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2002 PRAMS Surveillance Report: Multistate Exhibits
Prenatal Care Counseling: Breastfeeding |
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Data Highlights | References | Tables
Background
Pregnant women can enhance birth outcomes and infant health by engaging in healthy behaviors and avoiding risky ones around the time of pregnancy. About 84% of pregnant women initiate prenatal care in their first trimester,1 placing prenatal care providers in a unique position to screen for risky behaviors and to promote healthy ones early in pregnancy. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that prenatal care providers counsel women during prenatal care about the advantages of breastfeeding.2–5 Although human milk is widely recognized as the optimal and most complete form of nutrition for infant feeding,4–7 under certain conditions (e.g., infection with the human immunodeficiency virus [HIV]) some women should not breastfeed.4,5
Studies show that counseling about breastfeeding from prenatal care providers can increase breastfeeding rates.8–11 Although reports of breastfeeding counseling during pregnancy are fairly high (e.g., 80%–91% in 1997 and 1998),12 national breastfeeding goals have yet to be met. According to the 2004 National Immunization Survey (NIS), 70.3% of children aged 19–35 months were ever breastfed (i.e., breastfed or fed breastmilk).13 Of those who were ever breastfed, 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.13
Racial and ethnic disparities exist in both breastfeeding prevalence and prenatal breastfeeding counseling. The 2004 NIS data show that non-Hispanic black children have the lowest rates of breastfeeding initiation and continuation compared to children in other racial and ethnic groups. For example, 50.4% of non-Hispanic black children were ever breastfed compared to 71.0% of non-Hispanic white children.13 Furthermore, African American women are less likely than white women to report receiving advice on breastfeeding from their prenatal care providers.14,15
Successful implementation of the counseling guidelines may help meet national goals for increasing the initiation and duration of breastfeeding. The Healthy People 2010 objectives for breastfeeding include increasing the proportion of mothers who breastfeed their babies in the early postpartum period from 64% (1998) to 75% (Objective 16–19a), increasing the proportion of mothers who breastfeed their babies at 6 months from 29% (1998) to 50% (Objective 16–19b), and increasing the proportion of mothers who breastfeed their babies at 1 year from 16% (1998) to 25% (Objective 16–19c).16 PRAMS collects data on whether any health care provider or worker talked to women during a prenatal care visit about breastfeeding their baby. State and local agencies and professional organizations can use these data to monitor counseling practices to ensure that pregnant women receive information and counseling about breastfeeding.
Data Highlights
- In 2002, the proportion of women who reported that their prenatal care counseling included a discussion of breastfeeding ranged from 70.5% (New Jersey) to 91.0% (Maine).
References
- Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. National Vital Statistics Reports 2003;52(10):1–113.
- American Academy of Pediatrics (AAP) Committee on the Fetus and Newborn and American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Guidelines for Perinatal Care. Elk Grove Village, IL and Washington, DC: AAP and ACOG; 2002.
- American Academy of Pediatrics (AAP) Committee on Psychosocial Aspects of Child and Family Health. The prenatal visit. Pediatrics 2001;107(6):1456–1458.
- 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.
- American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496–506.
- U.S. Department of Health and Human Services (HHS), Office on Women's Health. HHS Blueprint for Action on Breastfeeding. Washington, DC: HHS; 2000.
- 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.
- Kistin N, Benton D, Rao S, Sullivan M. Breast-feeding rates among black urban low-income women: effect of prenatal education. Pediatrics 1990;86(5):741–746.
- Dermer A. Overcoming medical and social barriers to breast feeding. American Family Physician 1995;51(4):755–758, 761–763.
- Timbo B, Altekruse S, Headrick M, Klontz K. Breastfeeding among black mothers: evidence supporting the need for prenatal intervention. Journal of the Society of Pediatric Nurses 1996;1(1):35–40.
- Schwartz JB, Popkin BM, Tognetti J, Zohoori N. Does WIC participation improve breast-feeding practices? American Journal of Public Health 1995;85(5):729–731.
- Petersen R, Connelly A, Martin SL, Kupper LL. Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS). American Journal of Preventive Medicine 2001;20(4):245–250.
- 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.
- Kogan MD, Kotelchuck M, Alexander GR, Johnson WE. Racial disparities in reported prenatal care advice from health care providers. American Journal of Public Health 1994;84(1):82–88.
- Beal AC, Kuhlthau K, Perrin JM. Breastfeeding advice given to African American and white women by physicians and WIC counselors. Public Health Reports 2003;118(4):368–376.
