 |
2002 PRAMS Surveillance Report: Multistate Exhibits
Breastfeeding |
|
Data Highlights | References | Tables
Background
Human milk is widely recognized as the optimal and most complete form of nutrition for infant feeding. The U.S. Department of Health and Human Services (HHS),1 the American Academy of Pediatrics (AAP),2 the American College of Obstetricians and Gynecologists (ACOG),3 the U.S. Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),4 and other national and international authorities recommend and promote breastfeeding and human milk as the single best way to feed infants.
Breastfeeding provides a range of health and social benefits to infants, children, mothers, families, and society.2,3 Breastfeeding is associated with lower risk of postneonatal death,5 fewer episodes of infectious illness among infants,6,7 and protection against acute and chronic diseases8–13 and overweight and obesity in childhood.14–17 In addition, it nurtures and strengthens the bond between infants and mothers.3 A meta-analysis found that children who were breastfed had higher cognitive functions than those who were fed formula; this effect was more pronounced among low-birthweight infants.18 Furthermore, studies indicate several health benefits for the mother, including lowered risk of ovarian, endometrial, and premenopausal breast cancer.19–26
Breastfeeding and the use of human milk to feed infants are also cost effective for families, employers, and society.1,27 Breastfed infants generally have fewer doctor office visits, prescriptions, and days of hospitalization than formula-fed infants.28 In addition to the health savings from less infant illness, other potential economic benefits include decreased costs for WIC services and other public health programs and reduced employee absenteeism and loss of income.1,2
Under certain conditions, however, some women should not breastfeed. Examples of maternal health conditions for which breastfeeding is contraindicated include when a mother is taking street drugs or does not control alcohol use, is infected with the human immunodeficiency virus (HIV), is human T-cell lymphotropic virus type I- or II-positive, has active untreated tuberculosis (infant may be given expressed breast milk), has active varicella, has herpes simplex lesions on a breast (infant may feed from a breast that has no lesions), is taking certain medications, or is receiving treatment for breast cancer.2,3 While many medications are compatible with breastfeeding, some are contraindicated, including antineoplastic, thyrotoxic, and immunosuppressive agents.3
In 2004, according to the National Immunization Survey (NIS), 70.3% of children aged 19–35 months were ever breastfed (i.e., breastfed or fed breastmilk).29 Of those children, 36.2% and 17.8% were being breastfed at 6 and 12 months, respectively, and only 14.1% were breastfed exclusively (i.e., no solids, water, or other liquids) through 6 months of age.29 Children whose mothers were aged under 20 years, non-Hispanic black, unmarried, or had no more than a high school education or an income below 100% of the poverty level had the lowest rates of breastfeeding initiation and continuation.29
Educational and support programs—both clinician and peer—are associated with higher breastfeeding initiation rates and longer breastfeeding duration.30–35 Changes in maternity care practices in hospitals have also led to increases in breastfeeding initiation.36–38
The Healthy People 2010 goals for breastfeeding are to increase the proportion of mothers who breastfeed their babies in the early postpartum period from 64% (1998) to 75% (Objective 16–19a), at 6 months from 29% (1998) to 50% (Objective 16–19b), and at 12 months from 16% (1998) to 25% (Objective 16–19c).39
PRAMS provides data on the initiation and duration of breastfeeding or use of a breast milk pump. States can use PRAMS data to monitor progress towards achieving the Healthy People 2010 breastfeeding objectives, monitor implementation, and guide further development of breastfeeding promotion and support programs.
Data Highlights
- In 2002, the prevalence of breastfeeding initiation ranged from 50.3% (Louisiana) to 91.0% (Utah).
- During 2000–2002, the prevalence of breastfeeding initiation increased in 6 states (Illinois, Louisiana, Nebraska, North Carolina, South Carolina, and Utah).
- In 2002, the prevalence of breastfeeding at 4 weeks' postpartum ranged from 37.8% (Louisiana) to 80.4% (Utah).
- During 2000–2002, the prevalence of breastfeeding at 4 weeks' postpartum increased in 4 states (Illinois, North Carolina, South Carolina, and West Virginia).
References
- U.S. Department of Health and Human Services (HHS), Office on Women's Health. HHS Blueprint for Action on Breastfeeding. Washington, DC: HHS; 2000.
- American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496–506.
- American College of Obstetricians and Gynecologists (ACOG). Breastfeeding: maternal and infant aspects (ACOG educational bulletin number 258, July 2000). Compendium of Selected Publications. Washington, DC: ACOG; 2005:210–225.
- Schwartz JB, Guilkey DK, Akin JS, Popkin BM. The WIC Breastfeeding Report: The Relationship of WIC Program Participation to the Initiation and Duration of Breastfeeding. Alexandria, VA: U.S. Department of Agriculture; 1992.
- Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004;113(5):e435–e439.
- Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CD. Protective effect of breast feeding against infection. BMJ (British Medical Journal) 1990;300(6716):11–16.
- Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993;91(5):867–872.
- Raisler J, Alexander C, O'Campo P. Breast-feeding and infant illness: a dose-response relationship? American Journal of Public Health 1999;89(1):25–30.
- Lawrence RA. Breastfeeding: benefits, risks and alternatives. Current Opinion in Obstetrics and Gynecology 2000;12(6):519–524.
- Chulada PC, Arbes SJ Jr, Dunson D, Zeldin DC. Breast-feeding and the prevalence of asthma and wheeze in children: analyses from the Third National Health and Nutrition Examination Survey, 1988–1994. The Journal of Allergy and Clinical Immunology 2003;111(2):328–336.
- Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatric Clinics of North America 2001;48(1):125–141.
- Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Reports 2004;119(6):521–535.
- Daniels JL, Olshan AF, Pollock BH, Shah NR, Stram DO. Breast-feeding and neuroblastoma, USA and Canada. Cancer Causes and Control 2002;13(5):401–405.
- Gillman MW, Rifas-Shiman SL, Camargo CA Jr, Berkey CS, Frazier AL, Rockett HR, et al. Risk of overweight among adolescents who were breastfed as infants. JAMA (Journal of the American Medical Association) 2001;285(19):2461–2467.
- Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ. Association between infant breastfeeding and overweight in young children. JAMA (Journal of the American Medical Association) 2001;285(19):2453–2460.
- Dewey KG. Is breastfeeding protective against child obesity? Journal of Human Lactation 2003;19(1):9–18.
- Grummer-Strawn LM, Mei Z. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics 2004;113(2):e81–e86.
- Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. The American Journal of Clinical Nutrition 1999;70(4):525–535.
- Labbok MH. Health sequelae of breastfeeding for the mother. Clinics in Perinatology 1999;26(2):491–503, viii–ix.
- Newcomb PA, Trentham-Dietz A. Breast feeding practices in relation to endometrial cancer risk, USA. Cancer Causes and Control 2000;11(7):663–667.
- Tryggvadottir L, Tulinius H, Eyfjord JE, Sigurvinsson T. Breastfeeding and reduced risk of breast cancer in an Icelandic cohort study. American Journal of Epidemiology 2001;154(1):37–42.
- Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002;360(9328):187–195.
- Tung KH, Goodman MT, Wu AH, McDuffie K, Wilkens LR, Kolonel LN, et al. Reproductive factors and epithelial ovarian cancer risk by histologic type: a multiethnic case-control study. American Journal of Epidemiology 2003;158(7):629–638.
- Glaser SL, Clarke CA, Nugent RA, Stearns CB, Dorfman RF. Reproductive factors in Hodgkin's disease in women. American Journal of Epidemiology 2003;158(6):553–563.
- Jernstrom H, Lubinski J, Lynch HT, Ghadirian P, Neuhausen S, Isaacs C, et al. Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Journal of the National Cancer Institute 2004;96(14):1094–1098.
- Daniels M, Merrill RM, Lyon JL, Stanford JB, White GL Jr. Associations between breast cancer risk factors and religious practices in Utah. Preventive Medicine 2004;38(1):28–38.
- Montgomery DL, Splett PL. Economic benefit of breast-feeding infants enrolled in WIC. Journal of the American Dietetic Association 1997;97(4):379–385.
- Pettigrew MM, Khodaee M, Gillespie B, Schwartz K, Bobo JK, Foxman B. Duration of breastfeeding, daycare, and physician visits among infants 6 months and younger. Annals of Epidemiology 2003;13(6):431–435.
- Centers for Disease Control and Prevention (Web site). Breastfeeding: data and statistics: breastfeeding practices—Results from the 2004 National Immunization Survey. November 11, 2005. Available at http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.htm.
- Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis S. Georgia's breastfeeding promotion program for low-income women. Pediatrics 2000;105(6):E85.
- Deshpande AD, Gazmararian JA. Breast-feeding education and support: association with the decision to breast-feed. Effective Clinical Practice: ECP 2000;3(3):116–122.
- Pugh LC, Milligan RA, Frick KD, Spatz D, Bronner Y. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth 2002;29(2):95–100.
- Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA. The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Family Medicine 2003;1(2):70–78.
- Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003;112(1 Pt 1):108–115.
- Chapman DJ, Damio G, Young S, Perez-Escamilla R. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Archives of Pediatric and Adolescent Medicine 2004;158(9):897–902.
- Philipp BL, Merewood A, Miller LW, Chawla N, Murphy-Smith MM, Gomes JS, et al. Baby-friendly hospital initiative improves breastfeeding initiation rates in a U.S. hospital setting. Pediatrics 2001;108(3):677–681.
- DiGirolamo AM, Grummer-Strawn LM, Fein S. Maternity care practices: implications for breastfeeding. Birth 2001;28(2):94–100.
- Merewood A, Philipp BL, Chawla N, Cimo S. The baby-friendly hospital initiative increases breastfeeding rates in a U.S. neonatal intensive care unit. Journal of Human Lactation 2003;19(2):166–171.
- U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
Prevalence of Breastfeeding Initiation, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,429 |
57.5 |
1.5 |
54.5–60.5 |
| Alaska |
1,494 |
90.5 |
0.8 |
88.8–92.0 |
| Arkansas |
1,885 |
61.8 |
1.5 |
58.8–64.8 |
| Colorado |
2,206 |
85.5 |
1.0 |
83.5–87.3 |
| Florida |
1,889 |
77.5 |
1.4 |
74.7–80.1 |
| Hawaii |
1,736 |
89.3 |
0.9 |
87.4–90.9 |
| Illinois |
1,862 |
73.8 |
1.1 |
71.6–75.9 |
| Louisiana |
1,524 |
50.3 |
1.4 |
47.5–53.0 |
| Maine |
1,088 |
71.9 |
1.6 |
68.7–74.9 |
| Maryland |
1,381 |
72.4 |
1.9 |
