Breastfeeding in the USA: Are we doing enough? The new CDC study says no

This September, the Centers for Disease Control and Prevention released the Breastfeeding Report Card, a state-by-state breakdown of breastfeeding practices in the U.S. It’s a progress report on the goals outlined in Healthy People 2010, a broad government initiative to boost the country’s healthy habits.

The news was not great. The U.S. did hit one of its breastfeeding benchmarks – the one for # of mothers breastfeeding at least a little – but unfortunately the rest of the numbers stayed stubbornly where they were four years ago.

In hopes of making progress on these other factors, the Report Card also looked at how breast-friendly we are as a country – in terms of support, practices, and laws – giving states an idea of where they might need to step it up to increase their nursing stats.

We can take stock in the fact that most moms in this country do breastfeed, says the CDC. Three out of four moms start out nursing their newborns – and that’s a good turnout, meeting the government’s goals for breastfeeding initiation.

But more than half of U.S. moms stop nursing before six months, and only 22 percent make it to the end of the year. The American Academy of Pediatrics, along with other health organizations like the WHO, recommends breast milk only for six months and breast milk with complementary foods through a baby’s first birthday.

There is a big variation among states, though. For example, in Oregon, 62 percent of moms are breastfeeding at six months and 40 percent at 12 months, whereas only 20 percent of Louisiana moms breastfeed until six months and 10 percent through the year. In Utah, 90 percent of moms initiate breastfeeding, but in West Virginia, 53.

These are the percentages of moms, however, who give any breast milk to their babies. The numbers of those who would meet the AAP and WHO guidelines by doing so exclusively until six months are lower – only 13 percent nationwide and as low as 7 percent in some states.

Of course there’s debate about the importance of breast milk only. Most moms who supplement feel (rightly so) that some breast milk is better than none, although it might not be as beneficial as we’d like, since a recent study found that immunity benefits for babies came only with exclusive breastfeeding – those who were fed partial breast milk didn’t get the same protective effect against infections. This would suggest that the AAP and WHO guidelines should perhaps be taken even more seriously.

So which states get an A in breastfeeding outcomes? The CDC’s numbers tell us that moms in northwestern states are most apt to nurse – you see it in all the outcome indicators. For example, 50 percent of moms in Montana are exclusively breastfeeding at three months (the national average is 33 percent). Overall, the strongest breastfeeding states are in the northwest, along with Alaska, Hawaii, Minnesota, Massachusetts, Vermont, and New Hampshire, whereas the weakest tend to be in the South, including Kentucky, Louisiana and Mississippi.

The Report Card also gives an idea of how supportive of breastfeeding each state is, evaluating hospital practices, state legislation, and professional breastfeeding support.

For example, the survey found that an average of 25 percent of newborns in the U.S. receive formula in the first two days of life – not ideal for establishing nursing. In Texas and New Jersey it’s 35 percent and in Mississippi 38 percent – whereas in Montana and North Dakota it’s under 10 percent.

Hospital practices have a big influence on breastfeeding outcomes, so in 2007 the CDC sent a survey to all U.S. hospitals asking questions like whether skin-to-skin contact is encouraged, if infants stay with their moms for routine after-birth procedures, and how soon after birth moms are encouraged to try feeding. The result is each state’s Maternity Practices in Infant Nutrition and Care (mPINC) score. The average score for the U.S. was 65 out of 100. Here are some state mPINC highlights:

  • New Hampshire and Rhode Island: 81
  • Massachusetts: 79
  • Washington: 75
  • California: 73
  • Colorado and Connecticut: 71
  • New York: 67
  • Georgia: 59
  • Alabama: 57
  • Oklahoma: 55
  • Arkansas: 52
  • Mississippi: 51

The survey also counted the number of certified lactation consultants in each state to get an idea how much individual support moms get. The highest number was in Vermont, which had 11 consultants for every 1,000 births. Some states, including Mississippi and Nevada, had just around 1 consultant for 1,000 births.

All states except Idaho and Nebraska have legislation to protect breastfeeding in public places, and 16 states, including California and New York, mandate employer lactation support.

What’s the message? The good news is that most moms start to breastfeed, and slowly but surely, states are stepping up support and hospitals are converting to nursing-friendly practices. But the outcomes haven’t caught up – breastfeeding numbers at the 6- and 12-month benchmarks are still very low, with no improvement over the last few years.

Stay tuned for a follow-up column next week. The topic: if so many moms start to nurse, why do so few stick with it?

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