- U.S. Department of Health and Human Service. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
Prevalence of Prenatal Care Discussion of Breastfeeding, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,512 |
83.1 |
1.2 |
80.6–85.3 |
| Alaska |
1,592 |
88.5 |
0.9 |
86.5–90.2 |
| Arkansas |
1,900 |
78.4 |
1.3 |
75.7–80.8 |
| Colorado |
2,223 |
79.7 |
1.1 |
77.4–81.8 |
| Florida |
1,976 |
80.3 |
1.4 |
77.4–82.9 |
| Hawaii |
1,773 |
85.8 |
1.0 |
83.8–87.7 |
| Illinois |
1,892 |
81.9 |
0.9 |
80.0–83.7 |
| Louisiana |
1,640 |
84.7 |
1.0 |
82.7–86.6 |
| Maine |
1,123 |
91.0 |
1.0 |
88.9–92.7 |
| Maryland |
1,439 |
81.2 |
1.5 |
78.1–83.9 |
| Michigan |
1,526 |
82.5 |
1.1 |
80.2–84.5 |
| Minnesotaa |
1,105 |
85.2 |
1.4 |
82.4–87.7 |
| Montana |
1,027 |
86.0 |
1.1 |
83.7–88.1 |
| Nebraska |
1,837 |
82.2 |
1.1 |
80.0–84.2 |
| New Jerseyb |
910 |
70.5 |
1.8 |
66.9–73.9 |
| New Mexico |
1,514 |
87.1 |
0.9 |
85.2–88.8 |
| New Yorkc |
1,186 |
79.6 |
1.5 |
76.5–82.3 |
| North Carolina |
1,507 |
88.3 |
1.0 |
86.1–90.1 |
| North Dakota |
893 |
83.0 |
1.2 |
80.4–85.3 |
| Ohio |
1,353 |
79.9 |
1.4 |
77.0–82.6 |
| Oklahoma |
1,819 |
84.5 |
1.3 |
81.8–86.9 |
| Rhode Island |
1,381 |
81.4 |
1.2 |
78.9–83.8 |
| South Carolina |
1,349 |
88.2 |
1.4 |
85.3–90.7 |
| Utah |
1,544 |
71.9 |
1.5 |
69.0–74.7 |
| Vermont |
1,094 |
88.0 |
1.0 |
86.0–89.8 |
| Washington |
1,493 |
87.7 |
1.2 |
85.1–89.9 |
| West Virginia |
1,656 |
85.8 |
1.2 |
83.2–88.0 |
| All PRAMS states§ |
40,264 |
82.1 |
0.3 |
81.5–82.7 |
† 2002 state range is 70.5–91.0%.
‡ 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 Prenatal Care Discussion of Breastfeeding, 2002
Prevalence of Prenatal Care Discussion of Breastfeeding, 2000–2002
| State |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
85.3 |
86.0 |
83.1 |
0.193 |
| Alaska |
89.0 |
87.9 |
88.5 |
0.702 |
| Arkansas |
79.3 |
78.6 |
78.4 |
0.654 |
| Colorado |
81.9 |
80.7 |
79.7 |
0.161 |
| Florida |
80.2 |
81.3 |
80.3 |
0.983 |
| Hawaii |
85.8 |
85.2 |
85.8 |
0.942 |
| Illinois |
80.6 |
81.0 |
81.9 |
0.340 |
| Louisiana |
85.1 |
83.8 |
84.7 |
0.775 |
| Maine |
91.6 |
90.5 |
91.0 |
0.645 |
| Maryland |
— |
78.5d |
81.2 |
# # |
| Michigan |
— |
82.1e |
82.5 |
# # |
| Minnesota |
— |
— |
85.2a |
# # |
| Montana |
— |
— |
86.0 |
# # |
| Nebraska |
82.3 |
80.7 |
82.2 |
0.941 |
| New Jersey |
— |
— |
70.5b |
# # |
| New Mexico |
85.8 |
87.5 |
87.1 |
0.316 |
| New Yorkc |
78.1 |
80.7 |
79.6 |
0.461 |
| North Carolina |
87.2 |
86.3 |
88.3 |
0.485 |
| North Dakota |
— |
— |
83.0 |
# # |
| Ohio |
80.3 |
82.3 |
79.9 |
0.851 |
| Oklahoma |
82.5 |
85.7 |
84.5 |
0.284 |
| Rhode Island |
— |
— |
81.4 |
# # |
| South Carolina |
84.3 |
88.9 |
88.2 |
0.053 |
| Utah |
75.6 |
74.5 |
71.9 |
0.069 |
| Vermont |
—f |
87.1f |
88.0 |
# # |
| Washington |
85.7 |
88.0 |
87.7 |
0.240 |
| West Virginia |
84.9 |
85.2 |
85.8 |
0.619 |
# Based on a test for linear trend using logistic regression.
# # < 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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