Breastfeeding Report Card—United States, 2012

Background

Improving the health of mothers and their children is a primary goal of the Centers for Disease Control and Prevention (CDC). Protecting, promoting, and supporting breastfeeding, with its many known benefits for infants, children, and mothers, is a key strategy toward this goal.
There are many ways that states support mothers and babies to breastfeed, and everyone plays a role. The CDC Breastfeeding Report Card brings together state-by-state information to help tell the story of breastfeeding practices in states. It compiles many types of data so states can monitor progress, celebrate state successes, and identify opportunities to work with health professionals, employers, business owners, community partners and family members to protect, promote, and support breastfeeding.

Breastfeeding rates on the rise

Breastfeeding rates continue to rise, with increases of about 2 percentage points in breastfeeding initiation, and breastfeeding at 6 and 12 months. Breastfeeding initiation increased from 74.6% in 2008 to 76.9% in 2009 births. This improvement in initiation represents the largest annual increase over the previous decade. Breastfeeding at 6 months increased from 44.3% to 47.2%; breastfeeding at 12 months increased from 23.8% to 25.5%.

Progress in improving hospital practices

CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey assesses and scores how well maternity care practices at hospitals and birth centers support breastfeeding, on a scale of 0–100, with a higher score indicating better practices. From 2009 to 2011 the national average mPINC score increased from 65 to 70, and scores increased by 5 or more points in 26 states and DC. The last few years also have seen acceleration in the percent of babies that are born in hospitals designated as Baby-Friendly, an international recognition of best practices in maternity care. In 2008, less than 2% of births occurred in Baby Friendly facilities. In the last 4 years that number has more than tripled to 6%. While both of these indicators show national improvement in hospital maternity care practices, they also suggest that many mothers are not receiving the quality of care that will give them the best possible start to meeting their breastfeeding intentions.

Breastfeeding Report Card Indicators- 2012

Each indicator is measured in every state, allowing easy state-by-state comparisons.

Outcome Indicators

Five indicators profile the extent to which infants in a state are breastfed. Many of these are the breastfeeding goals outlined in Healthy People 2020, a description of the nation's health priorities.
For more, see Breastfeeding Report Card, United States: Outcome Indicators.

Process Indicators

Elements of breastfeeding-friendly communities are measured using indicators, measuring support from birth facilities, health professionals and child care settings.
For more, see Breastfeeding Report Card, United States: Process Indicators.

Healthy People 2020 Objective
MICH-21: Increase the proportion of infants who are breastfed
MICH-21.1	Ever	81.9%
MICH-21.2	At 6 months	60.6%
MICH-21.3	At 1 year	34.1%
MICH-21.4	Exclusively through 3 months	46.2%
MICH-21.5	Exclusively through 6 months	25.5%
MICH-22: Increase the proportion of employers that have worksite lactation support programs.		38%
MICH-23: Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.		14.2%
MICH-24: Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies.		8.1%

Percent of births at Baby-Friendly facilities in 2012, by state

Data Source: CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC)

Data Source: Baby-Friendly facilities : www.babyfriendlyusa.org & Live Births: CDC NCHS Live Births by State.

Breastfeeding rates for infants born in 2009 from the U.S. National Immunization Surveys, 2010-11

Ever Breastfed
Breastfeeding at 6 months
Breastfeeding at 12 months
Exclusive breastfeeding at 3 months
Exclusive breastfeeding at 6 months

This nationwide survey provides current national, state, and selected urban-area estimates of vaccination coverage rates for US children ages 19 to 35 months. Since July 2001, breastfeeding questions have been asked on the NIS to assess the population's breastfeeding practices.

