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Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US). The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011.

Cover of The Surgeon General's Call to Action to Support Breastfeeding

The Surgeon General's Call to Action to Support Breastfeeding.

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Rates of Breastfeeding

Over the last few decades, rates of breastfeeding have improved, but in recent years, rates generally have climbed more slowly. Figure 1 presents data from 1970 through 2007 from two sources. Data before 1999 are from the Ross Mothers Survey.38–40 Data for 1999 through 2007 are from the Centers for Disease Control and Prevention’s (CDC) annual National Immunization Survey (NIS), which includes a series of questions regarding breastfeeding practices.41

Figure 1. National Trends in Breastfeeding Rates.

Figure 1

National Trends in Breastfeeding Rates. Note: Data from before 1999 are from a different source, as indicated by the line break. Sources: 1970–1998, Ross Mothers Survey; 1999–2007, Centers for Disease Control and Prevention, National Immunization (more...)

National objectives for Healthy People 2010, in addition to calling for 75 percent of mothers to initiate breastfeeding, called for 50 percent to continue breastfeeding for six months and 25 percent to continue breastfeeding for one year.22 Healthy People 2010 also included objectives for exclusive breastfeeding: targets were for 40 percent of women to breastfeed exclusively for three months and for 17 percent to do so for six months.22

The most recent NIS data shown in Figure 1 indicate that, while the rate of breastfeeding initiation has met the 2010 target, rates of duration and exclusivity still fall short of Healthy People 2010 objectives.41 Among children born in 2007, 75 percent of mothers initiated breastfeeding, 43 percent were breastfeeding at six months, and 22 percent were breastfeeding at 12 months (see Figure 1). Although human milk is the only nutrition most babies need for about the first six months, many women discontinue breastfeeding or add other foods or liquids to their baby’s diet well before the child reaches six months of age. Among breastfed infants born in 2007, an estimated 33 percent were exclusively breastfed through age three months, and only 13 percent were exclusively breastfed for six months.

Although much is known about rates of breastfeeding in the population, mothers’ breastfeeding practices have not been well understood until recently. The Infant Feeding Practices Study II,42 conducted during 2005–2007 by the U.S. Food and Drug Administration (FDA) in collaboration with CDC, was designed to fill in some of the gaps. For this longitudinal study of women followed from late pregnancy through their infants’ first year of life, participants were selected from across the United States. On average, members of the study group had higher levels of education, were older, were more likely to be white, were more likely to have a middle-level income, and were more likely to be employed than the overall U.S. female population.42

Some of the findings from this study were discouraging; for instance, almost half of breastfed newborns were supplemented with infant formula while they were still in the hospital after birth.43 Most healthy, full-term, breastfed newborns have no medical need to receive supplemental infant formula,44 and supplementing with infant formula can be detrimental to breastfeeding.25 In addition, more than 40 percent of infants in the Infant Feeding Practices Study II sample were consuming solid foods within the first four months after birth43 despite recommendations by the AAP that no infant, whether breastfed or formula fed, should be given any solid foods until at least the age of four months.25

Disparities in Breastfeeding Practices

Despite overall improvements in breastfeeding rates, unacceptable disparities in breastfeeding have persisted by race/ethnicity, socioeconomic characteristics, and geography (see Table 2). For example, breastfeeding rates for black infants are about 50 percent lower than those for white infants at birth, age six months, and age 12 months, even when controlling for the family’s income or educational level. On the other hand, the gap between white and black mothers in initiation of breastfeeding has diminished over time, from 35 percentage points in 1990 to 18 percentage points in 2007. Yet, the gap in rates of breastfeeding continuation at six months has remained around 15 percentage points throughout this period.45,46

Table 2. Provisional Breastfeeding Rates Among Children Born in 2007.

Table 2

Provisional Breastfeeding Rates Among Children Born in 2007.

The reasons for the persistently lower rates of breastfeeding among African American women are not well understood, but employment may play a role.47 African American women tend to return to work earlier after childbirth than white women, and they are more likely to work in environments that do not support breastfeeding.48 Although research has shown that returning to work is associated with early discontinuation of breastfeeding,40 a supportive work environment may make a difference in whether mothers are able to continue breastfeeding.49,50

With regard to socioeconomic characteristics, many studies have found income to be positively associated with breastfeeding.40,51 For example, a study that included children participating in the U.S. Department of Agriculture’s (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which uses income to determine eligibility, found they were less likely to be breastfed than children in middle- and upper-income families.40 Educational status is also associated with breastfeeding; women with less than a high school education are far less likely to breastfeed than women who have earned a college degree. Geographic disparities are also evident; women living in the southeastern United States are less likely to initiate and continue breastfeeding than women in other areas of the country (see Figure 2), and women living in rural areas are less likely to breastfeed than women in urban areas.51,52 Understanding the reasons for these disparities is crucial for identifying, developing, and implementing strategies to overcome the barriers to breastfeeding that women and families experience throughout our country. Research suggests that 1) race and ethnicity are associated with breastfeeding regardless of income, and 2) income is associated with breastfeeding regardless of race or ethnicity.51 Other possible contributors to the disparities in breastfeeding include the media, which has often cited more difficulties with breastfeeding than positive stories,53–55 hospital policies and practices,52 the recommendations of WIC counselors,56 marketing of infant formula,57 policies on work and parental leave,58,59 legislation,52,60 social and cultural norms,57 and advice from family and friends.47

Figure 2. Percentage of Children Ever Breastfed Among Children Born in 2007,* by State.

Figure 2

Percentage of Children Ever Breastfed Among Children Born in 2007,* by State. * Survey limited to children aged 19–35 months at the time of data collection. The lag between birth and collection of data allowed for tracking of breastfeeding initiation (more...)

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