PRAMS Data on Breastfeeding
Using state birth certificate files to identify women who have given birth, the Pregnancy Risk Assessment Monitoring System (PRAMS) collects annual data from a sample of between 1,300 and 3,400 women in each state concerning specific behaviors during pregnancy and up to the time of the survey that may affect their health or the health of their child. PRAMS collects these data through mail surveys and follow-up telephone surveys and uses stratified sampling methods to obtain estimates of the prevalence of behaviors among women in various demographic groups. The surveys are administered 2–6 months after women give birth. Questions about breastfeeding include the following:
- Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period of time?
- Are you currently breastfeeding or feeding pumped milk to your new baby?
- How many weeks or months did you breastfeed or pump milk to feed your baby?
The prevalence estimates in the following two figures and three tables are based on survey participants’ responses to these three questions. Table 1 shows annual state-specific estimates of the prevalence of breastfeeding initiation for 2000 through 2008, and Table 2 shows annual state-specific estimates of the prevalence of breastfeeding at 4 weeks postpartum for 2000 through 2008. Figure 1 depicts the state-specific 2008 prevalence estimates of breastfeeding initiation, and Figure 2 depicts the state-specific 2008 prevalence estimates of any breastfeeding at 4 weeks postpartum. Table 3 shows combined 2008 prevalence estimates for these two breastfeeding measures by maternal age, race/ethnicity, participation in Medicaid, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Among women in the 29 states for which data were available, the overall 2008 prevalence of breastfeeding initiation was 77.1%, and state-specific prevalence estimates ranged from 49.5% (Mississippi) to 93.8% (Oregon) (Table 1). Significant increasing trends in the prevalence of breastfeeding initiation were shown in 24 of the 28 states for which 3 or more consecutive years of data were available. Breastfeeding initiation rates were generally lower in the southeastern states and higher in the western states (Figure 1). The prevalence of breastfeeding initiation was lowest by age among women less than 20 years old, lowest by race/ethnicity among black women, and significantly lower among women who received Medicaid and those who participated in WIC than among those who did not ( Table 3).
Figure 1 Prevalence of Breastfeeding Initiation, PRAMS States, 2008
Question: Did you ever breastfeed or pump breast milk to feed your new baby after delivery?
Alaska, 91.8
Arkansas, 66.5
Colorado, 90.4
Delaware, 74.0
Georgia, 72.5
Hawaii, 92.3
Illinois, 77.8
Maine, 78.3
Maryland, 81.2
Massachusetts, 81.6
Michigan, 73.4
Minnesota, 84.9
Mississippi, 49.5
Nebraska, 80.7
New Jersey, 80.2
New York, 75.6
North Carolina, 73.2
Ohio, 70.2
Oklahoma, 79.0
Oregon, 83.8
Pennsylvania, 72.4
Rhode Island, 75.0
Tennessee, 66.4
Utah, 91.2
Vermont, 85.1
Washington, 92.3
West Virginia, 58.4
Wisconsin, 78.6
Wyoming, 85.4
Figure 2 Prevalence of Any Breastfeeding at 4 Weeks Postpartum PRAMS States, 2008
Question: How many weeks or months did you breastfeed or pump breast milk to feed your baby?
Alaska, 80.5
Arkansas, 47.8
Colorado, 79.6
Delaware, 58.7
Georgia, 60.1
Hawaii, 81.9
Illinoi, 65.8
Maine, 64.7
Maryland, 67.8
Massachusetts, 70.9
Michigan, 57.5
Minnesota, 74.3
Mississippi, 35.6
Nebraska, 67.2
New Jersey, 68.2
North Carolina, 60.6
Ohio, 57.1
Oklahoma, 58.9
Oregon, 84.2
Pennsylvania, 59.8
Rhode Island, 61.4
Tennessee, 51.3
Utah, 81.3
Vermont, 74.0
Washington, 79.4
West Virginia, 45.2
Wisconsin, 68.3
Wyoming, 73.2
Table 1 Prevalence of Breastfeeding Initiation, PRAMS Participating States, 2000–2008
State | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 |
|---|---|---|---|---|---|---|---|---|---|
55.3 |
54.2 |
57.5 |
57.9 |
− |
− |
− |
− |
− |
|
88.9 |
90.6 |
90.5 |
90.3 |
91.0 |
90.6 |
92.7 |
91.0 |
91.8† |
|
60.2 |
61.6 |
61.8 |
65.3 |
63.5 |
64.5 |
64.7 |
66.0 |
66.6† |
|
85.5 |
84.3 |
85.5 |
85.3 |
87.2 |
90.2 |
90.0 |
89.6 |
90.4† |
|
− |
− |
− |
− |
− |
− |
− |
74.4 |
74.0 |
|
77.2 |
75.9 |
77.5 |
73.3 |
76.1 |
76.8 |
− |
− |
− |
|
− |
− |
− |
− |
70.2 |
67.3 |
69.8 |
66.3 |
72.5 |
|
89.3 |
89.8 |
89.3 |
89.3 |
91.1 |
90.1 |
92.0 |
92.5 |
92.3† |
|
69.0 |
68.6 |
73.8 |
72.0 |
75.0 |
76.2 |
76.7 |
74.8 |
77.8† |
|
46.1 |
50.4 |
50.3 |
51.2 |
55.5† |
− |
− |
− |
− |
|
75.6 |
77.4 |
71.9 |
77.6 |
78.5 |
78.5 |
80.3 |
78.2 |
78.3† |
|
− |
76.5 |
72.4 |
77.5 |
76.2 |
75.5 |
81.1 |
79.0 |
81.2† |
|
− |
− |
− |
− |
− |
− |
− |
81.5 |
81.6 |
|
− |
68.8 |
70.0 |
68.5 |
71.0 |
72.1 |
68.8 |
72.6 |
73.4† |
|
− |
− |
79.1 |
81.2 |
78.6 |
84.0 |
80.7 |
84.6 |
84.9† |
|
− |
− |
− |
52.8 |
52.1 |
− |
52.7 |
− |
49.5 |
|
− |
− |
− |
− |
− |
− |
− |
71.6 |
− |
|
− |
− |
85.8 |
− |
− |
− |
− |
− |
− |
|
71.9 |
75.2 |
76.4 |
76.7 |
78.1 |
78.0 |
81.3 |
81.3 |
80.7† |
|
− |
− |
74.0 |
75.9 |
74.8 |
77.0 |
79.3 |
79.0 |
80.2† |
|
80.0 |
80.2 |
82.1 |
82.5 |
84.4 |
83.7† |
− |
− |
− |
|
69.3 |
68.7 |
72.0 |
71.7 |
72.4 |
72.9 |
76.1 |
74.0 |
75.6† |
|
− |
− |
− |
− |
84.9 |
82.9 |
84.1 |
86.2 |
− |
|
63.1 |
67.8 |
70.3 |
70.1 |
72.0 |
70.1 |
− |
76.0 |
73.2† |
|
63.1 |
62.4 |
65.9 |
63.0 |
− |
68.9 |
69.9 |
71.1 |
70.2† |
|
68.1 |
70.7 |
68.0 |
68.9 |
74.5 |
73.3 |
75.7 |
74.2 |
79.0† |
|
− |
− |
− |
92.3 |
90.4 |
92.1 |
93.7 |
93.3 |
93.8† |
|
− |
− |
− |
− |
− |
− |
− |
66.7 |
72.4 |
|
− |
− |
67.0 |
72.2 |
70.9 |
71.4 |
74.5 |
74.8 |
75.0† |
|
52.6 |
57.4 |
58.6 |
63.1 |
62.0 |
61.2 |
70.2 |
67.9† |
− |
|
− |
− |
− |
− |
− |
− |
− |
− |
66.4 |
|
87.7 |
88.3 |
91.0 |
88.6 |
91.1 |
90.6 |
90.6 |
92.1 |
91.2† |
|
− |
78.5 |
79.3 |
80.7 |
82.1 |
82.9 |
83.7 |
84.8 |
85.2† |
|
88.4 |
90.4 |
90.3 |
90.1 |
90.5 |
93.3 |
90.9 |
92.6 |
92.3† |
|
53.5 |
55.8 |
55.5 |
56.7 |
62.4 |
60.6 |
55.6 |
57.2 |
58.4† |
|
− |
− |
− |
− |
− |
− |
− |
77.2 |
78.6 |
|
− |
− |
− |
− |
− |
− |
− |
83.3 |
85.4 |
|
Overall | 69.5 |
70.6 |
72.7 |
72.4 |
75.2 |
76.3 |
77.8 |
77.1 |
77.1§ |
- Data unavailable or excluded from analysis because response rate was <70% (2000–2006) or <65% (2007–2008).
† P value for linear trend is statistically significant at the 0.05 level. Linear trend was calculated for states with at least three consecutive years of data.
§ Because the total number of states included in overall prevalence estimates varied from year to year, a trend analysis was not performed.
a Excludes New York City.
Table 2 Prevalence of Any Breastfeeding at 4 Weeks Postpartum, PRAMS Participating States, 2000–2008
State | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 |
|---|---|---|---|---|---|---|---|---|---|
39.9 |
38.1 |
41.5 |
42.2 |
− |
− |
− |
− |
− |
|
79.0 |
79.6 |
80.3 |
77.1 |
78.2 |
81.1 |
82.1 |
79.8 |
80.5 |
|
44.3 |
44.5 |
47.2 |
47.0 |
46.2 |
48.3 |
48.5 |
49.9 |
47.8† |
|
75.0 |
72.8 |
75.1 |
73.9 |
77.0 |
77.8 |
80.6 |
78.2 |
79.7† |
|
− |
− |
− |
− |
− |
− |
− |
62.1 |
58.7 |
|
62.0 |
59.8 |
63.5 |
59.8 |
63.2 |
63.1 |
− |
− |
− |
|
− |
− |
− |
− |
58.4 |
55.0 |
56.5 |
52.8 |
60.1 |
|
77.6 |
76.9 |
77.5 |
77.4 |
78.9 |
77.8 |
81.1 |
80.4 |
81.9† |
|
56.1 |
56.7 |
60.2 |
58.4 |
62.4 |
61.8 |
64.4 |
62.4 |
65.8† |
|
36.0 |
39.6 |
37.8 |
37.0 |
41.7† |
− |
− |
− |
− |
|
62.6 |
65.1 |
61.0 |
65.1 |
65.4 |
66.2 |
68.6 |
63.7 |
64.7 |
|
− |
63.6 |
62.5 |
65.4 |
67.1 |
65.3 |
69.5 |
67.5 |
67.8† |
|
− |
− |
− |
− |
− |
− |
− |
70.3 |
70.9 |
|
− |
51.5 |
56.3 |
55.1 |
56.3 |
56.0 |
55.1 |
57.2 |
57.5 |
|
− |
− |
65.6 |
70.7 |
69.0 |
72.6 |
71.1 |
73.3 |
74.3† |
|
− |
− |
− |
37.8 |
35.5 |
− |
37.7 |
− |
35.6 |
|
− |
− |
− |
− |
− |
− |
− |
58.0 |
− |
|
− |
− |
74.7 |
− |
− |
− |
− |
− |
− |
|
59.4 |
61.7 |
59.7 |
61.9 |
64.9 |
64.6 |
69.8 |
66.7 |
67.2† |
|
− |
− |
61.9 |
63.5 |
62.6 |
64.2 |
67.5 |
68.8 |
68.2† |
|
66.3 |
66.1 |
68.4 |
67.2 |
69.8 |
70.0† |
− |
− |
− |
|
57.1 |
55.3 |
59.5 |
57.4 |
58.1 |
60.7 |
62.3 |
61.5 |
63.1† |
|
− |
− |
− |
− |
73.1 |
71.3 |
74.3 |
74.9 |
− |
|
50.4 |
54.4 |
56.0 |
56.0 |
60.0 |
60.1 |
− |
61.9 |
60.6† |
|
51.0 |
48.8 |
52.9 |
50.3 |
− |
53.3 |
55.5 |
57.2 |
57.1† |
|
54.3 |
53.4 |
52.7 |
53.6 |
55.0 |
54.8 |
56.6 |
55.2 |
58.9† |
|
− |
− |
− |
82.1 |
81.8 |
83.0 |
84.6 |
84.4 |
84.2 |
|
− |
− |
− |
− |
− |
− |
− |
50.8 |
59.8 |
|
− |
− |
55.2 |
59.2 |
58.2 |
58.6 |
59.5 |
62.3 |
61.4† |
|
38.8 |
42.4 |
46.6 |
49.6 |
49.4 |
48.1 |
56.9 |
54.4† |
− |
|
− |
− |
− |
− |
− |
− |
− |
− |
51.3 |
|
78.9 |
79.1 |
80.4 |
80.1 |
81.3 |
81.0 |
79.3 |
83.0 |
81.3† |
|
− |
68.0 |
67.8 |
69.8 |
72.7 |
71.5 |
74.0 |
