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Breastfeeding Report Card –– United States, 2009
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.
Throughout your community, everyone plays 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 are able to start breastfeeding and the length of time
they continue to breastfeed.
The 2009 Breastfeeding Report Card shows how breastfeeding is being
protected, promoted, and supported in each state using five “outcome” and
nine “process” indicators. This allows you to make comparisons across states
and indicators and work to increase breastfeeding nationwide.
The five 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 nine process indicators measure elements of
breastfeeding-friendly communities. Each indicator is measured
in every state, allowing easy state-by-state comparisons. As
measures of a state’s ability to protect, promote, and support
breastfeeding, the report card indicators show where a state has
been successful and where more work is needed.
The Breastfeeding Report Card can help you:
- Tell the story of breastfeeding practices in your state.
- Monitor progress and celebrate state successes.
- Identify opportunities for growth and improvement in breastfeeding protection, promotion, and support within your state.
Breastfeeding Report Card Indicators – 2009
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
- Percent 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 Maternity
Practices in Infant Nutrition and Care (mPINC) Survey, initiated
by CDC, in collaboration with the Battelle Centers for Public
Health Research and Evaluation in 2007, measures
breastfeeding-related maternity care practices at intrapartum
care facilities across the United States 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.
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 mandating support for 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 mandating support for breastfeeding mothers who return to
work encourage mothers to continue breastfeeding after returning
to work by requiring a minimum level of breastfeeding support
from the employer. 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
- Statewide breastfeeding coalitions with public websites
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 publicly available websites 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.
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, 2006 births. http://www.cdc.gov/breastfeeding/data/NIS_data
- 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: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2007. National vital statistics reports, Web release; vol 57 no 12. Hyattsville, MD: National Center for Health Statistics. Released March 18, 2009. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf (PDF-647k) Accessed 6/29/2009.- Percent of live births at facilities designated as Baby Friendly
(BFHI)
Source: Baby Friendly USA. Baby-Friendly Hospitals and Birth Centers as of May 2009. http://www.babyfriendlyusa.org/eng/03.html*- Hospital annual birth census information: American Hospital Association Annual Survey Database for Fiscal Year 2007
- 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 June 2009 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- Breastfeeding in public places
- Lactation and employment
Sources: National Conference of State Legislatures: Breastfeeding Laws, updated May 2009. (accessed 6/2/2009) http://www.ncsl.org/default.aspx?tabid=14389* and La Leche League Summary of Breastfeeding Legislation in the US as of 3/7/2009 (accessed 5/29/2009) http://www.llli.org/docs/summary.rtf*
e. State breastfeeding coalitions- Presence of coalition website
Source: United States Breastfeeding Committee. State and Territory Breastfeeding Coalitions Directory http://www.usbreastfeeding.org/State-Coalitions/coalitions-directory.html*
- Percent of live births at facilities designated as Baby Friendly
(BFHI)
Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.
* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.
Page last updated: July 29, 2009
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion