Breastfeeding Report Card

Overview

Breastfeeding has many health benefits for infants, children, and mothers and is a key strategy to improve public health. The 2020–2025 Dietary Guidelines for Americans (Dietary Guidelines)¹ and the American Academy of Pediatrics (AAP)² recommend that infants be exclusively breastfed for about the first 6 months, with continued breastfeeding alongside the introduction of complementary foods for at least 1 year (Dietary Guidelines) or at least 2 years (AAP), or longer if desired. CDC’s Breastfeeding Report Card, 2022 provides a compilation of data on breastfeeding practices and supports in all states, the District of Columbia, and Puerto Rico.

What Do the Numbers Tell Us?

Among infants born in 2019, most (83.2%) started out receiving some breast milk, and 78.6% were receiving any breast milk at 1 month. At 6 months, 55.8% of infants received any breast milk and 24.9% received breast milk exclusively (Figure 1). Families can face many challenges when it comes to breastfeeding. Yet data show that most infants start out breastfeeding, and many are still receiving some breast milk at 6 months. Even some breast milk is beneficial to infants. However, many families do not breastfeed for as long as they intend to³ and breastfeeding disparities by race and ethnicity persist.⁴ The steady decline in any and exclusive breastfeeding from month-to-month indicates that breastfeeding families may need stronger systems of support to reach their breastfeeding goals.

Figure 1. Percentage of Babies Receiving Any and Exclusive Breast Milk During the First 12 Months, Among Children Born in 2019

This year’s report highlights select breastfeeding support indicators that can help families reach their breastfeeding goals, including supportive maternity care practices, state paid family and medical leave laws, and early care and education (ECE) policies.

Evidence-based maternity care practices that support breastfeeding are critical in the first few hours and days to help mothers establish breastfeeding and reach their breastfeeding goals.⁵ Maternity care practices in the United States have improved slightly. National scores on CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey increased from 79 in 2018 to 81 in 2020. Hospitals implementing the Baby-Friendly Hospital Initiative’s Ten Steps help ensure that mothers have the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies, while reducing medically unnecessary formula supplementation. In 2021, over 1 in 4 babies were born in Baby-Friendly designated hospitals. Breastfeeding support in the maternity care setting continues to improve, but variations in care from state-to-state indicate that more work is needed.

Although a family’s breastfeeding journey usually begins in the hospital, supportive policies and access to continued, coordinated support in the community can help families continue breastfeeding. Once families leave their birthing setting, breastfeeding rates drop slowly but consistently, which suggests that families may need additional types of support that facilitate exclusive breastfeeding and a longer duration of breastfeeding.

Breastfeeding support is especially important for mothers taking leave from, and returning to, the workforce. The Surgeon General’s Call to Action to Support Breastfeeding (CTA) identified a lack of paid maternity leave as a significant barrier to breastfeeding, especially for employed mothers with lower incomes, who are also more likely to experience racial and ethnic disparities.⁶ To reduce the impact of employment on breastfeeding disparities, the CTA calls for efforts to establish paid maternity leave for all employed mothers. Child care centers can also support breastfeeding for employed mothers; the CTA encourages states to adopt and enforce national standards that support breastfeeding mothers and caring for breastfed infants.

Two new support indicators related to employment are included in CDC’s 2022 Breastfeeding Report Card:

Paid family and medical leave (PFML) refers to partially or fully compensated time away from work for specific and generally significant family caregiving needs, such as the arrival of a new child or serious illness of a close family member, or an employee’s own serious medical needs. The PFML indicator identifies whether a state has enacted legislation to create a PFML insurance program, whether the program is currently paying benefits, and the number of weeks of paid parental leave benefits that can be claimed by eligible employees (for the care of a new child by birth, adoption, or foster care). As of May 2022, 12 states had enacted PFML insurance legislation. Eight state programs are currently paying benefits, and 4 have not yet begun paying benefits. Among states with enacted PFML insurance legislation, the number of weeks of paid parental leave benefits (i.e., that can be claimed for the arrival of a new child) available to eligible employees ranges from 5 to 12 weeks within a benefit year (Table 2).

The State ECE Licensing Breastfeeding Support Score indicates the extent to which a state’s licensing regulations for child care centers meet the Caring for our Children’s standard to support and encourage breastfeeding best practices.⁷ To fully meet the standard, a state’s ECE licensing regulations must provide comfortable accommodations (e.g., dedicated, private space; comfortable chair; electrical outlet) for mothers to express milk and/or breastfeed their children on-site and recommend feeding of breast milk by parents or caregivers during normal operating hours. State breastfeeding support scores range from 30 to 100. In 2021, 9 states had licensing regulations that fully aligned (score = 100) with the breastfeeding support standard, 37 states’ regulations partially aligned (score = 70), and 5 states’ regulations did not address the standard (score = 30) (Figure 2).

Table 1. Breastfeeding Rates Among Infants Born in 2019^a,b

Table 2. Breastfeeding Support Indicators

Data Sources for the Breastfeeding Report Card Indicators – 2022

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