73.8 |
74.0† |
|
77.6 |
76.6 |
78.0 |
76.8 |
80.1 |
83.3 |
81.2 |
81.8 |
79.5† |
|
38.6 |
41.0 |
43.4 |
42.0 |
48.0 |
43.4 |
41.4 |
42.1 |
45.2† |
|
− |
− |
− |
− |
− |
− |
− |
66.2 |
68.3 |
|
− |
− |
− |
− |
− |
− |
− |
69.1 |
73.2 |
|
Overall | 56.7 |
56.8 |
59.6 |
59.1 |
62.6 |
63.3 |
65.5 |
64.3 |
64.3§ |
- Data unavailable or excluded from analysis because response rate was <70% (2000–2006) or <65% (2007–2008).
† P value for linear trend is statistically significant at the 0.05 level. Linear trend was calculated for states with at least three consecutive years of data.
§ Because the total number of states included in overall prevalence estimates varied from year to year, a trend analysis was not performed.
a Excludes New York City.
Table 3 Prevalence of Breastfeeding Initiation and Duration to 4 Weeks Postpartum Among 2008 PRAMS Participants, by Selected Maternal Characteristics, for All PRAMS States*† Combined
Maternal Characteristics | Breastfeeding Initiation | Breastfeeding at 4 weeks postpartum |
|---|---|---|
Age (years) |
|
|
<20 | 62.4 (59.7–65.0) |
39.2 (36.7–41.9) |
20-24 | 71.5 (70.0–73.1) |
54.5 (52.8–56.1) |
25-34 | 81.4 (80.5–80.2) |
71.1 (70.1–72.1) |
35+ | 80.6 (78.9–82.2) |
72.2 (70.3–73.9) |
Race/Ethnicity |
|
|
White | 77.3 (76.5–78.2) |
64.8 (63.8–65.7) |
Black | 61.8 (59.6–63.9) |
46.6 (44.4–48.8) |
Hispanic | 86.8 (85.3–88.2) |
74.2 (72.3–76.0) |
American Indian | 73.4 (67.2–78.7) |
56.7 (50.2–63.1) |
Alaskan Native | 88.7 (85.6–92.1) |
77.4 (73.6–80.9) |
Hawaiian | 91.2 (88.5–94.4) |
80.4 (75.7–84.3) |
Chinese | 91.6 (85.0–95.4) |
87.2 (80.5–91.8) |
Japanese | 98.5 (96.4–99.4) |
91.7 (79.3–96.9) |
Other Asian | 90.1 (87.5–92.3) |
82.2 (78.9–85.0) |
Filipino | 90.4 (84.8–94.1) |
76.1 (69.3–81.9) |
Mixed Race | 84.3 (76.9–89.7) |
69.8 (61.4–77.0) |
Other | 79.4 (69.2–86.9) |
67.7 (57.4–76.6) |
Medicaid recipient |
|
|
Yes | 69.2 (68.0–70.3) |
53.1 (51.9–54.3) |
No | 83.8 (83.0–84.6) |
73.7 (72.8–74.6) |
WIC recipient |
|
|
Yes | 68.6 (67.4–69.7) |
51.6 (50.4–52.9) |
No | 83.8 (83.0–84.6) |
74.2 (73.2–75.1) |
* See Table 1 for a list of the 29 participating states in 2008.
† Sample size for each demographic group exceeded 200 participants.
§ CI = confidence interval.
Note: Race and ethnicity data from Hawaii are included in the table and in Hawaii if more than one race/ethnicity is indicated, a singly coded race is generated into the electronic data.
