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

Breastfeeding Report Card

United States, 2007

Breastfeeding Report Card, United States — 2007: Outcome Indicators

Breastfeeding Report Card, United States — 2007: Process Indicators

One goal of the Centers for Disease Control and Prevention (CDC) is to improve the health of mothers and their children. One way to reach this goal is to encourage breastfeeding, which has many benefits for infants and children. People from all walks of life play a part in reaching this goal. When health care professionals, legislators, employers, business owners, and community and family members work together, their efforts can increase the number of women who breastfeed their babies and the number of months that they breastfeed them. The Breastfeeding Report Card — United States, 2007 is an important tool for spotting ways to improve breastfeeding nationwide. It gives states information on how breastfeeding is being promoted within a given state. It also makes it possible to compare states across the country.

The information on breastfeeding in the Breastfeeding Report Card shows where the states have had success. It also shows where more work is needed. As part of the Breastfeeding Report Card, each individual state has a State Profile. That profile gives specific information about each of the “indicators” from the Report Card for that state. These indicators are measures of a state’s ability to protect, promote, and support breastfeeding. (Note that the Profile also tells how to get in touch with the state’s breastfeeding coordinator and the state’s breastfeeding coalition. These are people responsible for state-level efforts to promote breastfeeding.)

The Breastfeeding Report Card is made up of eight “process” indicators that are elements of breastfeeding-friendly communities. In addition to the process indicators, the Breastfeeding Report Card has five “outcome” indicators that are derived from Healthy People 2010, a description of the nation’s health priorities.

An important use of the Report Card is for state-by-state comparisons. For this reason, each indicator included in the Breastfeeding Report Card is something that can be measured accurately and is available for every state. With such information, it is easier to see how states differ from one another. Changes in any given indicator should represent a change in the way that breastfeeding is protected, promoted, or supported within a state. Such changes eventually influence outcomes in the health of children, outcomes that are related to breastfeeding.

States can use their data on their progress on indicators in the Breastfeeding Report Card, in many ways:


Outcome Indicators

The importance of breastfeeding as a national health goal is shown by the five Healthy People 2010 breastfeeding goals included here. Each state’s progress on these goals is measured from the breastfeeding items included in the CDC National Immunization Survey. The state rates listed below (percentages of all infants of a given age in the state) are based on those goals:

Process Indicators

The eight process indicators represent five different types of support, and they can be compared across all states:

  1. Hospital support.
  2. Professional support.
  3. Mother-to-mother support.
  4. Legislation.
  5. Infrastructure (public facilities and services).

Hospital Support

The Baby-Friendly Hospital Initiative (BFHI) is a worldwide effort to improve maternity care in ways outlined in the World Health Organization/UNICEF Ten Steps to Successful Breastfeeding. To become a BFHI facility, it is necessary show a group of evaluators that the facility meets the requirements in the Ten Steps. All types and sizes of hospitals and birth centers can seek the BFHI name. Some states have several small BFHI health care facilities, others have only one or two large ones, and still others have none at all. Because BFHI facilities vary in their size and the number of births that occur there, measuring their impact on public health requires more than just counting the number of BFHI facilities per state. The best way to measure their impact is to look at the proportion of births in a given state occurring at BFHI facilities.

Professional Support

International Board Certified Lactation Consultants (IBCLCs) are health care professionals who specialize in helping mothers with breastfeeding. IBCLCs work in many health care settings, such as hospitals, physicians’ offices, public health clinics, and their own offices. A strong statewide group of professional breastfeeding experts (IBCLCs) is needed to provide such help as

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 groups are mother-to-mother support groups for pregnant women considering breastfeeding and mothers who are breastfeeding. La Leche League leaders run these groups and also provide breastfeeding support within their communities. The availability of this kind of peer support is an important element of comprehensive support for mothers with infants. The number of La Leche League groups per 1,000 live births provides a broad estimate of the availability of breastfeeding assistance in any given community.

Legislation

Most states now have some form of legislation (laws) about breastfeeding. States with laws protecting, promoting, or supporting breastfeeding show that they understand the importance of breastfeeding as a public health issue. Unfortunately, across the United States, there are still situations in which mothers who breastfeed their infants “in public” face negative reactions. Most states have laws protecting the basic human right to breastfeed. Such legislation shows that society accepts breastfeeding as a “normal” activity and that it cares for the health and well-being of children. Laws related to breastfeeding women who return to work have two purposes. They not only encourage employers to support these mothers, but also encourage mothers to continue breastfeeding after they return to work. Thus, both the well-being of the child and the economic goals of the employer and the employee can be served.

Infrastructure

State agencies responsible for public health and welfare of women and children include the state health department, WIC program, and Early Intervention program. They help ensure that breastfeeding is included in public programs and services that affect women and infants. FTEs dedicated to the protection, promotion, and support of breastfeeding are needed to develop and implement breastfeeding interventions.

A statewide coalition dedicated to breastfeeding represents a basic level of community support for breastfeeding. State breastfeeding coalitions differ between states in terms of what they do and how they do it. What they have in common is an understanding of the need for community members who can be agents of change locally. The coalition members make the case to their community for the importance of breastfeeding.

State coalitions with a Web site have an effective way to communicate. On their Web site, they can share information with existing coalition members and also recruit new members interested in the issues related to breastfeeding. Coalition Web sites are also an excellent way to reach community members who want quality breastfeeding information and online support.

1All references to ‘states’ in The Breastfeeding Report Card include the District of Columbia as well as the 50 states.

Data Sources

Percentage of live births at facilities designated as Baby Friendly (BFHI)

  1. Baby Friendly USA. June 2007. Baby-Friendly Hospitals and Birth Centers. 17 July 2007 http://www.babyfriendlyusa.org/eng/03.html*
  2. American Hospital Association Annual Survey Database for Fiscal Year 2005, 2007

Number of IBCLCs per 1,000 live births

  1. International Board of Lactation Consultant Examiners (personal communication)
  2. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2005. National vital statistics reports; vol 55. Hyattsville, MD: National Center for Health Statistics. Forthcoming. [Online Available] http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm

Number of La Leche League groups per 1,000 live births

  1. La Leche League International  (personal correspondence)
  2.  La Leche League in the USA. 2007. Groups. 17 July 2007
    http://www.lllusa.org/groups.php*

Number of state health dept FTEs dedicated to breastfeeding

  1. USDA Food and Nutrition Service. 26 July 2005. State Contacts. 17 July 2007 http://www.fns.usda.gov/wic/Contacts/ContactsMenu.HTM
  2. Personal communications from state health departments

State legislation about breastfeeding in public places

  1. National Conference of State Legislatures: the Forum for America’s Ideas. July 2007. 50 State Summary of Breastfeeding Laws. 17 July 2007
    http://www.ncsl.org/programs/health/breast50.htm*

State legislation about lactation and employment

  1. National Conference of State Legislatures: the Forum for America’s Ideas. July 2007. 50 State Summary of Breastfeeding Laws. 17 July 2007
    http://www.ncsl.org/programs/health/breast50.htm*

Presence of an active statewide breastfeeding coalition

  1. United States Breastfeeding Committee database of state breastfeeding coalitions (personal communication with Megan Renner)
  2. Information obtained through a World Wide Web search

Presence of statewide breastfeeding coalition website

  1. Information obtained through a World Wide Web search
  2. Personal communication from some state breastfeeding coalitions

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: May 22, 2007
Page last updated: May 22, 2007
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion