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PRAMS and Breastfeeding

The Importance of Breastfeeding

Breastfeeding is associated with numerous health benefits for infants and mothers.1,2 Benefits for infants include reduced risk of severe lower respiratory tract infection,3 diarrhea,4 childhood obesity,5 type 2 diabetes,6 sudden infant death syndrome (SIDS),7 and death from any cause.4 Benefits for women include reduced risk of breast 8 and ovarian3 cancers and possibly reduced risk of postpartum depression, although the mechanism through which breastfeeding may reduce depression risk is not well understood.9,10 Although U.S. breastfeeding rates are increasing, rates remain relatively low among some groups of women, particularly young women, black women, women at or below the federal poverty level, and women with less than a college education.11-13 Many women stop breastfeeding within the first month after giving birth; their reasons for doing so include pain, difficulty initiating, concerns about infant satisfaction, inadequate milk production, and the need to return to work.14,15

Baby laughingIn 2011, the United States Department of Health and Human Services (HHS) issued The Surgeon General’s Call to Action to Support Breastfeeding, which highlighted current research on the health, psychosocial, economic, and environmental effects of breastfeeding and outlined steps family members, health care providers, researchers, employers, and communities can take to encourage and support breastfeeding.16 In 2010, HHS released Healthy People 2020, which provided updated national breastfeeding objectives for 2020, including to increase the proportion of infants who are ever breastfed to 81.9%, to increase the proportion who are breastfed at 6 months to 60.6%, to increase the proportion who are breastfed at 12 months to 34.1%, to increase the proportion who are exclusively breastfed at 3 months to 46.2%, and to increase the proportion who are exclusively breastfed at 6 months to 25.5%.17 Healthy People 2020 also introduced several new breastfeeding objectives, including to increase the proportion of employers that have work site lactation support programs to 38.0%, to reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life to 14.2%, and to increase the proportion of live births that occur in facilities providing recommended care for lactating mothers and their babies to 8.1%.17 The 2010 CDC Breastfeeding Report Card for the United States shows that 75.0% of U.S. women who gave birth in 2007 initiated breastfeeding, but that only 43.0% of those women were breastfeeding at 6 months.18


Data to Action Success Stories on Breastfeeding

PRAMS collects 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. Data results on breastfeeding from the PRAMS questionnaire.

PRAMS Data To Action Success Stories by States:

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Related Links


1. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical profession. 7th ed. Saunders 2010.

2. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506.

3. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries: Evidence Report/Technology Assessment No. 153. Agency for Healthcare Research and Quality; 2007. AHRQ Publication No. 07-E007.

4. Lambert L, Fischer Walker C, Noiman A, Victora C, Black, R. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health 2011;11(Suppl 3):S15.

5. Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity—a systematic review. Int J Obes Relat Metab Disord 2004;28:1247–1256.

6. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr 2006;84:1043–1054.

7. Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM. Breastfeeding and reduced risk of Sudden Infant Death Syndrome: a meta-analysis. Pediatrics 2011;128:103–110.

8. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002;360:187–195.

9. Sibolboro Mezzacappa E, Endicott J. Parity mediates the association between infant feeding method and maternal depressive symptoms in the postpartum. Arch Womens Ment Health 2007;10:259–266.

10. Dennis CL, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 2009;123:e736–e751.

11. Polhamus B, Dalenius K, Mackintosh H, Smith B, Grummer-Strawn L. Pediatric Nutrition Surveillance 2009 Report [PDF - 700KB]. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.

12. Provisional Breastfeeding Rates by Sociodemographic Factors, Among Children Born in 2007. CDC National Immunization Survey.

13. Racial and ethnic differences in breastfeeding initiation and duration, by state—National Immunization Survey, United States, 2004-2008. MMWR 2010;59:327–334.

14. Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics 2005;116:1408–1412.

15. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 2008;122(Suppl 2):S69–S76.

16. Department of Health and Human Services, The Surgeon General’s Call to Action to Support Breastfeeding [PDF - 904KB]. U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.

17. Healthy People 2020 Objectives [PDF- 1.43MB]

18. Breastfeeding Report Card—United States, 2010. [PDF - 2.2MB] CDC National Immunization Survey.

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