by Melissa Clark Vickers
August 11, 2011

The first few days after birth are a key time for breastfeeding mothers and babies. According to a recent report from the Centers for Disease Control and Prevention (CDC), Vital Signs: Hospital Practices to Support Breastfeeding—United States, 2007 and 2009, 11,000 babies are born in U.S. hospitals every day. The majority of mothers (81 percent) intend to breastfeed and 75 percent initiate breastfeeding. But within one week, 50 percent of babies are given formula, and by nine months, only 31 percent of babies are still breastfeeding. These numbers are an improvement over recent years, but there is clearly a long way to go to achieve the Healthy People 2020 breastfeeding objectives:

• Babies ever breastfed—81.9 percent
• Babies breastfed 6 months—60.6 percent
• Babies breastfed one year—34.1 percent
• Babies exclusively breastfed 3 months—46.2 percent
• Babies exclusively breastfed 6 months—25.5 percent
• Employers with worksite lactation support programs—38 percent
• Babies given formula by day 2—14.2 percent
• Births in facilities with best breastfeeding practices—8.1 percent

Using the Ten Steps to Successful Breastfeeding as measure of performance, progress towards the Healthy People 2020 goals are measured by looking at scores on the mPINC (Maternal Practices in Infant Nutrition and Care) surveys from 2007 and 2009. Scores have improved on nine of the 10 indicators since 2007, with the highest scores for informing pregnant women about the benefits and management of breastfeeding (92.8 percent), showing mothers how to breastfeed and maintain lactation even if separated from their infants (89.1 percent), and encouraging breastfeeding on request (81.8 percent). About half of the hospital report competency assessments for staff and helping mothers initiate breastfeeding within an hour of birth (49.7 percent and 50.9 percent respectively). Lower scores deal more with specifics—no supplementation unless medically indicated (21.5 percent), no artificial teats or pacifiers (30.1 percent), and rooming in (33.2 percent). The lowest score is perhaps the most telling—only 14.4 percent of hospitals responding to the mPINC survey in 2009 report having a written breastfeeding policy that includes those 10 model policy elements.

Most hospitals (54.3 percent) implement 3–5 of the 10 practices, and only 3.5 percent implement at least nine of the 10. In fact, less than 1 percent of hospitals can boast that they implement all 10 practices. The Baby-Friendly Hospital Initiative (BFHI) recognizes hospitals that utilize these best practices, combined with compliance with the International Code of Marketing of Breast-Milk Substitutes by paying fair market value for infant formulas and not providing discharge bags with formula samples or coupons.

Reaction to this report has been interesting. Judicial Watch, Inc., a conservative group promoting “integrity, transparency, and accountability in government, politics and the law,” declared in a recent blog post, “CDC Becomes Breastfeeding Police,” that the CDC’s efforts are “federal, state and local directives to force hospitals across the country to promote breastfeeding.” What this group fails to understand is that the CDC is not trying to strong-arm women into breastfeeding, but, instead, to ensure that hospitals are giving those mothers choosing to breastfeed the support they need. No one faults hospitals for providing healthy meal options or encouragement to exercise or stop smoking, and the lifelong breastfeeding benefits to both infant and mother should be treated no differently.

The CDC, through reports like Vital Signs and the recently released Breastfeeding Report Card—United States, 2011, is working to provide objective means of identifying how well our U.S. hospitals are conforming to the internationally recognized strategies for supporting breastfeeding such as skin-to-skin contact between mother and baby and rooming-in. These recommendations are evidence-based, and have been shown to improve both initiation and duration rates for breastfeeding, including exclusive breastfeeding. We’re making progress, but there is much work to be done.