After WIC package revisions, mixed changes in breastfeeding outcomes

A Tufts press release last week describes recent research by Ann Collins, Meena Fernandes and Anne Wolf at Abt Associates, and myself, which was published in the September 2012 issue of the American Journal of Clinical Nutrition (AJCN) (may be gated). 

In 2009, the federal government’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the make-up of its food packages to meet several nutritional goals, including stronger promotion of breastfeeding. For new mothers participating in WIC, there were mixed outcomes after implementation of the policy change, according to an analysis from the Friedman School of Nutrition Science Policy at Tufts University and the global research and program implementation firm Abt Associates.

WIC provides three main food packages for mothers and infants: a full breastfeeding option with no infant formula but more supplemental food for the mother, a partial breastfeeding option with some formula, and a full formula option with less supplemental food for the mother. Among other changes, the new 2009 policy, called an “interim rule,” lowered the amount of infant formula in the partial breastfeeding option.

By studying administrative records of more than 206,000 mother-infant pairs from 17 local WIC agencies (LWAs) nationwide, the researchers found that more mothers received the full breastfeeding option after the 2009 package change but more mothers also received the full formula option. Fewer mothers received the partial breastfeeding option.

In the first four weeks following birth, the percentage receiving the full breastfeeding option increased from 9.8% to 17.1% and the percentage receiving the full formula option increased from 20.5% to 28.5%. The percentage receiving the partial breastfeeding option fell from 24.7% to 13.8%. The remaining mothers fell into other miscellaneous classifications.

After the implementation of the interim rule, there was a small increase in the amount of infant formula provided in the first month of life (548.6 fluid ounces to 559.6 fluid ounces per mother). The percentage of mothers who “initiated”, or reported trying to breastfeed the infant at least once, remained unchanged at approximately 65%.

“There had been some hope that breastfeeding initiation would increase after the policy change,” said Parke E. Wilde, Ph.D., corresponding author and an associate professor at the Friedman School. “While this did not happen, the good news is there was no decrease in the breastfeeding initiation, and more mothers did, at least, adopt the full breastfeeding package.”

The article in the AJCN also discusses opportunities for WIC to make further progress in breastfeeding promotion.

“We asked WIC participants about the point in time when they made their decisions about breastfeeding and what helped them when they made their choices about the decision to breastfeed,” said senior author Ann Collins, a principal associate at Abt Associates.  “More than three quarters of the women reported that they had decided before delivery how they wanted to feed their baby. What’s more, more than 84% of women reported that information on breastfeeding from WIC was ‘important’ or ‘very important.’ These findings suggest that special efforts by WIC agencies to reach out to WIC participants during pregnancy with information on breastfeeding could be very beneficial.”

The analysis does not account for all factors that changed during the same time period, for example the volatility of the 2009 economy. The study compared outcomes in the three months before the policy change and the nine months afterward.

The study also is a "recent featured journal article" on the Abt Associates front page.  The analysis was conducted with the support of the U.S. Department of Agriculture Food and Nutrition Service.  [Minor edit Sep 27:] The views and opinions expressed by the authors of the journal article do not necessarily reflect those of the U.S. Department of Agriculture.

There is a lot happening on the topic of further improving WIC's impact on breastfeeding.  Here are some links.  A longer report (.pdf) from this same research effort is available on the USDA FNS website.  An excellent literature review (.pdf) by Silvie Colman and coauthors helps put the new study in the context of a larger body of research.  In another report, Nancy Cole and colleagues explain the various detailed options selected by different states (.pdf), which is important for understanding how the changes actually were implemented.  A workshop summary (.pdf) posted on the FNS site describes a wide variety of ambitious options for future research.

Figure 1.  Food packages issued to new mothers, by age of infant.

(click for larger image)

Lawsuit challenges pork board purchase of "Other White Meat" slogan

A lawsuit filed today in the U.S. District Court for the District of Columbia charges that the $60 million sale of the pork industry's "Other White Meat" slogan illegally diverts money to the lobbying efforts of the National Pork Producers Council (NPPC).

