Primary Navigation for the CDC Website
CDC en Español
Breastfeeding
Email Icon Email this page
Printer Friendly Icon Printer-friendly version

On This Page:
See also:

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:

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

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

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

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

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

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

  1. Breastfeeding outcome indicators – Ever Breastfed, Breastfeeding at 6 months, Breastfeeding at 12 months, Exclusive breastfeeding at 3 months, Exclusive breastfeeding at 6 months
  2. 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*

back to top

PDF Document Icon 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 reviewed: July 29, 2009
Page last updated: July 29, 2009
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion