a successful manufacturing center; in the eighties, the high
school’s graduating class was over 650 students (Dow 2015). However, many of the
manufacturers have closed or moved out of the area, and the graduating class has fallen to
around 350 per year, with a 76% graduation rate in 2014 (Dow 2015). While the area is still
surviving, the loss of capital has severely affected the ability of the community’s population to
provide healthy food and nutritional education to their families, much less breastfeeding support.
This is where WIC steps in.

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As I have mentioned several times above, WIC seeks to aid low-income families with
their nutritional needs, in order to alleviate the effects of poverty on health. Breastfeeding, while
very healthy, is practiced much less by lower-income mothers than by higher-income mothers,
and in order to combat this trend WIC policies promote and encourage breastfeeding over using
formula (Jensen 2012:625). The specific services that WIC provides in addition to breastfeeding
support are health screenings, nutritional education, food supplementation, and health care
referrals (U.S. Department of Agriculture 2015). These services are facilitated at the local WIC
office by a variety of health professionals such as dieticians, diet technicians, and nurses, as well
as a breastfeeding peer.
The issue of low or less-than-desirable breastfeeding rates is both a nationwide and local
problem. Although “the 2006 National Immunization Survey found that nearly 74% of children
had been breastfed,” this only accounts for children that had been breastfeed ever, without regard
to exclusivity (Jensen 2012:624). In reality, much fewer infants are receiving the benefits of
breastfeeding, and there are large disparities between different socio-economic levels. Because
WIC serves over half of all infants born in the United States, the program is in a unique position
to be able to provide services to address the breastfeeding disparities experienced by families of
low socio-economic status (Jensen 2012:625).
The local WIC office at which I conducted my research served 3,300 clients in 2013; of
these, 878 were infants; of these, only 112 were breastfed either exclusively or partially (U.S.
Department of Agriculture 2015). This means that only 13% of the infants served by this
county’s office are breastfed, which is much less than the overall national rate, as well as the
national rate for those with low incomes. Clearly, a lack of breastfeeding is a real issue in this
local county.

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As I reviewed the literature and learned more about breastfeeding and its relationship
with social factors and health outcomes, I became curious about how the staff at my field site
worked to address the problem, and how they affected the choices their clients made in regard to
breastfeeding. In order to answer this, I formulated the following research question: how do the
staff at WIC conceptualize breastfeeding, and how do they perceive clients who do or do not
choose to breastfeed?
THEORETICAL FRAMEWORK
In order to better understand the information I have uncovered, I have applied the critical
paradigms as the theoretical framework for my project. The critical paradigms deal with
dominant ideologies and how being a certain race, social class, gender, or sexuality can affect
one’s relationship with the dominant ideologies and therefore one’s life experiences. In the
context of my project, the idea that breastfeeding is the best and the normal way to feed one’s
infant is the dominant ideology, disseminated from studies, health groups, doctors, the
government, and other influential entities. However, an underlying issue is included in this
ideology: the “ideal” breastfeeding mother is white and middle or upper class, and women who
do not fit this image tend to be neglected by those who should be helping them (Spencer and
Grassley 2013:608).
Many of the articles I have reviewed mention the disparities in breastfeeding rates among
women of different socio-economic classes, races, and education levels, making it clear that
breastfeeding cannot be linked purely to personal choice: there are societal factors that make a
woman more or less likely to breastfeed (Colen and Ramey 2014). Based on the literature, I find
that social class is one of the most important deciding factors of a client’s standpoint on whether
or not to breastfeed, as her class limits how she perceives and navigates the world (Hartsock

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1983:285). But this limit does not necessarily come from within; in fact, the way doctors, WIC
health professionals, her family, or others see her social class and her role within it affects the
support and education she is given.
Because infants born to low-income mothers need all the nutrition they can get, the fact
that they are often neglected is a big problem. My research question’s goal is to uncover how the
staff perceive their clients and their clients’ choices, and whether or not the staff treat their
clients differently based on their choices. Using the critical paradigms to analyze my data helps
me understand how the identities of the clients shape the staff’s perceptions, and how WIC
addresses the issues that affect their clients.
METHODS
Participant Observation
In order to answer my research question, I have elected to use participant observation,
interviews, and document analysis as methods to gather data. I have chosen participant
observation as a research method because it provides data that helps contextualize my findings
from the interviews, while also giving me a look at how WIC works in a more natural setting
(Denscombe 2010:206). Participant observation is also suitable because it is very feasible; it
requires very little resources beside myself, and I gained access to the field site through this
class. While there are some ethical issues stemming from my covert researcher status (my
supervisor was fully aware of my role), when shadowing clients their permission was always
asked and confidentiality assured. In this case, the benefits of participant observation outweigh
the minor ethical questions.
The strengths of participant observation, as discussed above, are that it is holistic,
insightful, and there is little interference in the natural setting. While observing the activity at

