Breastfeeding Report Card
August 2008
Background
Improving the health of mothers and their children is a primary goal of
the Centers for Disease Control and Prevention (CDC). Encouraging
breastfeeding, with its many known benefits for infants, children, and
breastfeeding women, is a key strategy toward this goal. People from all
walks of life play a role in fostering breastfeeding. When health care
professionals, legislators, employers, business owners, and community and
family members work together, their efforts can increase the number of women
who start breastfeeding and the length of time they continue to breastfeed.
The Breastfeeding Report Card — United States, 2008 shows how breastfeeding
is being protected, promoted, and supported in each state and allows
comparisons across states, making it an important tool for increasing
breastfeeding nationwide.
The Breastfeeding Report Card reports information for each state on five
“outcome” and nine “process” indicators. The outcome indicators are derived
from the breastfeeding goals outlined in Healthy People 2010, a description
of the nation’s health priorities. They profile the extent to which infants
in a state are breastfed. The process indicators measure elements of
breastfeeding-friendly communities. Each indicator can be measured
accurately in every state, allowing easy state-by-state comparisons. As
measures of a state’s ability to protect, promote, and support
breastfeeding, the outcome and process indicators show where a state has
been successful and where more work is needed.
The Breastfeeding Report Card indicators can be used to:
- Tell the story of breastfeeding practices in each state.
- Monitor progress and celebrate state successes.
- Identify opportunities for growth and improvement in breastfeeding protection, promotion, and support within each state.
Outcome Indicators
The five outcome indicators directly track the Healthy People 2010 breastfeeding objectives. Outcomes are estimated using data from the annual CDC National Immunization Survey (NIS).
Process Indicators
The nine process indicators measure five different types of breastfeeding
support: birth facility support; professional support; mother-to-mother
support; state legislation; and public infrastructure (public facilities and
services).
Birth Facility Support
- State mPINC score
- Percent of live births occurring at facilities identified as part of the Baby-Friendly Hospital Initiative
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.
Two initiatives, one national and one global, provide informative
measures of birth facility support. The Maternity Practices in Infant
Nutrition and Care (mPINC) Survey, initiated in 2007 by CDC in collaboration
with Battelle Centers for Public Health Research and Evaluation, is designed
to measure breastfeeding-related maternity care practices at all intrapartum
care facilities across the United States and to compare the extent to which
such 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.
To be designated as “Baby-Friendly,” facilities undergo external evaluation
to demonstrate that the facility meets all of the Ten Steps requirements.
All types and sizes of birth facilities can seek the Baby-Friendly
designation. Some states have several small Baby-Friendly facilities, others
have only one or two large ones, and still others have none at all. Because
facilities vary in size and the number of births, measuring their impact on
public health requires more than just counting the number of Baby-Friendly
facilities per state. The best way to measure their impact is to look at the
proportion of births in a given state occurring at facilities that have
earned the Baby-Friendly distinction.
Professional Support
- Number of International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births
International Board Certified Lactation Consultants (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. Much of an IBCLC’s
work is done one-on-one. Therefore, only a rough estimate can be made of
their availability to provide professional support within a state. The best
measure is the ratio of IBCLCs to the number of live births.
Mother-to-Mother Support
- Number of La Leche League Groups per 1,000 live births
La Leche League is an organization of trained and accredited volunteer
mothers who provide mother-to-mother support and help to pregnant women
considering breastfeeding and mothers who are breastfeeding in group
meetings, as well as online and via telephone. This kind of assistance is an
important element of comprehensive breastfeeding support. The number of La
Leche League groups per 1,000 live births provides a broad estimate of the
availability of breastfeeding assistance in a given community.
Legislation
- Laws protecting breastfeeding in public
- Laws supporting breastfeeding mothers who return to work
Most states now have some form of legislation (laws) protecting the basic human right to breastfeed. Unfortunately, despite protective laws, mothers and babies who breastfeed “in public” still face obstacles and negative reactions. Legislation reflects social acceptance of breastfeeding as a “normal” activity, concern for the health and well-being of children, and the importance of breastfeeding as a public health issue.
Laws supporting breastfeeding mothers who return to work serve a dual
purpose: they not only encourage employers to support their employees, they
also encourage mothers to continue breastfeeding after returning to work.
Such laws support the economic goals of employers and employees as well as
the well-being of mothers and children.
Infrastructure
- Number of state health department full-time equivalents (FTEs) responsible for breastfeeding
- Presence of an active statewide breastfeeding coalition
- Presence of statewide breastfeeding coalition Web site
State health departments are the central state agencies responsible for the public health and welfare of women and children. Among their many responsibilities, employees in these agencies help ensure appropriate consideration of breastfeeding in public programs and services. FTEs dedicated to the protection, promotion, and support of breastfeeding are needed to develop, implement, monitor, and maintain breastfeeding interventions.
A statewide coalition dedicated to breastfeeding represents a basic level of community support for breastfeeding. Though these coalitions differ in terms of what they do and how they do it, they share a commitment to empower community members to be local change agents. Coalition members make the case to their community for the importance of breastfeeding.
State coalitions with a Web site have an effective way to communicate. On their Web site, coalition members can share information with existing members and also recruit new members interested in breastfeeding issues. Coalition Web sites are also an excellent way to reach community members who want quality breastfeeding information and online support.
The CDC Breastfeeding Report Card was first released in 2007 and is updated annually.
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
- CDC National Immunization Survey, 2005 births. http://www.cdc.gov/breastfeeding/data/NIS_data (URL to go live approx. 8/1/2008)
- Breastfeeding process indicators
a. Average mPINC Score
Source: DiGirolamo AM, Manninen DL, Cohen JH, Shealy KR, Murphy PE, MacGowan CA, Sharma AJ, Scanlon KS, Grummer-Strawn LM, Dee DL. Breastfeeding-Related Maternity Practices at Hospitals and Birth Centers --- United States, 2007. MMWR Morbid Mortal Wkly Rep:7(23);621-625. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm
b. Modes of support per live births by state
Source: Total live birth information: CDC National Center for Health Statistics (NCHS) 2006 births http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm- Percent of live births at facilities designated as Baby Friendly
(BFHI)
Source: Baby Friendly USA. Baby-Friendly Hospitals and Birth Centers as of July 2008. http://www.babyfriendlyusa.org/eng/03.html*- Hospital annual birth census information: American Hospital Association Annual Survey Database for Fiscal Year 2005
- Birth center annual birth census information: 2007 CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey
- Number of IBCLCs per 1,000 live births
Source: International Board of Lactation Consultant Examiners. IBCLC Facts and Figures as of July 2008. http://americas.iblce.org/factsandfigures.php#USstate* - Number of La Leche League Groups per 1,000 live births
Source: La Leche League in the USA list of groups by state as of July 2008. http://www.lllusa.org/groups.php*
c. Number of state health dept FTEs dedicated to breastfeeding
Source: Personal communications with state WIC Breastfeeding Coordinators and other state employees in each state
d. State legislation about breastfeeding
Source: National Conference of State Legislatures: the Forum for America’s Ideas. 50 State Summary of Breastfeeding Laws as of July 2008. http://www.ncsl.org/programs/health/breast50.htm*- Breastfeeding in public places
- Lactation and employment
e. State breastfeeding coalitions
Source: United States Breastfeeding Committee. State and Territory Breastfeeding Coalitions Directory http://www.usbreastfeeding.org/State-Coalitions/coalitions-directory.html*- Presence of an active statewide breastfeeding coalition
- Presence of coalition website
- Percent of live births at facilities designated as Baby Friendly
(BFHI)
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Page last updated: July 29, 2008
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion