National WIC Association

Liberty City WIC: Expanding Innovation and Outreach for Black WIC Families

February 4, 2022
Categories: Black Americans Florida Health Equity

How does your WIC agency engage with Black families?

Liberty City, a Miami neighborhood, is home to the largest population of non-Hispanic Black families in our county and, unfortunately, has the distinction of having the highest infant mortality and lowest breastfeeding initiation rates in the city. We knew that if we wanted to improve breastfeeding rates in our county as a whole, we had to start with the residents and families in Liberty City. Our agency created an interdisciplinary workgroup that included  International Board-Certified Lactation Consultants, Registered Dietitians, breastfeeding peer counselors, and representatives from our local Community Health and Planning office. It was essential to involve members who directly work with this community's families. 

Despite all of our shared knowledge and expertise, our agency found that the reasons for low breastfeeding rates in the Liberty City community were poorly understood. We realized that the collective "we" did not accurately represent the culture and community we were analyzing. The Liberty City community is a melting pot of many cultures and backgrounds. We needed to directly tap into that to understand the forces limiting breastfeeding in this community truly. We went back to the drawing board and decided to take the following actions:

  1. We wanted to identify inconsistencies in breastfeeding support, policies, and processes at the Liberty City WIC clinic, which may have hindered breastfeeding initiation. To do this, we surveyed WIC staff to assess their beliefs about breastfeeding and identify procedural inconsistencies in breastfeeding support and formula assignment. 

  2. We moved our focus to the families in Liberty City to identify and assess the core beliefs associated with breastfeeding. We surveyed non-Hispanic Black post-partum WIC mothers about their knowledge, attitudes, and thoughts about breastfeeding. 

  3. We also focused on the community as a whole and surveyed community members, partners, and organizations about breastfeeding beliefs and attitudes via a county-wide wellness survey administered as a part of the local Community Health Improvement Plan; which was the first-time breastfeeding questions were included in this community-wide survey.

Our primary findings discovered:

  • A general lack of breastfeeding support in the non-Hispanic Black community (family, friend, partner, medical providers, workplace); 

  • The rights of mothers and families to breastfeed in public are not being enforced nor protected; 

  • And breastfeeding support would be more successful coming from someone representative of their race, ethnicity, and/or cultural background. 

Our agency selected two action items to help effectively change this culture within the Liberty City community from this information. First, we created a community support network for mothers, fathers, families, and extended family members (grandparents, aunts, etc.) led and attended by members representative of this population. Next, we created a new position within the clinic, Breastfeeding Advocate, that provides breastfeeding support for Liberty City families. The women in this role mirror our target community's culture, races, and ethnicities, provide on-the-job breastfeeding training, and work directly with our families in this community. 

What can WIC agencies and clinics do to be more inclusive?

  • WIC clinics should recommend identifying and working with partners representing the community's race, ethnicity, and cultural background to be more inclusive and engage with Black WIC participants. 

  • Consider staff's beliefs about equity and how they might impact their role within WIC. 

  • Agencies should include multiple viewpoints, backgrounds, and cultures within decision-making to ensure decisions are diverse and non-homogeneous, look at internal policies and assess unknown or implicit biases by having tough conversations about race. 

Our agency looked at breastfeeding peer counselor requirements and found some of our hiring pre-requisites disproportionately limited minority populations with historically lower breastfeeding rates from applying, which we are proactively working to correct. 

  What can USDA and FNS do to be more inclusive and engaging towards Black families? 

  • USDA needs to review the WIC food packages and modernize the WIC shopping experience to ensure they are culturally inclusive and reflect the realities of how families consume, shop, and access nutritious foods. With Black families experiencing a disproportionate burden of food and nutrition insecurity attributed to systemic racism,

  • USDA needs to take action and invest in the WIC food packages. The shopping expeUSDA can urge Congress to extend the WIC benefit bump, one of the most substantial investments in healthy food access and improved maternal and child nutrition since WIC's establishment in 1974, so families can continue having greater access to more vegetables and fruits. This is critical, especially as our nation's families continue to face heightened economic and nutrition insecurity due to the COVID-19 pandemic, with Black families experiencing greater hardship and health disparities during this time.

Overall, a few things we learned are: 

  • Don’t be afraid to look internally at your own biases at the individual, community, and institutional levels. 

  • Subject matter experts aren’t necessarily the community or culture experts. When planning and implementing population-level initiatives, make sure the right people are at the table.

  • We must understand the communities we work for before enacting change, and meaningful change is possible! Don’t be afraid to tackle big issues. It will likely take longer than you think but stick with it! 

Cheryl Lorie is the Breastfeeding Coordinator for the Florida Department of Health at Miami-Dade County WIC Program and an International Board-Certified Lactation Consultant (IBCLC).