Inclusive Care: Strategies to Support Infant Feeding for Parents with Disabilities Through WIC

Infant feeding, involving breastfeeding, formula feeding, and the introduction of solid foods, is crucial for parenting. Pregnant and postpartum individuals with intellectual and developmental disabilities face challenges in infant feeding compared to parents without intellectual and developmental disabilities, often due to ableism and inaccessible care. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, a federal nutrition initiative, can address these disparities by offering inclusive and accessible support and counselling. 

A recent research article opens in new tab/window in the Journal of Nutrition Education and Behavior opens in new tab/window, published by Elsevier, explored WIC staff experiences, perceptions, and training needs surrounding the provision of infant feeding support for pregnant and postpartum individuals with intellectual and developmental disabilities. 

Lead author Noelene K. Jeffers, PhD, CNM, IBCLC, Johns Hopkins School of Nursing, explained, “Improving infant feeding communication through universal design or accommodations can improve access and quality of services for pregnant and postpartum individuals with intellectual and developmental disabilities."

Researchers at the Johns Hopkins School of Nursing and Bloomberg School of Public Health conducted in-depth semistructured interviews between October and November 2021 with Maryland WIC staff who provide infant feeding counseling and support. The interviews gathered comprehensive insights into their experiences and perspectives.  

The research team audio-recorded, transcribed, and analyzed interviews using MAXQDA software. They employed qualitative conventional content analysis to generate codes directly from the data, a method particularly useful for topics with little prior research. Then, they collaboratively refined and organized codes into categories, ensuring reliability through regular meetings and consensus to develop and finalize themes. 

WIC staff members cite needing additional resources to help aid parents with intellectual and developmental disabilities with infant feeding. The photo depicts breastfeeding support and help for a nursing mother. A mother in the hospital postnatal department is feeding a newborn baby assisted by a lactation consultant (Credit: Iryna/Adobe Stockstock.adobe.com). 

Three themes were identified: identifying and documenting intellectual and developmental disabilities, facilitating effective communication and infant feeding education, and assessing WIC staff competence and readiness. Identification of intellectual and developmental disabilities often relied on staff perceptions rather than formal diagnoses, leading to discomfort about potentially mislabeling WIC participants. While staff saw potential benefits in systematic screening, such as better preparation for appointments, they also expressed concerns about stigma, bias, and the practicality of implementing such procedures. 

The interviews during the study suggest it is necessary to examine the risks and benefits for identifying and documenting parental disability. They also emphasized the importance of creating accessible teaching materials that enable understanding and engagement. Furthermore, formally educating and training WIC staff to offer care that is respectful and responsive to the needs of disabled parents is crucial. Future efforts to improve inclusivity and accessibility should be guided by actively engaging parents with intellectual and developmental disabilities to understand their perspectives and lived experiences. 

Dr. Jeffers commented, "WIC provides staff teaching resources in a variety of modalities such as handouts, props, and videos. This is an important strategy to accommodate the different ways that WIC participants may process and receive information. However, specific guidelines, developed in partnership with disabled parents, to support staff with adapting communication and modifying teaching aids to better support disabled WIC participants are lacking. Using easy-to-read written materials, which entail plain language and clear images, might be one promising strategy among many to enhance accessibility.”

Notes for editors 

The article is “Infant Feeding Support for Pregnant and Postpartum Parents With Intellectual and Developmental Disabilities: Perspectives of WIC Staff,” by Noelene K. Jeffers, PhD, CNM, IBCLC; Stacy V. Lu, MSPH; Susan M. Gross, PhD, MPH, RDN, LDN; and Allison West, PhD, MSW (https://doi.org/10.1016/j.jneb.2024.02.007 opens in new tab/window). It appears in the Journal of Nutrition Education and Behavior, Volume 56, Issue 6 (June 2024), published by Elsevier. 

The article is openly available for 90 days at https://www.jneb.org/article/S1499-4046(24)00044-7/fulltext opens in new tab/window.  

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 406 1313 or [email protected] opens in new tab/window to obtain a copy or additional information. To schedule an interview with the author(s), please contact Noelene K. Jeffers, PhD, CNM, IBCLC, Johns Hopkins School of Nursing, [email protected] opens in new tab/window.  

An audio podcast featuring an interview with Noelene K. Jeffers, PhD, CNM, IBCLC; and other information for journalists are available at www.jneb.org/content/media opens in new tab/window. Excerpts from the podcast may be reproduced by the media with permission from Eileen Leahy. 

About the Journal of Nutrition Education and Behavior (JNEB)  

The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior (SNEB), is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues, and practices relevant to nutrition education and behavior worldwide and to promote healthy, sustainable food choices. It supports the Society's efforts to disseminate innovative nutrition education strategies, and communicate information on food, nutrition, and health issues to students, professionals, policymakers, targeted audiences, and the public. 

The Journal of Nutrition Education and Behavior features articles that provide new insights and useful findings related to nutrition education research, practice, and policy. The content areas of JNEB reflect the diverse interests of health, nutrition, education, Cooperative Extension, and other professionals working in areas related to nutrition education and behavior. As the Society's official journal, JNEB also includes occasional policy statements, issue perspectives, and member communications. www.jneb.org opens in new tab/window

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