Breastfeeding Report Card
United States, 2020
Breastfeeding has many known health benefits for infants, children, and mothers and is a key strategy to improve public health. The American Academy of Pediatrics recommends infants are exclusively breastfed for about the first 6 months with continued breastfeeding while introducing complementary foods for at least 1 year. CDC’s Breastfeeding Report Card, 2020, provides data on breastfeeding practices and supports in all states, the District of Columbia (DC), Puerto Rico, Guam, and the US Virgin Islands. This year’s report highlights data from CDC’s 2018 national survey of Maternity Practices in Infant Nutrition and Care (mPINC) that assesses practices and policies affecting newborn feeding, feeding education and support, staff skills, and discharge support.
The 2020 Breastfeeding Report Card presents data that were collected before the start of the COVID-19 pandemic. Maternity care practices that support breastfeeding may have changed in some hospitals because of the COVID-19 pandemic. CDC is working to learn more about potential changes in hospital practices that could affect breastfeeding. In 2020 CDC administered a supplemental survey to hospitals that participated in the 2018 mPINC survey to ask about hospital practices supportive of breastfeeding in the context of COVID-19. See CDC’s Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 – United States, July 15-August 20, 2020 MMWR to learn more.
What Do the Numbers Tell Us?
Evidence-based hospital practices are important for establishing breastfeeding. Individualized support in the first few hours and days is critical to help mothers meet their breastfeeding goals. Although most infants born in 2017 started breastfeeding (84.1%), only 58.3% of infants were breastfeeding at 6 months (Table 1). The percentage of breastfed infants supplemented with infant formula before 2 days of age was 19.2% among infants born in 2017, an increase from 16.9% among infants born in 2016. Comprehensive hospital practices and policies that support breastfeeding have been shown to reduce medically unnecessary formula supplementation, reduce disparities in breastfeeding, and help give infants the best start in life.
CDC’s national mPINC survey assesses maternity care practices that affect how babies are fed. About every 2 years, all maternity care hospitals in the United States and US territories are invited to participate. In 2018, 2,045 hospitals participated and were asked about early postpartum care practices, feeding practices, education and support of mothers and caregivers, staff and provider responsibilities and training, and hospital policies and procedures. These policies and practices are organized into six main areas of care called subdomains that are scored and comprise each state’s total mPINC score (Table 2). Data can be used to monitor and improve evidence-based maternity care practices and policies. The national total mPINC score was 79 out of 100 and state total mPINC scores ranged from 68 to 96.
Figure 1 represents the range of scores from the highest state score to the lowest state score for each of the 6 mPINC subdomains across 50 states and Puerto Rico. The horizontal bar represents the national average score for each subdomain. States are performing well in the area of Feeding Education and Support with state scores ranging from 83 to 99 and a national score of 92. This domain includes teaching mothers to position and latch their newborn, assessing effective breastfeeding, hand expressing milk, recognizing and responding to feeding cues, breastfeeding on demand, and understanding the risks of using artificial nipples and pacifiers. This subdomain also assesses whether mothers whose newborns are fed any formula are taught feeding techniques and how to safely prepare and feed a baby formula. There is a wide range of scores for the other 5 subdomains, indicating room for improvement.
Figure 1. National score and state score ranges for Maternity Practices in Infant Nutrition and Care (mPINC) subdomains, 2018.
|Immediate Postpartum Care||Rooming-In||Feeding Practices||Feeding Education & Support||Discharge Support||Institutional Management|
|Highest State Score||93||96||96||99||100||95|
|National Average Score||81||71||82||92||78||70|
|Lowest State Score||57||56||64||83||61||47|
One area for improvement is institutional management. State scores for Institutional Management ranged from 47 to 95 with a national score of 70. Institutional Management demonstrates the commitment of hospitals’ administrations to policies and practices that support optimal infant nutrition and care. The Institutional Management subdomain score includes the elements listed in Box 1. Institutional Management score for each state or territory is presented in Figure 2. Only 6 states scored an 80 or higher for this subdomain. Although most hospital accreditation programs require hospitals to track exclusive breastfeeding (Box 1, element 3), quality improvement efforts that focus on the other elements within Institutional Management will improve this subdomain score.
See Maternity Practices in Infant Nutrition and Care (mPINC) Survey for more information about mPINC and to view individual state and territory reports .
- Nurses are required to demonstrate competency in assessing breastfeeding (milk transfer and maternal pain), assisting with breastfeeding (positioning and latch), teaching hand expression, safe formula preparation and feeding, and demonstrating safe skin-to-skin practices.
- Hospital requires nurses to be formally assessed for clinical competency in breastfeeding support and lactation management.
- Hospital records and tracks exclusive breastfeeding throughout the entire hospitalization.
- Hospital pays a fair market price for infant formula.
- Hospital has 100% of all written policy elements that support breastfeeding in place.
Figure 2. Institutional Management subdomain scores for Maternity Practices in Infant Nutrition and Care (mPINC) by state, mPINC 2018.
Note: Data are not reported for District of Columbia, Guam, American Samoa, Northern Mariana Islands, or the US Virgin Islands because of a small sample.
|District of Columbia||.|
|US Virgin Islands||.|
|State/Territory||Ever breastfed||Breastfeeding at 6 months||Breastfeeding at 12 months||Exclusive breastfeeding through 3 months||Exclusive breastfeeding through 6 months||Breastfed infants receiving formula before 2 days of age|
|District of Columbia||88.0||64.7||39.3||47.3||24.0||24.3|
|US Virgin Islandsc||—||—||—||—||—||—|
|aSource: CDC National Immunization Survey (NIS) 2018–2019, among 2017 births. Breastfeeding rate indicators are the percentage of infants breastfeeding at the specified time points, calculated among all infants. The rate for infants receiving formula before 2 days of age is calculated among breastfed infants.
bData from District of Columbia, Guam, American Samoa, Northern Mariana Islands, or the US Virgin Islands are not included in the national average for any breastfeeding rate.
cData not reported for District of Columbia, Guam, American Samoa, Northern Mariana Islands, or the US Virgin Islands.
|Total Score||Immediate Postpartum Care||Rooming-In||Feeding Practices||Feeding Education and Support||Discharge Support||Institutional Management|
|District of Columbiaa||—||—||—||—||—||—||—|
|US Virgin Islandsa||—||—||—||—||—||—||—|
|amPINC scores are not reported for District of Columbia, Guam, American Samoa, Northern Mariana Islands, or the US Virgin Islands because of low sample sizes but are included in the US National Total mPINC Score and US mPINC Subdomain scores.|
Call to Action
Use your state’s data to:
- Celebrate state achievements in breastfeeding and breastfeeding supportive maternity care practices.
- Identify gaps and opportunities for improvement in maternity care practices.
- Bring together partners to promote and support breastfeeding.
- Prioritize the next steps to put into action best practices and policies in maternity care.
|Key Breastfeeding Indicators||Current Rates|
|Percentage of infants who are breastfed: Ever.a||84.1|
|Percentage of infants who are breastfed: At 6 months.a||58.3|
|Percentage of infants who are breastfed: At 1 year.a||35.3|
|Percentage of infants who are breastfed: Exclusively through 3 months.a||46.9|
|Percentage of infants who are breastfed: Exclusively through 6 months.a||25.6|
|Percentage of employers that have worksite lactation support programs.b||51.0|
|Percentage of breastfed newborns who receive formula supplementation within the first 2 days of life.a||19.2|
|aCurrent rates represent infants born in 2017, National Immunization Survey 2018–2019.
bCurrent rates represent employers providing an on-site lactation room, Society for Human Resource Management, 2019 surveyexternal icon.
|Ever breastfed||National Immunization Survey (NIS)||Breastfeeding rates for infants born in 2017 come from the US National Immunization Surveys (NIS) 2018 and 2019. The NIS provides current national, state, and selected urban-area estimates of vaccination coverage rates for US children.
Because breastfeeding data are obtained by maternal recall when children are between 19 and 35 months of age, breastfeeding rates are analyzed by birth cohort rather than survey year.
|Breastfeeding at 6 months|
|Breastfeeding at 12 months|
|Exclusive breastfeeding through 3 months|
|Exclusive breastfeeding through 6 months|
|Breastfed infants receiving formula before 2 days of age|
(Total, Immediate Postpartum Care, Rooming-In, Feeding Practices, Feeding Education and Support, Discharge Support, Institutional Management)
|mPINC||CDC’s national survey of Maternity Practices in Infant Nutrition and Care (mPINC) assesses maternity care practices and provides feedback to encourage hospitals to make improvements that better support breastfeeding. Data for this report come from the 2018 mPINC survey. From 2007 to 2015, CDC administered the mPINC survey every 2 years. mPINC was revised in 2018 and these data should NOT be compared to previous mPINC survey years.
Available at https://www.cdc.gov/breastfeeding/data/mpinc/index.htm.
Older Breastfeeding Report Cards
- Breastfeeding Report Card, 2018 pdf icon[PDF-461KB]
- Breastfeeding Report Card, 2016 pdf icon[PDF-2.72MB]
- Breastfeeding Report Card, 2014 pdf icon[PDF – 1.21 MB]
- Breastfeeding Report Card, 2013 pdf icon[PDF – 1.12 MB]
- Breastfeeding Report Card, 2012 pdf icon[PDF – 848 KB]
- Breastfeeding Report Card, 2011 pdf icon[PDF – 753 KB]
- Breastfeeding Report Card, 2010 pdf icon[PDF – 1.8 MB]
- Breastfeeding Report Card, 2009 pdf icon[PDF – 204 KB]
- Breastfeeding Report Card, 2008 pdf icon[PDF – 375 KB]
- Breastfeeding Report Card, 2007 pdf icon[PDF – 473 KB]
Data, Trends and Maps is an interactive tool that provides state-specific data about obesity, nutrition, physical activity, and breastfeeding. Choose “Breastfeeding” as “Indicator Category” to find more state-specific data and view statistics in a variety of formats, including maps, tables, and trend lines.