CDC Efforts and Leadership on Breastfeeding

Policy Development

Over the past year, CDC has partnered with the Office on Women's Health of the U.S. Department of Health and Human Services to convene a steering committee drafting a policy document on breastfeeding for the Surgeon General. The report used significant public input garnered through online comments, an expert panel meeting, and two stakeholder hearings. Additionally, we reviewed recommendations from various strategic plans for breastfeeding and investigated the feasibility of numerous policy and strategy options to promote, protect, and support breastfeeding. The policy document is targeted for release this fall.

The CDC worked with the White House to include breastfeeding goals in the report of the Task Force on Childhood Obesity. Specific goals included improvements in maternity care practices, increased information for pregnant women and new mothers on breastfeeding, connections to breastfeeding support programs, development of peer support programs, and improved support for breastfeeding in childcare settings.

Additionally, CDC has served as the focal point for breastfeeding objectives within the Healthy People 2020 development process. Planned objectives include those to increase breastfeeding initiation, duration, and exclusivity, increase births in “Baby-Friendly” hospitals, increase workplace accommodation for breastfeeding, and decrease early supplementation with formula.

Program Support

The CDC supports long-term cooperative agreements with state health departments to improve nutrition and physical activity across the country. In 2010, CDC dramatically increased the amount of funding to states and communities through the Communities Putting Prevention to Work initiative, which provides $470 million of funding to all 50 states and 44 selected communities to effect policy and environmental changes on nutrition, physical activity, and tobacco. Approximately one-third of the states and communities selected breastfeeding initiatives as a key component of their work plans, primarily focusing on hospital practice improvements and workplace accommodations for breastfeeding. CDC provides technical assistance on breastfeeding interventions in the funded states and communities.

The CDC also supports state-level breastfeeding coalitions directly and indirectly through the United States Breastfeeding Committee. CDC provides funding to the committee to assist in the formation and networking of state coalitions as well as for general operations.

The CDC sponsors bimonthly teleconferences with the coalitions to provide updates on various breastfeeding programs and to foster networking across states. CDC cosponsored the National State Breastfeeding Coalitions Conference in January 2010.

Monitoring

The CDC monitors rates of breastfeeding by using a variety of data systems that meet different data needs. The National Immunization Survey is used for tracking the Healthy People 2010 objectives at the national and state levels. The most recent statistics, reflecting birth cohorts through 2006, showed a continued rise in rates of exclusive breastfeeding at 3 and 6 months as well as 12 months of any breastfeeding, but the data also showed no improvement in initiation rates. ¹ Data from the Pediatric Nutrition Surveillance System, which are timelier but only represent low-income families, show continued improvements in breastfeeding rates through 2008. ²

Through the State Breastfeeding Report Card, CDC also tracks state-to-state differences in how breastfeeding is supported. ¹ For example, the 2009 report documents that although many states have no hospitals designated as “Baby-Friendly,” over 20% of the births in Alaska and Nebraska occur in “Baby-Friendly” hospitals. Access to lactation consultants also varies widely, with less than one lactation consultant per 1,000 live births in Alabama and Nevada.

Through the Maternity Practices in Infant Nutrition and Care survey, CDC tracks the progress of hospitals and birthing centers in their support of breastfeeding during the maternity stay. The survey was first done in 2007, and the 2009 iteration was completed in April 2010 with an 82% response rate. Findings are shared with participating hospitals/birthing centers as well as with state officials.

Research

A major part of CDC's breastfeeding research portfolio has revolved around a collaborative project with the Food and Drug Administration to conduct and analyze data from the Second Infant Feeding Practices Study. This longitudinal study followed women and their babies almost monthly from the third trimester of pregnancy until the babies turned 12 months old. Current research projects include analyses of bottle-emptying behaviors, infant weight gain, and postpartum weight retention. A follow-up study is being planned to survey the mothers when the children are 6–7 years old.

Research is also being done with other national surveys. A recent project examined racial/ethnic disparities in breastfeeding rates. This project documented that the black/white gap in breastfeeding initiation and duration is largest in southeastern states and that, although Hispanics and non-Hispanic whites have similar rates of breastfeeding at a national level, the rates differ substantially in some states. ³

Another project on public attitudes about breastfeeding shows that in 2009, 46% of adults believed there should be a federal law providing maternity leave for workers. A majority of survey respondents in 2009 (56%) agreed that breastfeeding mothers should have flexible work schedules or additional break time, up from 51% in 2006. ¹

Conclusion

The CDC is advancing national and state breastfeeding programs and is fully committed to making policy and environmental improvements to better support mothers as they breastfeed their babies throughout the United States.