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WIC, I was able to see the processes that both clients and staff members go through on a daily
basis. In seeing each side of the program, I gained a fuller picture of how WIC actually works.
This led to the opportunity for useful insights that I may not have gotten if I had only conducted
interviews. With insight into a holistic view of WIC, I was able to better craft my interview
questions because I knew certain things about how the health professionals and other staff
members conducted their work. Since participant observation prevents much interference in the
normal goings-on at WIC, the data gathered is likely to reflect how things actually run without
the presence of an interloper. Although the information gained from participant observation does
not form the bulk of my data, it forms a useful foundation through which I can contextualize the
data from interviews.
Limiting my ability to answer my research question is the questionable reliability and
representativeness of the data of participant observation. I am not an experienced field
researcher, so I may not have noticed important details that could have added to my data; and,
the data comes from my own inherently biased observations, which could alter the data. In
addition, since in order to use participant observation as a method the researcher has to actually
participate, my data can only represent a very small cross-section of WIC: the parts of the local
agency I that participated in. I gain insight into how the staff of a local WIC program
conceptualizes breastfeeding, but I cannot really claim that it represents WIC offices all across
the United States. And yet, despite these limitations, participant observation provides rich data
that only augments my ability to answer my research question.
In conducting participant observations, I have collected data through observation, both
overtly and covertly, in several locations: the WIC waiting room, the front office, the
examination room, the offices of the health professionals, and the office of the breastfeeding

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peer. When shadowing a client or a staff member, I was usually a silent observer that only
interacted with them when they were not busy with their appointments, in an attempt to preserve
the naturalism of the setting. When I was not shadowing, I often asked questions and engaged
with the staff member I was paired with. Several of my visits to WIC involved completing
necessary, although intellectually uninteresting, tasks that removed some strain from the staff but
did not provide much data.
In order to record my observations, I took quick notes in a notebook while shadowing;
trying to keep the notes to a minimum to lower my obtrusion and to appear less critical and more
observational. On the other hand, when I was in situations in which having a notebook would be
inappropriate, I tried to take mental notes to remember for later (Lofland et al. 2006:109). For
me, the easiest way to take mental notes was to remember the topics of conversations I had and
phrases that surprised me or intrigued me. I jotted notes only while I shadowed, most of which
were short phrases in order to remember the sequence and focus of events and conversations.
In creating my full field notes, I combined any mental and jotted notes I had taken that
day in double-entry format, while adding as many details as I could remember and my own
personal reactions, emotions, and observations (Lofland et al. 2006). In addition to these notes, I
did short free writes after each session that addressed what surprised, intrigued, and disturbed me
in order to gain a fuller idea of what my experience had revealed. The field notes created from
participant observation provide valuable information that allow me to better see how the
perceptions expressed in the interviews tie in with the daily routines of WIC.
To analyze my field notes, I went back and pinpointed all the entries that talked about
breastfeeding, and coded them using the codes I used initially with my interviews. Because I did
not plan to use the field notes as anything more than a foundation for the other data, I did not go

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much beyond open coding with them. While the surprised/intrigued/disturbed free writes served
as simple elemental memos, information from the field notes was included in the integrating
memos that combined data from field notes, interviews, documents, and literature. The coding
and memoing process I followed is described with more detail in the interviews section below, as
the interviews provided the most data to be analyzed.
Interviews
Interviews are also a suitable research method because they provide the kind of in-depth
and complex data I was looking for, and they are quite feasible to conduct in the given time,
access, and resource restraints. There were almost no obstacles that prevented me from
interviewing the appropriate sample. In addition, the interviews I conducted followed all ethical
guidelines; I obtained informed consent from the participants and gave them confidentiality
through pseudonyms, and they experienced little to no harm during the process.
The strength of semi-structured interviews as a research method comes from the depth of
information and insights I gained, the focus on informants’ priorities, and the flexible nature of
interviews (Denscombe 2010:192). My research question seeks to uncover complex information
that cannot be addressed through a cut-and-dry survey, such as the “hows” and “whys” of the
ways in which the staff of WIC perceive breastfeeding, as these are complex social questions. By
asking them to do the talking, I learned how they see things rather than filtering their responses
through my own conceptions or limiting their expression, as a survey would do. Such a focus on
the priorities and the perceptions of the participants allows my data to reflect a clearer image of
the staff’s own thoughts, as they expressed what they deem important—and revealed information
I would have never had access to.