One of the plaintiffs is Harvey Dillenburg, a pork producer in Adair County, Iowa.  Mr. Dillenburg is not a member of the NPPC.  He is required by law to pay a portion of every sale to the National Pork Board, which is supposed to use the money for promotions and advertising.  The National Pork Board is not allowed to lobby.  In 2006, the National Pork Board agreed to pay the NPPC $60 million in return for the property rights to the "Other White Meat" brand.  The resulting payments of $3 million per year for 20 years help fund the NPPC's powerful lobbying machine.

Think about how this arrangement looks from the point of view of Mr. Dillenburg.  Although he does not choose to support the NPPC, the federal government forces him along with all other pork producers to pay the National Pork Board, which in turn pays the NPPC.

The other plaintiff is the Humane Society of the United States, a leading animal welfare organization.  As the Congressional Research Service (.pdf) explains, the HSUS recently brokered a successful agreement with egg producers, reaching a judicious compromise about what type of cages seem ethically acceptable for hens.  Although the leading trade association for egg producers is now working with HSUS to get this balanced policy approved by Congress, the agreement faces implacable opposition from the NPPC.  The egg agreement causes no harm to pork producers, but the NPPC is worried that the precedent of a successful egg agreement will generate unrealistic hopes for similar good-faith negotiations about gestation crates for pork.  It is not surprising that HSUS has been looking into how the federal government's pork board -- which is not supposed to support lobbying -- helps fund the NPPC's efforts to spoil the egg agreement.

This blog, U.S. Food Policy, began covering the tale of the "Other White Meat" sale in a June 2006 blog post, which called for greater transparency about the terms of the sale.  When nobody would give me the documents voluntarily, I filed a Freedom of Information Act (FOIA) request.  USDA initially turned down my request, arguing that the information was "pre-decisional and deliberative".  When I appealed, USDA's Agricultural Marketing Service in December 2006 released partly-blacked out versions of the key documents.

Although AMS hid critical details, enough information was revealed in 2006 to suggest that this was a poor use of pork producers' money.  For example, I pointed out accounting flaws in the supposedly independent appraisal upon which the $60 million sale price was based.  In the HSUS and Dillenburg lawsuit today, I learned for the first time that Mark Williams, who is largely responsible for pulling together the supposedly independent price appraisals, actually has been responsible for developing the "Other White Meat" branding since its inception. 

The HSUS explains further:

Through months of research, The HSUS uncovered glaring legal violations, conflicts of interest, and an exorbitantly over-inflated $60 million price tag associated with the deal. Much of the extraordinarily inflated value of the slogan resulted from 20 years of promotional campaigns funded entirely with pork producers’ own checkoff funds: roughly half a billion dollars. In essence, NPPC charged pork producers twice: once to make The Other White Meat successful, and again to pay for the value of that success.

Now, the case against this sale has only gotten stronger.  The National Pork Board has largely retired the "Other White Meat" slogan, in favor of the new "Be Inspired" slogan, and yet the pork board continues to pay the NPPC $3 million each year for the nearly worthless old slogan.  The NPB has an escape clause allowing it to cancel the payments, but it chooses not to exercise this clause.

The HSUS and Dillenburg lawsuit (.pdf) is well written, with astonishing details beyond what can be described in this space.  It was covered today in Feedstuffs and other trade publications.  I encourage everybody interested in U.S. Food Policy to read it in full.

Hill District supermarket is delayed by multiple challenges

The supermarket that is planned for the Hill District neighborhood in Pittsburgh has been delayed by serious challenges. The project requires several million dollars in public and non-profit financing, in addition to the usual private sector financing, but not all of the expected money has been confirmed. The opening had been expected in November 2011 but is now scheduled for spring 2013.  Neighborhood residents are angry and frustrated.