68.6–75.9 |
| Michigan |
1,452 |
70.0 |
1.4 |
67.2–72.7 |
| Minnesotaa |
1,099 |
79.1 |
1.5 |
75.9–81.9 |
| Montana |
1,022 |
85.8 |
1.1 |
83.4–87.8 |
| Nebraska |
1,847 |
76.5 |
1.2 |
74.1–78.8 |
| New Jerseyb |
918 |
74.0 |
1.7 |
70.5–77.2 |
| New Mexico |
1,498 |
82.1 |
1.0 |
80.0–84.1 |
| New Yorkc |
1,163 |
72.0 |
1.7 |
68.6–75.2 |
| North Carolina |
1,463 |
70.3 |
1.5 |
67.3–73.1 |
| North Dakota |
894 |
71.7 |
1.5 |
68.7–74.5 |
| Ohio |
1,266 |
65.9 |
1.7 |
62.5–69.1 |
| Oklahoma |
1,702 |
68.0 |
1.8 |
64.5–71.3 |
| Rhode Island |
1,359 |
67.0 |
1.5 |
64.0–69.9 |
| South Carolina |
1,227 |
58.6 |
2.2 |
54.3–62.7 |
| Utah |
1,490 |
91.0 |
0.9 |
88.9–92.7 |
| Vermont |
1,075 |
79.3 |
1.2 |
76.8–81.6 |
| Washington |
1,473 |
90.3 |
1.1 |
87.9–92.3 |
| West Virginia |
1,592 |
55.4 |
1.7 |
52.0–58.8 |
| All PRAMS states§ |
39,034 |
72.7 |
0.4 |
71.9–73.4 |
† 2002 state range is 50.3–91.0%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Breastfeeding Initiation, 2002
Healthy People 2010 Objective 16–19
Increase the proportion of mothers who breastfeed their babies in the early postpartum period to at least 75%. |
Prevalence of Breastfeeding Initiation, 2000–2002
| State |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
55.3 |
54.2 |
57.5 |
0.323 |
| Alaska |
88.9 |
90.6 |
90.5 |
0.169 |
| Arkansas |
60.1 |
61.6 |
61.8 |
0.468 |
| Colorado |
85.5 |
84.3 |
85.5 |
0.983 |
| Florida |
77.2 |
75.9 |
77.5 |
0.849 |
| Hawaii |
89.3 |
89.8 |
89.3 |
0.975 |
| Illinois |
69.0 |
68.6 |
73.8 |
0.003* |
| Louisiana |
46.1 |
50.4 |
50.3 |
0.029* |
| Maine |
75.6 |
77.4 |
71.9 |
0.090 |
| Maryland |
— |
76.5d |
72.4 |
# # |
| Michigan |
— |
68.8e |
70.0 |
# # |
| Minnesota |
— |
— |
79.1a |
# # |
| Montana |
— |
— |
85.8 |
# # |
| Nebraska |
71.9 |
75.2 |
76.5 |
0.007* |
| New Jersey |
— |
— |
74.0b |
# # |
| New Mexico |
80.0 |
80.2 |
82.1 |
0.158 |
| New Yorkc |
69.3 |
68.7 |
72.0 |
0.263 |
| North Carolina |
63.1 |
67.8 |
70.3 |
0.001** |
| North Dakota |
— |
— |
71.7 |
# # |
| Ohio |
63.1 |
62.4 |
65.9 |
0.244 |
| Oklahoma |
68.1 |
70.7 |
68.0 |
0.976 |
| Rhode Island |
— |
— |
67.0 |
# # |
| South Carolina |
52.6 |
57.4 |
58.6 |
0.046* |
| Utah |
87.7 |
88.3 |
91.0 |
0.027* |
| Vermont |
—f |
77.9f |
79.3 |
# # |
| Washington |
88.4 |
90.4 |
90.3 |
0.222 |
| West Virginia |
53.5 |
55.8 |
55.4 |
0.411 |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
** p value is less than 0.001.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001. |
Prevalence of Breastfeeding at 4 Weeks After Delivery, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,413 |
41.5 |
1.6 |
38.5–44.6 |
| Alaska |
1,475 |
80.3 |
1.2 |
78.0–82.5 |
| Arkansas |
1,872 |
47.2 |
1.6 |
44.2–50.3 |
| Colorado |
2,188 |
75.1 |
1.2 |
72.7–77.4 |
| Florida |
1,878 |
63.5 |
1.6 |
60.3–66.6 |
| Hawaii |
1,717 |
77.5 |
1.2 |
75.1–79.8 |
| Illinois |
1,856 |
60.2 |
1.2 |
57.8–62.5 |
| Louisiana |
1,507 |
37.8 |
1.4 |
35.2–40.5 |
| Maine |
1,078 |
60.9 |
1.7 |
57.6–64.2 |
| Maryland |
1,374 |
62.5 |
2.0 |
58.6–66.3 |
| Michigan |
1,417 |
56.3 |
1.5 |
53.3–59.2 |
| Minnesotaa |
1,094 |
65.6 |
1.8 |
62.0–69.1 |
| Montana |
1,014 |
74.7 |
1.4 |
71.9–77.3 |
| Nebraska |
1,841 |
60.0 |
1.4 |
57.3–62.7 |
| New Jerseyb |
901 |
61.9 |
1.9 |
58.1–65.5 |
| New Mexico |
1,489 |
68.4 |
1.3 |
65.9–70.8 |
| New Yorkc |
1,157 |
59.5 |
1.8 |
55.9–63.0 |
| North Carolina |
1,455 |
56.0 |
1.6 |
52.8–59.1 |
| North Dakota |
888 |
59.0 |
1.6 |
55.8–62.2 |
| Ohio |
1,250 |
52.9 |
1.8 |
49.4–56.4 |
| Oklahoma |
1,691 |
52.7 |
1.9 |
49.0–56.3 |
| Rhode Island |
1,350 |
55.2 |
1.6 |
52.0–58.3 |
| South Carolina |
1,212 |
46.6 |
2.2 |
42.3–50.9 |
| Utah |
1,477 |
80.4 |
1.3 |
77.7–82.9 |
| Vermont |
1,069 |
67.8 |
1.4 |
65.0–70.5 |
| Washington |
1,471 |
78.0 |
1.6 |
74.7–80.9 |
| West Virginia |
1,588 |
43.4 |
1.7 |
40.0–46.8 |
| All PRAMS states§ |
38,722 |
59.6 |
0.4 |
58.8–60.4 |
† 2002 state range is 37.8–80.4%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Breastfeeding at 4 Weeks After Delivery, 2002
Prevalence of Breastfeeding at 4 Weeks After Delivery, 2000–2002
| State |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
39.9 |
38.1 |
41.5 |
0.488 |
| Alaska |
78.9 |
79.6 |
80.3 |
0.413 |
| Arkansas |
44.3 |
44.5 |
47.2 |
0.230 |
| Colorado |
75.0 |
72.8 |
75.1 |
0.907 |
| Florida |
62.0 |
59.8 |
63.5 |
0.510 |
| Hawaii |
77.6 |
76.9 |
77.5 |
0.973 |
| Illinois |
56.1 |
56.7 |
60.2 |
0.018* |
| Louisiana |
36.0 |
39.6 |
37.8 |
0.323 |
| Maine |
62.6 |
65.1 |
60.9 |
0.496 |
| Maryland |
— |
63.6d |
62.5 |
# # |
| Michigan |
— |
51.5e |
56.3 |
# # |
| Minnesota |
— |
— |
65.6a |
# # |
| Montana |
— |
— |
74.7 |
# # |
| Nebraska |
59.4 |
61.7 |
60.0 |
0.760 |
| New Jersey |
— |
— |
61.9b |
# # |
| New Mexico |
66.3 |
66.1 |
68.4 |
0.236 |
| New Yorkc |
57.1 |
55.3 |
59.5 |
0.364 |
| North Carolina |
50.4 |
54.4 |
56.0 |
0.013* |
| North Dakota |
— |
— |
59.0 |
# # |
| Ohio |
51.0 |
48.8 |
52.9 |
0.446 |
| Oklahoma |
54.3 |
53.4 |
52.7 |
0.542 |
| Rhode Island |
— |
— |
55.2 |
# # |
| South Carolina |
38.8 |
42.4 |
46.6 |
0.009* |
| Utah |
78.9 |
79.1 |
80.4 |
0.433 |
| Vermont |
—f |
67.9f |
67.8 |
# # |
| Washington |
77.6 |
76.5 |
78.0 |
0.873 |
| West Virginia |
38.6 |
41.0 |
43.4 |
0.046* |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001. |
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Page last reviewed: 5/13/09
Page last modified: 8/23/06
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion |
|
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