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Survey: Breastfeeding Rates

National Immunization Survey (NIS)

Wording of the Breastfeeding Questions

The breastfeeding questions used in the NIS were modified in 2004 and 2006 (Table A1). In January 2004, the third question was modified slightly to remove “or water” from the first part of the question and add it to the list of items other than breast milk. Additionally, the interviewers were instructed to always read the clarification of foods and liquids to consider. Our examination of the influence of this question change on the rate of exclusive breastfeeding at 3 and 6 months of age revealed a minimal effect.

In 2006, additional changes were made to two of the NIS breastfeeding questions (Table A1). These changes were on the basis of cognitive testing results for the questions used before 2006. Question 2 was revised to read “How old was [child’s name] when [child’s name] completely stopped breastfeeding or being fed breast milk?” The wording change on question 2 resulted in a minimal effect on our reported duration of breastfeeding. Question 3, “How old was [child] when s/he was first fed something other than breast milk?” was asked as two separate questions in 2006, which yielded significantly lower estimates of exclusive breastfeeding. Because of this large effect, we only show trends of exclusive breastfeeding and formula supplementation of breast milk for children whose caregivers were interviewed after December 31, 2005.

The 2006 breastfeeding questions continue to be used in the NIS survey.

Table A1. Changes in breastfeeding questions, National Immunization Survey 2001–Present
Questions 2001–2003 Questions 2004–2005 Questions 2006–present
1. Was [child] ever breastfed or fed breast milk? 1. Was [child] ever breastfed or fed breast milk? 1. Was [child] ever breastfed or fed breast milk?
2. How long was [child] breastfed or fed breast milk? 2. How long was [child] breastfed or fed breast milk? 2. How old was [child’s name] when [child’s name] completely stopped breastfeeding or being fed breast milk?
3. How old was [child] when s/he was first fed something other than breast milk or water? [If respondent hesitates, add: This includes formula, juice, cow’s milk, sugar water, solid foods or anything else.] 3. How old was [child] when s/he was first fed something other than breast milk? This includes formula, juice, cow’s milk, water, sugar water, solid foods or anything else. 3. How old was [child’s name] when (he/she) was first fed formula?
4. This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow’s milk, sugar water, baby food, or anything else that [child] may have been given, even water. How old was [child’s name] when (he/she) was first fed anything other than breast milk or formula?

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