This blog reported in July 2011 on early plans for the supermarket.  I viewed the cleared building site and took a long walk through the Hill District while visiting Pittsburgh for the Agricultural and Applied Economics Association annual meeting that summer.  I was interested in this particular supermarket because it will be the subject of economic analysis in Rand's Phresh study, comparing food and health outcomes before and after the introduction of the supermarket.

The Hill District is famous for its jazz history and as the setting for the plays of the great American playwright August Wilson.  There is some question about whether the Hill District meets official definitions of a food desert, because some parts of the neighborhood do have other supermarkets less than a mile away, but these official definitions cannot easily adjust for the steep hills that give the neighborhood its name.  Some federal financing sources seek to target neighborhoods that meet a technical definition.  Any visitor on foot would immediately recognize the Hill District as an exceptionally impoverished neighborhood, which seems like a food desert in laypersons' terms.

Even as recently as September 30, 2011, a report (.pdf) from the Reinvestment Fund, a neighborhood financing initiative, seemed to expect the store to open in November 2011.  However, the report did explain just some of the challenges facing the Hill House Economic Development Corporation (HHEDC), which played a central role in organizing the supermarket project.  About $6.8 million in financing was anticipated from multiple sources, which may have been difficult to coordinate.  The Reinvestment Fund wrote, "Despite a strong board and significant community support, a project of this scale was still a daunting task for HHEDC as a small [Community Development Corporation]."

These challenges have worsened.  Julie Matthews, who had led the Hill House development arm, was fired on February 9 this year, a day before she was scheduled to make a presentation about the project's financing.  In April, Matthews filed a whistleblower lawsuit, alleging that Hill House used restricted funds from the Reinvestment Fund and the Mellon Foundation in other unspecified ways. I have no information other than the news report about this allegation.  This week I noticed that the Reinvestment Fund's website has a whistleblower policy (.pdf), making clear that people involved in projects financed by the fund, who become aware of any misuse of funds, are obliged to report the misuse.

It seems likely that the project will go forward in 2013 despite these challenges.  Politicians and institutions in both local and national food financing initiatives would lose face if this high-profile project failed.  It is possible that resolving all the problems will require even more public and non-profit financing than initially expected.

Nobody should judge major national policies from one example, but this episode is likely to contain some cautionary lessons by the time it is over.  Though I fear some readers might think me an incorrigible economist for saying so, I think we should ask why supermarket chain managers could not make this project work using purely private financing, or even with just $1 or $2 million in public financing.  Supermarket chains are astute judges of local food retail conditions and market demand.  Just to take one example, they must recognize that not all Hill District residents will use the local market even after it arrives.  Despite the very high level of poverty, about a third of local resident households own an automobile, and even more have some access to shared automobile transport for grocery shopping.  One reason a supermarket may require a large public subsidy before choosing a particular location may be that they anticipate a tough competitive environment when they start operating. 

If the public bill reaches $6 or $8 million for a single supermarket, and even then the project is stressed by financial management challenges and delays, it raises hard questions about this supermarket-centered and high-budget approach to addressing food retail problems in low-income neighborhoods.

Pittsburgh, July 2011 (Wilde)

Incorrect reports say that California's Prop 37 has zero tolerance for accidental GMO content

California voters are considering a ballot initiative to require mandatory labeling for foods that contain Genetically Modified Organism (GMO) ingredients.

A recent Oakland Tribune editorial against the initiative gets key facts wrong. The editorial, which was widely published in other newspapers, claims that the proposal has a zero-tolerance for accidental GMO content in foods that aren't labeled as containing GMOs. Such a policy would force producers of essentially non-GMO products to use the label "may contain GMOs," simply out of fear of litigation.  But the editorial is mistaken. The initiative rightly allows foods that do not intentionally contain GMOs to carry a "non-GMO" label.

