by Melissa Clark Vickers
September 23, 2010

The Centers for Disease Control and Prevention (CDC) uses the term “Report Card,” but its annual assessment of breastfeeding rates is far more important than the scholastic definition of the term. More than a child’s reading or mathematics comprehension, the CDC tracks the health of mothers and children across the country—both state-by-state and nationwide—recognizing that “protecting, promoting, and supporting breastfeeding, with its many known benefits for infants, children, and mothers, is a key strategy toward…improving the health of mothers and their children.”

The Breastfeeding Report Card 2010 outlines how America fared in reaching the Healthy People 2010 breastfeeding targets:

Increase the proportion of mothers who breastfeed their babies…

• in early postpartum to 75 percent;
• at 6 months to 50 percent;
• at 12 months to 25 percent;
• exclusively through 3 months to 40 percent; and
• exclusively through 6 months to 17 percent.

The good news is that the U.S. has achieved the first goal—75 percent of mothers in the U.S. initiate breastfeeding. State averages range from a low of 52.5 percent (Mississippi) to a high of 89.8 percent (Utah). Unfortunately, we have fallen short of the other four targets:

• Breastfeeding at 6 months: 43 percent nationally, ranging from 22.2 percent (Louisiana) to 62.2 percent (Oregon);
• Breastfeeding at 12 months: 22 percent nationally, ranging from 8.0 percent (Mississippi) to 39.7 percent (Vermont);
• Exclusively through 3 months: 33 percent nationally, ranging from 15.2 percent (Mississippi) to 50.5 percent (Oregon);
• Exclusively through 6 months: 13.3 percent nationally, ranging from 6.5 percent (Mississippi) to 23.7 percent (Oregon).

In addition to target goals on initiation and exclusivity of breastfeeding, the CDC Report Card provides national and state scores for nine other initiatives:

• Average mPINC score. The CDC National Survey of Maternity Practices in Infant Nutrition and Care, first administered in 2007 and recently repeated in 2009, measures hospital maternity practices against evidence-based care deemed supportive of breastfeeding. The survey asks about such things as the percentage of healthy breastfed babies receiving breast milk as the first feeding after birth and the use of pacifiers. The results of the 2007 survey have recently been released; specific hospital scores are sent directly to each participating hospital or birthing center. National average: 65 percent, ranging from 51 percent (Mississippi) to 81 percent (Rhode Island, New Hampshire)

• Percentage of live births occurring at facilities designated as Baby Friendly. The Baby Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and UNICEF to encourage and recognize hospitals and birthing centers that follow the WHO/UNICEF Ten Steps to Successful Breastfeeding. National average: 3.78 percent

• Percentage of breastfed infants receiving formula before two days of age. While there are times when supplementation is medically necessary, the higher the percentage, the greater the likelihood that babies who don’t need formula are getting it anyway. National average: 25.4 percent

• Number of IBCLCs per 1,000 births. The International Board Certified Lactation Consultant is the professional standard for lactation care. IBCLCs must undergo extensive training and education before sitting for a comprehensive exam, repeating the certification process every five years. They typically work one-on-one with mothers, so this measure is an attempt to determine the availability of specialized support for mothers intending to breastfeed. National average: 2.4 IBCLCs per 1,000 births.

• State legislation about breastfeeding in public places and mandating employer lactation support. These two measures indicate a state’s commitment to breastfeeding support through legal statutes. Forty-nine states have passed breastfeeding legislation.

• Number of state health department employees dedicated to breastfeeding. Currently there are 97 full time employees who oversee breastfeeding issues at the state level—that’s less than two per state!

• Breastfeeding coalition with public website. Most states have a breastfeeding coalition of health care professionals and volunteers dedicated to improving breastfeeding in their state. Forty-one states, plus the District of Columbia, have a breastfeeding coalition with a companion public website.

• State child care center regulation supports lactation. Nearly two-thirds of infants in the U.S. are cared for by someone other than their parents, and half of those children attend child care facilities. Supportive child care guidelines for breastfeeding infants are an important piece of national breastfeeding support. Child care facilities are encouraged to meet the national standards set by Caring for Our Children. Only 12 states have these regulations in place.

Putting it all in perspective
As evidenced from the CDC Breastfeeding Report Card 2010, there are significant regional differences in the progress toward the national goals. In general, breastfeeding rates are lowest in the south, and highest in the northwest. And just as a “C” in arithmetic on a child’s report card only tells parents the overall picture, but not exactly where problems lie or what might be done to improve the grade, these overall scores don’t adequately describe the underlying issues involved in the achievement of these breastfeeding targets. As data show, less than 4 percent of babies are born in one of the (only!) 99 hospitals and birthing facilities in the U.S. designated as Baby Friendly—a clear indication that too many babies are being born in facilities without adequate breastfeeding support.

The Healthy People 2010 targets were set at levels that were reasonable to achieve over a 10-year period. Most professional health care organizations would like to see much higher numbers of infants and children breastfeeding for a year or more. The American Academy of Pediatrics, for example, recommends exclusive breastfeeding for about six months, and continued breastfeeding with appropriate complementary foods for at least one year. And, given the many benefits of breastfeeding and breast milk for both mother and baby, WHO recommends children breastfeed for at least two years.

As previously reported by baby gooroo, there is a high cost associated with not breastfeeding. If 90 percent of new mothers exclusively breastfed their babies for the first six months of life, the savings in lives and dollars would be 911 babies and $13 billion each year; if 80 percent of mothers exclusively breastfed for the first six months, 741 deaths would be prevented and $10.5 billion saved; and if the Healthy People 2010 goals were met (which calls for 50 percent of mothers to continue breastfeeding for six months), 142 deaths would be prevented annually and $2.2 billion would be saved.

We’re not even close. Not yet.

The Healthy People 2020 objectives are being finalized, and will include these same indicators (though it isn’t clear whether the goals will change). One objective has been added in recognition of the importance of workplace support for breastfeeding employees. Passed earlier this year, the Patient Protection and Affordable Care Act offers workplace protection for breastfeeding mothers; as part of the Healthy People 2020 objectives, progress will be charted, state by state.

So here we are. We’ll celebrate the progress we have made (after all, 75 percent of mothers are initiating breastfeeding, up from 64 percent in 1998), but there’s still much work to be done.