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PRAMS Data on Breastfeeding

Mother breastfeeding infantUsing 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?

Figure 1: Prevalance of breastfeeding initiation, PRAMS states, 2008.
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
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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?

Figure 2: Prevlence of any breastfeeding at 4 weeks postpartum, PRAMS states, 2008.

Alaska, 80.5
Arkansas, 47.8
Colorado, 79.6
Delaware, 58.7
Georgia, 60.1
Hawaii, 81.9
Illinois, 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

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Table 1 Prevalence of Breastfeeding Initiation, PRAMS Participating States, 2000–2008

State

2000
(%)

2001
(%)

2002
(%)

2003
(%)

2004
(%)

2005
(%)

2006
(%)

2007
(%)

2008
(%)

Alabama

55.3

54.2

57.5

57.9

Alaska

88.9

90.6

90.5

90.3

91.0

90.6

92.7

91.0

91.8

Arkansas

60.2

61.6

61.8

65.3

63.5

64.5

64.7

66.0

66.6

Colorado

85.5

84.3

85.5

85.3

87.2

90.2

90.0

89.6

90.4

Delaware

74.4

74.0

Florida

77.2

75.9

77.5

73.3

76.1

76.8

Georgia

70.2

67.3

69.8

66.3

72.5

Hawaii

89.3

89.8

89.3

89.3

91.1

90.1

92.0

92.5

92.3

Illinois

69.0

68.6

73.8

72.0

75.0

76.2

76.7

74.8

77.8

Louisiana

46.1

50.4

50.3

51.2

55.5

Maine

75.6

77.4

71.9

77.6

78.5

78.5

80.3

78.2

78.3

Maryland

76.5

72.4

77.5

76.2

75.5

81.1

79.0

81.2

Massachusetts

81.5

81.6

Michigan

68.8

70.0

68.5

71.0

72.1

68.8

72.6

73.4

Minnesota

79.1

81.2

78.6

84.0

80.7

84.6

84.9

Mississippi

52.8

52.1

52.7

49.5

Missouri

71.6

Montana

85.8

Nebraska

71.9

75.2

76.4

76.7

78.1

78.0

81.3

81.3

80.7

New Jersey

74.0

75.9

74.8

77.0

79.3

79.0

80.2

New Mexico

80.0

80.2

82.1

82.5

84.4

83.7

New York**

69.3

68.7

72.0

71.7

72.4

72.9

76.1

74.0

75.6

New York City

84.9

82.9

84.1

86.2

North Carolina

63.1

67.8

70.3

70.1

72.0

70.1

76.0

73.2

Ohio

63.1

62.4

65.9

63.0

68.9

69.9

71.1

70.2

Oklahoma

68.1

70.7

68.0

68.9

74.5

73.3

75.7

74.2

79.0

Oregon

92.3

90.4

92.1

93.7

93.3

93.8

Pennsylvania

66.7

72.4

Rhode Island

67.0

72.2

70.9

71.4

74.5

74.8

75.0

South Carolina

52.6

57.4

58.6

63.1

62.0

61.2

70.2

67.9†

Tennessee

66.4

Utah

87.7

88.3

91.0

88.6

91.1

90.6

90.6

92.1

91.2

Vermont

78.5

79.3

80.7

82.1

82.9

83.7

84.8

85.2

Washington

88.4

90.4

90.3

90.1

90.5

93.3

90.9

92.6

92.3

West Virginia

53.5

55.8

55.5

56.7

62.4

60.6

55.6

57.2

58.4

Wisconsin

77.2

78.6

Wyoming

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.
** Excludes New York City.

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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
(%)

Alabama

39.9

38.1

41.5

42.2

Alaska

79.0

79.6

80.3

77.1

78.2

81.1

82.1

79.8

80.5

Arkansas

44.3

44.5

47.2

47.0

46.2

48.3

48.5

49.9

47.8

Colorado

75.0

72.8

75.1

73.9

77.0

77.8

80.6

78.2

79.7

Delaware

62.1

58.7

Florida

62.0

59.8

63.5

59.8

63.2

63.1

Georgia

58.4

55.0

56.5

52.8

60.1

Hawaii

77.6

76.9

77.5

77.4

78.9

77.8

81.1

80.4

81.9

Illinois

56.1

56.7

60.2

58.4

62.4

61.8

64.4

62.4

65.8

Louisiana

36.0

39.6

37.8

37.0

41.7

Maine

62.6

65.1

61.0

65.1

65.4

66.2

68.6

63.7

64.7

Maryland

63.6

62.5

65.4

67.1

65.3

69.5

67.5

67.8

Massachusetts

70.3

70.9

Michigan

51.5

56.3

55.1

56.3

56.0

55.1

57.2

57.5

Minnesota

65.6

70.7

69.0

72.6

71.1

73.3

74.3

Mississippi

37.8

35.5

37.7

35.6

Missouri

58.0

Montana

74.7

Nebraska

59.4

61.7

59.7

61.9

64.9

64.6

69.8

66.7

67.2

New Jersey

61.9

63.5

62.6

64.2

67.5

68.8

68.2

New Mexico

66.3

66.1

68.4

67.2

69.8

70.0

New York**

57.1

55.3

59.5

57.4

58.1

60.7

62.3

61.5

63.1

New York City

73.1

71.3

74.3

74.9

North Carolina

50.4

54.4

56.0

56.0

60.0

60.1

61.9

60.6

Ohio

51.0

48.8

52.9

50.3

53.3

55.5

57.2

57.1

Oklahoma

54.3

53.4

52.7

53.6

55.0

54.8

56.6

55.2

58.9

Oregon

82.1

81.8

83.0

84.6

84.4

84.2

Pennsylvania

50.8

59.8

Rhode Island

55.2

59.2

58.2

58.6

59.5

62.3

61.4

South Carolina

38.8

42.4

46.6

49.6

49.4

48.1

56.9

54.4

Tennessee

51.3

Utah

78.9

79.1

80.4

80.1

81.3

81.0

79.3

83.0

81.3

Vermont

68.0

67.8

69.8

72.7

71.5

74.0

73.8

74.0

Washington

77.6

76.6

78.0

76.8

80.1

83.3

81.2

81.8

79.

West Virginia

38.6

41.0

43.4

42.0

48.0

43.4

41.4

42.1

45.2

Wisconsin

66.2

68.3

Wyoming

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.
** Excludes New York City.

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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 CharacteristicsBreastfeeding Initiation
% (95% CI§)
Breastfeeding at 4 Weeks Postpartum
% (95% CI§)
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.

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