The initiative has several moderate and reasonable features.  For example, it would require genetically modified animals -- such as a fast-growing genetically modified salmon -- to contain a "GMO" label, but it would not require such a label for ordinary beef that had been fed genetically modified corn and soybeans.  A farmer or food manufacturer would not have to do any fancy testing to prevent accidental contamination with GMOs (for example by drifting seeds from a neighboring field, or from GMO-containing dust left over on farm machinery).  It suffices for the food producers to claim in writing that they used crop varieties and food ingredients that they reasonably believed were not genetically modified.  For example, a food manufacturer purchasing non-GMO corn would have to get the supplier to sign such an affidavit, but would not have to do scientific testing.  Some anti-GMO advocates might have wanted stricter rules, but there are good common-sense reasons why the initiative took these positions.

In this context, the Oakland Tribune editorial is particularly disappointing.  Whether you support or oppose GMOs, it is important to explain the initiative clearly so that our democracy can function as well as possible.

The Tribune editorial echoed a point that was also made in a recent working paper by the highly esteemed agricultural economist Colin Carter and several coauthors.  They wrote:

The California initiative would implement a zero-tolerance policy for accidental presence of small amounts of GM substances, even if the U.S. government has approved the GM material for human consumption.

But, after reading the text of the initiative, this seems incorrect. I wrote Professor Carter to ask about this, and his brief response by email while traveling made several good points in opposition to Prop 37, but didn't really back up this claim that the initiative takes a zero-tolerance position on accidental contamination.  Essentially, opponents fear that firms will anticipate legal problems and prophylactically label their products with "may contain GMO" labels, but I cannot really find a reasonable basis for that fear in the initiative itself.

Here's a subtle but important point.  A food manufacturer with a complex ingredient list, including corn or soybean ingredients from commodity sources, may have to use a "may contain GMO" label, but that's not a policy error.  Given that most U.S. corn and soybeans are produced with GMO varieties, it really is true that such products may contain GMOs, so the label is correct.  A food manufacturer who has made reasonable effort to use non-GMO ingredients is permitted under this initiative to use a "non-GMO" label.  I really don't see any part of the initiative that requires these essentially non-GMO foods to be labeled as "may contain GMOs" merely out of caution.

There are good reasons why some people will oppose this California Prop 37.  GMO technologies may well not be dangerous to humans.  Or they may have some risks and tradeoffs, just as non-GMO foods do, that are worthwhile because of the production advantages from the new technology.  Or, as economists in particular are likely to point out, it may be that a well-crafted voluntary labeling regime would have functioned as well as mandatory labeling without as much burden on society.  Still, opponents should make those points clearly rather than mischaracterizing Prop 37. 

FERN asks: Whose Side is the American Farm Bureau On?

The Nation this week explores the American Farm Bureau, which, through affiliated organizations, is simultaneously one of the most important farm lobby groups and also a major insurance operation.  The story is by Pulitzer-winning writer Ian Shearn.  It was supported by the Food and Environment Reporting Network (FERN).

Interesting passages address influence over the upcoming Farm Bill ...

In Washington, the 2012 Farm Bill has predictably been a top priority for the Farm Bureau lobby team. They have surprised players from both sides of the debate by conceding cuts in traditional subsidies in exchange for a large expansion of subsidized crop insurance that protects against disasters and falling prices at an estimated cost to taxpayers of $9 billion a year. The tactical, philosophical shift garnered praise even from Farm Bureau adversaries. Nonetheless, it should be noted that crop insurance is a small, but significant piece of Farm Bureau insurance companies’ portfolio. In 2011, they collected over $300 million in crop insurance premiums. 

... and contribution to the tenor of U.S. agricultural policy debate:

American Farm Bureau Federation president Bob Stallman was succinct, almost militant in his opening address last year at the group’s annual meeting: “We will not stand idly by while opponents of today’s American agriculture…try to drag us down…try to bury us in bureaucratic red tape and costly regulation—and try to destroy the most productive and efficient agricultural system in the world,” he said.