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However, interviews do have their limitations. They are time-consuming, and the
interviewer effect and the inhibitions of the participants could alter the data (Denscombe
2010:193). While the parameters of this research project kept the interviews to a manageable
thirty to forty-five minutes each, in general the depth of knowledge gained from interviews
requires extended amounts of time devoted to engaging with the participants. In addition, my
presentation of myself, along with the overall scrutiny involved in the situation, could have made
the participants uncomfortable which could have resulted in important omissions from the data
(Denscombe 2010:178). Although these limitations could be cause for mild concern, on the
whole the strengths involved in the interview method made it a great choice for collecting data
for my research project.
To collect data from interviews, the specific activities I have engaged in include
developing the questions I asked the participants and conducting the interviews themselves.
Though it may seem like a trivial or simple matter to the untrained observer, creating the actual
questions is a vital part of the research process (please see Appendix A for a copy of the
questionnaire). The interview questions needed to reflect the goals of the research question,
while being worded in such a way that they would provide the best and least-biased data possible
for me and cause the least amount of harm for the participants.
The population from which I selected my interview sample is the entirety of the local
county WIC program staff, and the sample itself includes three health professionals (one of
whom is the director), two administrative assistants (at least one of whom has a background in
women’s health), and the breastfeeding peer. The sampling technique I used to choose this
sample was purposive sampling, because by choosing the participants I was able to ensure that
they had the knowledge and experiences that I want to learn about in order to answer my

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research question. The staff of WIC is not comprised of many individuals, and only a select
number have the experience and roles that are relevant to my research; therefore it makes the
most sense for me to purposefully select those who are able to provide the information and points
of view I am looking for in my interviews.
In analyzing the interviews, I engaged in both coding and memoing to fully analyze the
data. I first developed deductive codes based on the information I had expected to uncover with
the questionnaire, and in reading through several interviews I was able to pinpoint several
inductive codes as well that I had not expected to see, as well as eliminate a few deductive codes
that proved unnecessary. I then “coded the codes” and created a couple codes that added
specificity to some of the original codes. The first few elemental memos I wrote to analyze the
codes focused on two or three themes that seemed most prevalent in the interviews, and I
attempted to discuss how these themes emerged and what they meant for my research question.
Finally, I created an integrating memo that synthesized data from all different research methods
to create an in-depth and comprehensive analysis of the most important themes.
Document Analysis
In addition to interviews and participant observation, I also elected to use document
analysis as a method to answer my research question. This is a suitable method because it
provides useful information about how WIC as an organization conceptualizes breastfeeding, and
it is also very feasible and ethical. All I needed to complete an analysis were the documents, and
as no people were involved there were no ethical issues to worry about.
A document analysis strengthens my research because it gave me access to data and
insight into WIC as the author of the documents. I was able to see exactly the type of information
that the health professionals and breastfeeding peer give out to mothers who want to breastfeed,

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as well as the information available to potential and current clients on the WIC website and
through its links. With this data, I was able to form a better idea of how WIC staff presents
breastfeeding to their clients, and compare and contrast the ideas proposed in the documents with
the ideas expressed by the staff to see how the promotion of breastfeeding is carried out
experimentally rather than theoretically.
Limitations of document analysis include mainly, in this instance at least, that the data is
very broad and may not always pertain to my specific research question. Additionally, I have no
way of knowing how many clients use each document or whether the clients even think they are
useful, so their relevance to my research could be questioned. However, because I use the data
gathered from document analysis to merely supplement the data from interviews and participant
observation, this limitation does not hinder my research process in any way.
The specific documents I have analyzed are the pamphlets and brochures about
breastfeeding that are given to clients and the official WIC website and pertinent links that may
be included there. I also used purposive sampling to select these documents; of the brochures, I
only took the ones that the breastfeeding peer had out on her desk because they are likely what
most clients are given since they are in easy reach. I also chose to analyze the website, as it is
easily to available to clients. These particular documents are suitable for answering my research
question because they are the resources WIC provides to their clients, and as such they represent
the way breastfeeding is conceptualized by WIC. Through analyzing these documents, I gain
insight into some of the ways WIC staff present breastfeeding to their clients.
Analysis of the documents was similar to that of my field notes, in that it was not given
quite as much focus as the interviews and I mainly used the codes developed during the coding
of the interviews. I concentrated on finding connections to what was articulated in the interviews,

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because I knew that the staff would most likely agree with the information they were tasked with
handing out. After I completed coding of the documents, I synthesized their analysis with the
analysis of the interviews, field notes, and literature in the integrating memo.
ETHICS
As with any social science project, the consideration of ethics played an important role in
the entire process. I had never thought about the implications of ethical or unethical social
research, and making sure I was following ethical guidelines helped form the way my questions
were worded and organized, as well as reminded me to act responsibly while at the field site.
However, due to the nature of the project and the business conducted at WIC, it was almost
inevitable that I would find myself in ethically questionable situations. Even though it was with
the full knowledge of my supervisor, no one else at WIC knew that I was actually a field
researcher, and several times I had access to information I probably should not have had.
While shadowing clients, I was privy to quite a few sensitive and personal conversations
which I would not have wanted a stranger to hear if I had been the client. These instances made
me very uncomfortable, because I felt rude and a bit ashamed that I was using private
information in my field notes without any knowledge on the part of the clients (or staff). One of
the staff showed me a client’s personal files so that I could understand what they went through
with each client, and at another point I was working unsupervised on a computer where I could
have accessed WIC’s database and client information. All of these encounters reinforced the idea
that ethics is a real issue, and that it is up to the researcher to make sure he or she acts
responsibly and carefully in a situation where ethics are blurred.
Prior to beginning the interviews, I was given training in class in order to minimize risk
to the participants, as well as thoroughly thinking through and conceptualizing the procedural

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ethics of the project in the IRB proposal (available upon request). In the proposal, my team and I
articulated the training we had received as well as the fact that our supervisor was well aware of
our role as field researchers and the requirements of the class. In addition, the confidentiality of
participants was ensured through password protection of files, the use of pseudonyms, and the
destruction of confidential files when they were no longer needed. Informed consent and
debriefing forms were distributed to the participants, in order to ensure that they understood the
project they were agreeing to provide data for.
Under review of the Denison IRB, this project received expedited review. This low level
of scrutiny was appropriate for this project because the foundations of the project had already
been approved in a more comprehensive proposal submitted by Dr. Tuominen, the class
instructor. In addition, this project involved minimal risk to the participants. Possible risks
included embarrassment, feelings of judgement, invasion of privacy, or offense, due to the
sensitive nature of some of the questions’ subjects. However, these risks were minimal as I
refrained from asking about experiences the participants had not had, and due to the training I
received in class confidentiality was honored and the interview questions were carefully
formulated to adhere to ethical guidelines.
FINDINGS
Through investigating breastfeeding at a local WIC office, I have discovered that by
providing education and support to their clients, WIC staff address the lack of confidence they
perceive in their clients by giving them the tools they need in order to successfully and
comfortably breastfeed. In addition, breastfeeding is seen as the best choice for new mothers and
infants, because it is the healthiest option and it promotes an emotional bond between mother and

16. Daugherty 16
baby. However, although the staff at WIC do all they can to encourage breastfeeding, they also
emphasize supporting women if they do not choose to breastfeed.
Healthy Benefits and the Emotional Bond
Another key finding that developed from my research was the way the staff conceptualize
breastfeeding; specifically, that it is the healthiest option and that it promotes a stronger
emotional bond between a mother and her child. According to staff and the literature, the myriad
health benefits attributed to breastfeeding is the most compelling and seemingly relevant reason
to breastfeed. I expected to find this outcome, but was surprised to learn about the so-called bond
that was involved and its presence in the breastfeeding process.
Support for breastfeeding has swung like a pendulum over the past few centuries. For a
period of time it will be supported, and then it tends to fall out of favor again once its benefits are
forgotten (Wolf 2001). However, whenever opinion is in favor of breastfeeding, its many health
benefits, for both mother and child, are extolled. According to Emily, mothers should breastfeed
“just cuz of the nutrition.” Breastfeeding has been instrumental in lowering infant mortality
levels, and provides protection against childhood cancers, allergies, infections, and other issues
infants may face; as well as helping mothers’ bodies return to normal after pregnancy and
decreasing risk for some cancers (Witters-Green 2003:417).
All of these health benefits were mentioned by the participants during their interviews,
and some of them talked quite extensively about the good breastfeeding can do, especially with
the nutrients found in breastmilk that formula cannot provide. Only Emily talked in-depth about
the health benefits for the mother, implying that breastfeeding is more beneficial to infants than
their mothers. The pamphlets, on the other hand, don’t make much mention of the health benefits
of breastfeeding; most likely because they are intended for use by women who have already been

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made aware of the benefits. In any case, the main reason WIC staff endorse breastfeeding is
because it is truly the healthiest option that will help address the nutrition needs of low-income
infants.
Many of the studies examined in the literature articulated the long-term health benefits
usually attributed to breastfeeding, such as higher educational performance, are probably actually
the result of the influence of the social factors acting upon the mother-infant dyad (Der, Batty,
and Deary 2006). For example, the women who are most likely to breastfeed are the same
women who are most likely to have access or be a member of groups that are able to provide the
best care to their children (white, middle or upper class, highly educated, etc.). The staff only
briefly mentioned any of this in the course of their interviews, despite there being a probing
question that directly addressed it. This could be representative of the fact that WIC staff is more
concerned with the immediate effects of breastfeeding, because the WIC program addresses the
health needs of young children only. But as further studies shed light on this issue, it will be
interesting to see how WIC handles the changes they may have to make to their rhetoric to
account for these new discoveries.
While the staff expounded upon the health benefits to be gained from breastfeeding, each
participant in their primary response to the benefits of breastfeeding said something similar to
what Paula described as “a special bond there that forms between mom and baby.” But when
they were asked to provide more specific benefits or to elaborate, the bond was never mentioned
again. This emotional bond seems to be mostly rhetoric used to convince women to breastfeed,
but I was able to find one study that confirmed that mothers who breastfeed are more attentive
toward their infants and more responsive to their distress (Kim et al. 2011).

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The pictures included in the pamphlets, which are almost exclusively of mothers lovingly
cradling their babies in their arms, subtly encourage this perception of breastfeeding. Similarly, a
nationwide strategy developed to promote breastfeeding to WIC clients emphasized the
emotional aspects of the practice over the health benefits (Lindenberger and Bryant 2000). Yet
when comparing the discussions of health benefits versus discussions of emotional benefits, the
health benefits are clearly the priority of WIC, most likely because it is a program that focuses on
the improved health and education of its clients.
Despite the obvious health and emotional benefits associated with breastfeeding, only
0.6% of WIC’s budget is allocated to breastfeeding materials and support, and WIC is the largest
consumer of infant formula nationwide (Langellier et al. 2014:S118). I was also surprised to
notice several large boxes of formula sitting in the breastfeeding peer’s office, which seems like
the wrong place for them to be stored. These statistics and observations seemingly contradict the
enthusiastic promotion of breastfeeding that WIC engages in, and raises interesting questions
about the level of devotion to breastfeeding experienced by those in charge of WIC’s goals and
services.
Confidence, Education, and Support
Another key theme that emerged through analysis of my research findings is the concept
that WIC fills the supportive and educational lack that clients experience and that prevents them
from having enough confidence to breastfeed. This shows how WIC staff perceive clients: clients
lack confidence in their breastfeeding abilities, which causes them to decide not to breastfeed if it
is not addressed. Because all staff members talked about the confidence issues their clients face,
it is clear that this is a widespread view, at least at this local county office. The perceptions that

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staff members hold directly correspond to their own actions in dealing with their clients, in that
they seek to inform and support mothers so that they do feel confident.
When asked what a barrier to breastfeeding is, almost all of the participants identified a
lack of confidence as being an issue. Most staff members mentioned many indicators of low
confidence in women, but Marie succinctly went out and said “a lot of moms aren’t confident in
it.” According to WIC staff, the many factors that contribute to this are that clients incorrectly
believe that their own health issues prevent them from breastfeeding, they simply do not think
they have the ability to successfully latch or produce enough milk, their family has not breastfed
in decades, or they just have not been exposed to breastfeeding acceptance. In addition, for some
women who are interested in breastfeeding, a lack of support from their family and friends
makes breastfeeding an unattractive decision; in fact, support from doctors and family members,
especially a new mother’s own mother, is one of the most important factors influencing a
woman’s decision to breastfeed (Spencer and Grassley 2013:617).
The literature validates this perception of confidence that WIC staff have. In a study that
surveyed several WIC clients on why they would not breastfeed, the participants articulated all
the same reasons as the WIC staff; mainly that they could not produce enough milk, were unable
to foster a latch, or possible supporters of breastfeeding discouraged them from doing so (Stolzer
2010:431-433). In addition, most doctors have been found to not have the appropriate knowledge
needed to counsel women on breastfeeding, causing women who might otherwise breastfeed to
default to formula due to a lack of information (Stolzer 2010:433). That the literature and
interviews reflect such similar responses indicate that the perceptions the staff hold of their
clients are largely accurate, at least in this arena.

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Because of this accurate perception of how WIC clients view breastfeeding, staff are able
to provide educational materials in order to help restore clients’ confidence in themselves. In
their interviews, the participants mentioned the various efforts they make to inform their clients
to aid them in making educated choices, whether or not they actually choose to breastfeed; WIC
director Chris expressed that “we do provide information regardless of a woman’s intent to
breastfeed… We just want to make sure whatever they do, if we can help, let us know.” In fact,
contrary to my original hypotheses, nearly every staff member emphasized the importance of
acknowledging that breastfeeding is not for everyone and that all mothers deserve to be educated
and supported, regardless of their choices.
In providing the education clients do not have, staff explain information over the course
of several visits, hand out pamphlets with helpful information, and have clients talk with the
breastfeeding peer, Paula. WIC’s website, surprisingly, had very little educational information; it
seemed to be more aimed at getting potential clients acclimated with what WIC’s goals and
services are. In a review of the eleven pamphlets sitting out on Paula’s desk, seven present useful
factual information about how to breastfeed, diagrams, signs of problems, what to do if
something is not right, and when to seek outside help. When used in conjunction with the
information the health professionals and Paula talk about during appointments, the pamphlets are
useful tools that help mothers become more confident in their knowledge and abilities. On the
other hand, if a mother decides not to breastfeed, Emily expressed that WIC ensures that she
knows how to prepare formula and how to take care of her breasts and unused milk.
In addition to WIC stepping in and providing an educational experience that clients lack,
WIC also provides the much needed support that clients might not get from their social networks
or doctors. Paula, the breastfeeding peer, is available to answer questions, give explanations in

21. Daugherty 21
person, and check-in via telephone to make sure breastfeeding mothers feel comfortable and
knowledgeable with their choice. However, perhaps more importantly, because Paula herself is a
former breastfeeding WIC client, she can empathize with “her girls” and be the supportive figure
they need. This is made very clear by all the participants, as Marie says:
“If [Paula] doesn’t have a mom in her office, where she’s like trying to teach her how to
get the baby to latch, or different ways to help the mom, she’s counseling them over the
phone, and, I mean it, it builds their confidence and makes them feel more comfortable.
And if they have issues, they have a mom that’s been there, been through it with six kids
and she kind of puts them at ease…”
Paula is there when clients’ families and friends are not, and even when they are to provide that
extra help and support.
Several of the pamphlets Paula had on hand reflect her role, and WIC’s role, as a
supportive entity for breastfeeding mothers. Three pamphlets give information about
breastfeeding support groups and classes sponsored by WIC, and list the phone numbers of Paula
and other lactation consultants, extolling mothers to call with any sort of question. In addition,
the pamphlets themselves inherently provide support; because the educational pamphlets are
designed to be taken home and to alleviate mothers’ worries, they represent WIC’s support of
mothers even when mothers are not physically at WIC. It is clear that WIC’s policy of education
and support represents a goal to enable women to make informed, safe, and healthy decisions for
themselves and their families.
My theoretical framework, the critical paradigms, explains how the lack of confidence
WIC addresses is partially a result of the lower socio-economic status of WIC clients. Because of
their social class, these women are exposed to systems that discourage them from breastfeeding.

22. Daugherty 22
The typical breastfeeding mother is white and middle-class, and doctors are more willing to give
women who fit this ideal the tools to breastfeed, rather than a poor black woman (Spencer and
Grassley 2013).
Adding to this issue is that WIC clients are more likely to work in the types of low-wage
hourly jobs that do not have spaces or policies that make breastfeeding easy, even though it is
required by law for employers to allow mothers breaks and spaces to pump while at work.
However, obtaining such a space is often difficult for women, because of both needing to stand
up for themselves in a situation where they have little power and because people are simply
unaware of their rights. As Chris says, “it’s difficult… people don’t realize that by law you are
required to, you are allowed to do this and they are required to provide this.”
The more educated a woman is, the more likely she is to breastfeed (Colen and Ramey
2014). Only 76% of Newark students graduate high school, and only 17% of Newark residents
have at least a bachelor degree (Dow 2015). These statistics help explain why so few WIC
clients do end up breastfeeding, and why there is such a lack of confidence in clients who have
the opportunity to breastfeed. Without access to the education that makes breastfeeding a more
likely option and less intimidating, it is no surprise that WIC clients need the education and
support that WIC staff provide. WIC clients do not have the tools necessary that allow them to
make informed decisions about breastfeeding or to feel comfortable in choosing a path that has
the potential to be difficult because of their socio-economic status, but the services WIC provides
encourage women to make the best and healthiest decisions for their own lifestyles.
WIC staff promote breastfeeding to their clients mainly because it is a very healthy
option that can offer some emotional benefits to the clients as well. In order to encourage women
to breastfeed, WIC staff address the lack of confidence their clients experience by educating

23. Daugherty 23
them about these various benefits as well as providing much-needed support. And, even though
women who do not breastfeed do not quite fit into WIC’s breastfeeding policy, they are still
given what they need in order to remain safe and healthy. While these findings go a long way
toward answering my research question, there are still quite a few aspects that deserve a deeper
look in order to more fully understand WIC and its relationship with breastfeeding.
CONCLUSION
Breastfeeding is a very healthy way for mothers to provide nutrition to their infants, yet
few women take advantage of such a valuable practice. For WIC clients, this is largely because
of a lack of confidence in their abilities to breastfeed. A local WIC office’s staff members
acknowledge and address this issue by providing education and support to their clients. Although
the staff members highly encourage breastfeeding because of the health benefits and emotional
bond, even if a client decides not to breastfeed the staff still provide the necessary education and
support in order to help her and her infant stay safe and healthy.
These findings are important for the knowledge of the general population because
breastfeeding has become an important health issue in recent years, and a better understanding of
the phenomenon is necessary to improve the health of mothers and infants. These findings are
useful for women—both WIC and non-WIC clients—who are trying to decide whether or not to
breastfeed, as they could use my data to better understand how their health advisors perceive the
concept. This is especially important for women who are not interested in breastfeeding or who
are on the fence. These women would know beforehand the arguments their health advisors
could make, and this will allow them to competently respond. Because those who choose not to
breastfeed go against the recommended practices, it is important that they are given the tools to
stand by their decisions and retain their agency.

24. Daugherty 24
RESEARCHER’S INFLUENCE
Because this research project involved participant observation, a large amount of
reflexivity was inevitable. This was integral to my research, because a good amount of data was
filtered through my own assumptions, viewpoints, and emotions, and in order to critically
analyze the data it is necessary to understand how my standpoint affected the research. However,
this adds a whole other layer to the analysis, while keeping me engaged with the research and
allowing me to learn more about myself. Being aware of my standpoint, as well as the
standpoints of others, helped me be more critical during observation and interviews and try to
record what was as close to the objective truth as possible and not take things at face value.
For the most part, I come from a place of privilege: I am white and middle class, with a
good education. I have not had any difficulties in my life that stem from my identity, and I will
never be able to fully understand the perspectives of WIC clients, who come from a place of
marginalization. Unfortunately, I have been exposed to many insidious stereotypes and
assumptions about low-income people: they are lazy, unintelligent, dirty, they do not know how
to be good parents, etc. Luckily over the past several years my education and other factors in my
life have shown me that these stereotypes are untrue and harmful, but it is difficult to override
these deeply ingrained assumptions.
Going into my field site at WIC, I was constantly reminding myself to stay reflexive and
catch myself when I was slipping into thinking the assumptions. Working at WIC helped
reinforce the fact that the stereotypes were false, because almost none of the clients fit them and
they constantly proved the opposite was true. In order to be as reflexive as possible, I had to
constantly remind myself to pay attention and stay critical of my thoughts, and in field notes I
tried to address whether or not my observations were based on an assumption.

