Integrating Social Marketing Into a State System: Shifting Stigmas and Building Innovation. "Breastmilk. Every Ounce Counts."

Background: WHO states that infants should be exclusively breastfed for the first six months of life "to achieve optimal growth, development and health." In 2007, the rate of exclusive breastfeeding through six months of age in Texas was 11.1 percent; in the U.S. the rate was 12 percent. More than 900 infants lost their lives and 95% of these deaths could have been prevented by breastfeeding. Breastfeeding has been shown to reduce the likelihood of 10+ causes of infant mortality. The rates of premature deaths correlated to low levels of breastfeeding are estimated to inflict a $13 billion burden on U.S. institutions, annually.

Program background: Texas Department of State Health Services could not let this serious and preventable health disparity persist. Low levels of breastfeeding are tied to limitations in education and ingrained stigmas. The goal of the campaign is to ensure that every child is breastfed, exclusively, through the first 6 months of life. We developed a multi-layered, research driven campaign to motivate behavior change in multiple segments of the population; illicit a groundswell of support to encourage change at the institutional (hospital and workplace) and individual (new and expecting mom) levels; and reduce the stigma associated with breastfeeding. These activities worked in concert to accomplish the shared goal and supporting objectives—raising awareness of the benefits of breastfeeding for mom and baby, creating familiar and institutional support systems for moms, developing tools to educate and support the practice of breastfeeding. The campaign touches every aspect of the lives of nursing women and their influencers. The campaign was framed on the key notion that breast milk is the gold standard. The tagline “Every Ounce Counts” speaks to mom and says that every amount makes a difference and that breastfeeding is nutrition only a mother can give to her baby.

Evaluation Methods and Results: The campaign has shifted behaviors and beliefs of individuals, policy makers, hospitals, workplace and state government. The results of this work boil down to the improved overall health of mothers and their babies. By reinforcing these health messages using both traditional and non-traditional media, Texas WIC reached Healthy People 2010 goal of 75 percent initiation rate. This milestone for initiation rate is up from 64 percent in August 2004.

Conclusions: The efficacy of this campaign has been evident in the overall integration within the state, and has arrived at an international level. The campaign has been distributed in all 50 U.S. states and 13+ countries. It illustrates the possibility of positive social change and proves that state-run social programs can market health practices in a beautiful, innovative way that rivals any multi-million dollar campaign.

Implications for research and/or practice: Messages and creative elements were pre-tested with the primary audience, WIC mothers. This research illustrated important barriers for mothers in terms of breastfeeding their children including lack of understanding of the laws that protected their rights to breastfeed; negative experiences concerning public breastfeeding; and lack of training and support among health professionals and hospitals.