Federal government says all sorts of things about soy milk

Mark Bittman this week describes how he overcame years of heartburn by giving up milk.  Though the NYT columnist agrees this experience hardly counts as a controlled experiment, it does point his critical attention toward USDA's dietary guidance message about dairy.

Today the Department of Agriculture’s recommendation for dairy is a mere three cups daily — still 1½ pounds by weight — for every man, woman and child over age 9. This in a country where as many as 50 million people are lactose intolerant, including 90 percent of all Asian-Americans and 75 percent of all African-Americans, Mexican-Americans and Jews. The myplate.gov site helpfully suggests that those people drink lactose-free beverages. (To its credit, it now counts soy milk as “dairy.”)

There’s no mention of water, which is truly nature’s perfect beverage; the site simply encourages us to switch to low-fat milk. 

Regarding MyPlate's inclusion of soy milk in the dairy group, however, not all federal government messaging seems to agree.

Soybean checkoff message

Like Bittman and MyPlate, the United Soybean Board also has high praise for soy milk. The board is a government-sponsored checkoff program, which has authority from Congress to issue federal government messages in favor of soybeans using money from a mandatory assessment on soybean producers. From the soybean checkoff website link we learn:

Soymilk is a great source of high-quality soy protein, frequently fortified with calcium and vitamin D for bone health, and an option for the lactose-intolerant.

Dairy checkoff message 

But the federal government's dairy checkoff program disagrees.  The program has authority from Congress to issue federal government messages in favor of dairy products using money from a mandatory assessment on dairy producers.  The dairy checkoff program has a bitterly sarcastic satirical flash-based interactive website, mocking soy milk for its sugar content, long ingredient list, and food science chemistry manipulations.

Mixed messages

By using checkoff programs to sponsor contradictory messages for different commodities -- while approving each message as "government speech" -- the federal government serves consumers poorly.  When will these programs be reformed?

House Agriculture Committee to propose deep cuts to SNAP

In contrast with the medium-sized cuts to SNAP proposed by the Senate (see earlier post), the House Agriculture Committee today proposed deep cuts.

"Do Republicans in Congress want to fix the food stamp program — or punish it?," asks David Rogers at Politico:

That’s the question facing the House Agriculture Committee leadership as it rolls out its plan this week to cut farm subsidies together with about $16 billion in 10-year savings from food stamps — also known as the Supplemental Nutrition Assistance Program.

The Politico account portrays House Agriculture Committee chair Rep. Frank Lucas (R-OK) as a relative moderate, compared to House leadership that almost appears to want to sink Farm Bill legislation for the year.

The story quotes Rep. Austin Scott (R-GA) to illustrate some Republicans' animosity toward the nation's most important anti-hunger program:

“Americans, working Americans, the middle income and low-income working Americans — they are out there doing the best they can and struggling — are sick and tired of watching the abuses of the system,” Scott said. “I just want to say this one more time. You can’t feed the hungry by starving the farmer.”

"Starving the farmer" is quite some rhetoric. Net farm income this year is $91.7 billion, the second highest on record in nominal terms. For the commercial farm households who receive the highest level of subsidy, average farm income in 2010 (the most recent year available) was $135,000 and average household income was $185,000.  The many farmers who are "starving," relatively speaking, get much lower subsidies.

I am surprised that the politics of this works out well for the House Republicans. If the point is to protect farm programs and taxpayers by sticking it to poor people, it would still seem necessary to craft a bill that actually can pass. Tom Laskawy writes at Grist:

I would argue that the cuts to food stamps will be a non-starter for numerous House Democrats — many of whose votes will be needed to pass the bill, probably ending hopes for a new farm bill before the election.

Picking a no-holds-barred brawl with the Senate, leading to the bill's failure this year, drawing the wider public's scrutiny to farm policy, seems likely to harm the constituencies of rural and urban legislators alike.  But perhaps they see something I don't.