25. Daugherty 25
In completing this project, I learned a lot about myself as a field researcher. Reflexivity
taught me about myself and helped me understand how to conceptualize my viewpoints within a
research framework. I learned that keeping participants safe by following ethical guidelines is
important to me, because I do not think knowledge should be gained at the expense of the
wellbeing of human beings. In addition, I learned that I have the ability to conduct successful
interviews. I had been worried that I would not be able to direct the interview and ask the right
questions to get the data I needed, but I was in fact able to successfully run two interviews, and
now I have more confidence for other research projects.
Understanding that flexibility is necessary is also an important lesson I have learned. I
prefer to have things be clearly set out with little deviation from the plan, but now I know that
sometimes that is just not possible. Fieldwork in sociology and anthropology can be a bit messy,
because it deals with people and people are changeable. There is always room to flex, and
different methods and methodologies can be used to gather the best data possible. This project
was very good for my growth as a person, and I look forward to utilizing these newfound skills
in the future.

26. Daugherty 26
Appendix A
● In a typical day, what might you eat for (a) breakfast, (b) lunch, and (c) dinner?
○ What are the main reasons you choose these dishes?
○ Can you tell me more?
○ Are you preparing these meals? If so, are you preparing them for other people as
well?
● What are your favorite foods to indulge in?
○ On what occasions do you eat these foods?
○ What is it that make these foods indulgent?
○ Can you tell me more?
○ How often do you eat these foods?
● What would be on your menu if you were to create a healthy lunch meal?
○ Do you ever make this meal?
○ Would you consider this meal to be tasty?
○ If so, how often? If not, what are the inhibitors?
○ Can you tell me more?
● How would you best describe the food culture of your current city of residence? Of the
state of Ohio?
○ Have you lived in any other states?
○ If so, what makes the food culture of Ohio different from these states?
○ What are the most popular restaurants in your city of residence?
○ Do you like these food cultures? How would you change them?
○ Can you tell me more?
● In what ways do you feel that your food choices are similar or different from those of
WIC clients?
○ Can you tell me more?
○ What role does your socioeconomic status play?
○ What role does your location of residence play?
○ How similar are your food choices to those of clients (scale of 1-5, with 1 being
least similar, and 5 being most similar)?
● Why is it important for mothers to breastfeed their children?
○ Could you describe some specific short-term benefits?
○ Could you describe some specific long-term benefits?
● Why might a mother decide not to breastfeed?
○ What are some barriers to breastfeeding a WIC client might face?
○ Do you think the reasons why a client and a non-client would not breastfeed are
the same, or different? Why?
○ Are any of these reasons not a good excuse to not breastfeed?

27. Daugherty 27
● If one of your clients expressed that they were not interested in breastfeeding, how would
you respond?
○ Are there any sort of institutional regulations or suggestions that encourage you to
convince mothers to breastfeed?
○ Are there any services available for those who decide not to breastfeed?
○ How does your role differ when a mother decides to breastfeed and when she
decides not to?
● What role does WIC’s breastfeeding policy play in advising clients?
○ How do you feel about these policies?
○ Do you think the recent [2009] package changes to promote breastfeeding have
made a difference?
○ Are these changes ethical?
● How has Robin’s role as the breastfeeding peer impacted the experiences of new mothers
who receive WIC benefits?
○ Overall has she had a positive impact, a negative impact, or no impact on these
clients?
○ Overall has she had a positive impact, a negative impact, or no impact on the WIC
office as a whole?
○ In your opinion does Robin represent new mothers, or governmental requirements
in Ohio in her support of breastfeeding?
● How do you feel about having the opportunity to engage personally with clients and
children daily?
○ What are some of the rewarding aspects of talking to clients everyday?
○ Do you enjoy working for the WIC program?
● What are some of the most important governmental requirements the local county WIC
office is required to adhere to?
○ Which of these requirements do you feel are necessary?
○ Do you find any of these requirements frustrating?
○ Which of these requirements do you find unnecessary to the overall achievement
of WIC’s goals?
○ Has your need to stick to these requirements had any impact, either positive or
negative, on a personal interaction with a client?
● Do you think the eligibility requirements for receiving WIC benefits are reasonable?
○ Why?
○ If not, how would you change them?
● If you could change one thing about the way your WIC office is run from a governmental
standpoint what would it be?
○ What are some problems you face daily that are a result of federal requirements?

28. Daugherty 28
○ Do you think WIC is successful in your county? Do you think it is successful
nationally?
● What have I not asked you about WIC that is important for me to know about?
● If I have any questions after I review my notes from our conversation, can I get back to
you for clarification?
● Thank you very much for your time and for sharing your experiences.
● (Share debriefing statement with participant for their signature.)

29. Daugherty 29
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