Breast is Best: A Case Study of Bottom-Up Implementation

The institutional narrative surrounding breastfeeding is that breast is best. Research on infant feeding practices in the United States are abundant, especially among WIC recipients. Although WIC is championed as being a breastfeeding promotional venue, WIC recipients demonstrate lower breastfeeding rates than non-WIC recipients of similar economic standing suggesting the need for further research into the policies and breastfeeding promotional tools being implemented within WIC. Concurrently, research demonstrates that breastfeeding duration rates among WIC recipients can be prolonged with women’s interaction with a Breastfeeding Peer Counselors (BFPC). However, there has been little exploration into the experiences of BFPC or the barriers they may encounter in trying to aid their clientele. This research fills the gap by examining the Social construction of WIC recipients and the policy implementation process from a bottom-up perspective. The theoretical perspectives guiding this study are narrative analysis, Social construction of target populations, and bottom-up implementation. I utilize a qualitative research design with four points of entry. First, I employ content analysis of the Center for Disease and Control’s Breastfeeding Report Card and Policy Suggestions to explore the institutional narrative. Secondly, I conduct three in-depth interviews with the state bureaucrats of the Arkansas Breastfeeding Pilot Project to assess the organizational narrative. Lastly, I assembled and questioned two focus groups of the Breastfeeding Peer Counselors (BFPC) within the Pilot Project and five follow up in-depth interviews with the BFPC individually to assess the personal narrative. This research reveals that there are multiple compounding cultural, and structural barriers to breastfeeding policy implementation despite being championed as best