Birth Facility Support

State Maternity Practices in Infant Nutrition and Care (mPINC) score
Percent of live births occurring at facilities designated as Baby-Friendly
Percentage of breastfed infants receiving formula before 2 days of age

Birth facility policies and practices significantly impact whether a woman chooses to start breastfeeding and how long she continues to breastfeed. Several specific policies and practices, in combination, determine how much overall support for breastfeeding a woman birthing in a given facility is likely to receive and how likely her baby is to receive formula in the first 2 days.
Two initiatives, one national and one global, provide informative measures of birth facility support. The mPINC Survey initiated by CDC, measures breastfeeding-related maternity care practices at intrapartum care facilities across the US and compares the extent to which these practices vary by state. Thus, the state mPINC score represents the extent to which each state’s birth facilities provide maternity care that supports breastfeeding.
The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation based on the WHO/UNICEF Ten Steps to Successful Breastfeeding for Hospitals.

Mother-to-Mother Support

Number of La Leche League Leaders per 1,000 live births

La Leche League (LLLI) is an organization of trained and accredited volunteer mothers who provide support and help to pregnant and breastfeeding mothers. This support is provided through group meetings, online, via telephone and partnership efforts throughout their communities. This kind of assistance is an important element of comprehensive breastfeeding support. The number of La Leche League Leaders per 1,000 live births provides a broad estimate of the availability of breastfeeding assistance in a given state.

Professional Support

Number of International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births

IBCLCs are health professionals who specialize in the clinical management of breastfeeding. IBCLCs work in many health care settings, such as hospitals, birth centers, physicians’ offices, public health clinics, and their own offices. A strong statewide group of professional breastfeeding experts (IBCLCs) is needed to assist the mother-infant pair, create and administer lactation programs, and educate other health professionals about breastfeeding. Availability is measured by the ratio of IBCLCs to the number of live births.

Support in Child Care Settings

States child care regulation support onsite breastfeeding

In the US, many infants are routinely cared for by someone other than a parent. About half of these infants attend child care centers; the other half spend time in a variety of home-based settings including licensed family child care homes or the home of a family member, friend, or neighbor. Thus, child care facilities – both family child care homes and child care centers – play an important role in supporting breastfeeding among mothers whose infants are cared for in these facilities. State scores were obtained from appropriate fluids rating (1A1) as determined by the National Resource Center for Health and Safety in Child Care and Early Education, which categorized state regulation as fully supportive of onsite breastfeeding with a score of 4. States with a score of 4 were categorized as “Yes,” and any scores less than 4 were categorized as “No.”

Data Sources

Breastfeeding outcome indicators – Ever Breastfed, Breastfeeding at 6 months, Breastfeeding at 12 months, Exclusive breastfeeding at 3 months, Exclusive breastfeeding at 6 months
1. Source: CDC National Immunization Surveys 2010 and 2011, Provisional Data, 2009 births. http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm
Breastfeeding process indicators
1. Average mPINC Score
  2011 CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey.
  http://www.cdc.gov/breastfeeding/data/mpinc/index.htm
2. Percent of live births at facilities designated as Baby Friendly (BFHI)
  Sources: Baby Friendly USA. Baby-Friendly Hospitals and Birth Centers as of June 2012. Available at http://www.babyfriendlyusa.org/eng/03.html
3. Number of La Leche League Leaders per 1,000 live births.
  Source: Personal Communication with La Leche League USA, June 2012. Group listing available at http://www.lllusa.org/groups.php
4. Number of IBCLCs per 1,000 live births
  Source: International Board of Lactation Consultant Examiners. IBCLC Facts and Figures as of April 24, 2012. Source: http://americas.iblce.org/facts-and-figures Accessed 6/20/2012.
5. States child care regulation fully supports onsite breastfeeding
  Source: National Resource Center for Health and Safety in Child Care and Early Education, University of Colorado Denver. 2011. National Resource Center for Health and Safety in Child Care and Early Education: Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations 2011. Aurora, CO.
6. Births by state
  Source: Total live birth information: Martin, J., et al., Births: Preliminary data for 2010. National vital statistics reports, 2011. 60(1): p. 1-70. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf . Accessed 6/20/2012.