Breastfeeding Report Card—United States, 2007

Background

One goal of the Centers for Disease Control and Prevention (CDC) is to improve the health of mothers and their children. One way to reach this goal is to encourage breastfeeding, which has many benefits for infants and children. People from all walks of life play a part in reaching this goal. When health care professionals, legislators, employers, business owners, and community and family members work together, their efforts can increase the number of women who breastfeed their babies and the number of months that they breastfeed them. The Breastfeeding Report Card — United States, 2007 is an important tool for spotting ways to increase breastfeeding nationwide. It gives states information on how breastfeeding is being promoted within a given state. It also makes it possible to compare states* across the country.

The information on breastfeeding in the Breastfeeding Report Card shows where the states have had success. It also shows where more work is needed. As part of the Breastfeeding Report Card, each individual state has a State Profile that gives specific information about each of the "indicators" from the Report Card for that state. These indicators are measures of a state's ability to protect, promote, and support breastfeeding. (Note that the Profile also tells how to get in touch with the state's breastfeeding coordinator and the state's breastfeeding coalition. These are people responsible for state-level efforts to promote breastfeeding.)

The Breastfeeding Report Card is made up of eight "process" indicators that are elements of breastfeeding-friendly communities. In addition to the process indicators, the Breastfeeding Report Card has five "outcome" indicators that are derived from Healthy People 2010, a description of the nation's health priorities.

An important use of the Report Card is for state-by-state comparisons. For this reason, each indicator included in the Breastfeeding Report Card is something that can be measured accurately and is available for every state. With such information, it is easier to see how states differ from one another. Changes in any given indicator should represent a change in the way that breastfeeding is protected, promoted, or supported within a state. Such changes eventually influence outcomes in the health of children, outcomes that are related to breastfeeding.

States can use their data on their progress on indicators in the Breastfeeding Report Card in many ways:

To help tell the story of breastfeeding
To celebrate state successes
To identify good opportunities for growth and improvement in breastfeeding protection, promotion, and support statewide.

Breastfeeding Report Card Indicators – 2007

Outcome Indicators

The importance of breastfeeding as a national health goal is shown by the five Healthy People 2010 breastfeeding goals included here. Each state's progress on these goals is measured from the breastfeeding items included in the CDC National Immunization Survey. The state rates listed below (percentages of all infants of a given age in the state) are based on those goals:

Increase breastfeeding in the early postpartum period (soon after the baby's birth) to 75%
Increase breastfeeding at age 6 months to 50%
Increase breastfeeding at age 12 months to 25%
Increase exclusive breastfeeding at age 3 months to 40%
Increase exclusive breastfeeding at age 6 months to 17%

For more, see Breastfeeding Report Card, United States: Outcome Indicators.

Process Indicators

The eight process indicators represent five different types of support, and they can be compared across all states:

Hospital support
Professional support
Mother-to-mother support
Legislation
Infrastructure

For more, see Breastfeeding Report Card, United States: Process Indicators.

Hospital Support

Percentage of live births occurring at facilities identified as part of the Baby-Friendly Hospital Initiative

The Baby-Friendly Hospital Initiative (BFHI) is a worldwide effort to improve maternity care in ways outlined in the World Health Organization/UNICEF Ten Steps to Successful Breastfeeding. To become a BFHI facility, it is necessary to show a group of evaluators that the facility meets the requirements in the Ten Steps. All types and sizes of hospitals and birth centers can seek the BFHI name. Some states have several small BFHI health care facilities, others have only one or two large ones, and still others have none at all. Because BFHI facilities vary in their size and the number of births that occur there, measuring their impact on public health requires more than just counting the number of BFHI facilities per state. The best way to measure their impact is to look at the proportion of births in a given state occurring at BFHI facilities.

Professional Support

Number of International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births

International Board Certified Lactation Consultants (IBCLCs) are health care professionals who specialize in helping mothers with breastfeeding. IBCLCs work in many health care settings, such as hospitals, physicians' offices, public health clinics, and their own offices. A strong statewide group of professional breastfeeding experts (IBCLCs) is needed to provide such help as assisting the mother-infant pair, creating and administering lactation programs, educating other health professionals about breastfeeding, and offering their expertise to others who support the mother-infant pair.

Much of an IBCLC's work is done one on one. Therefore, only a rough estimate can be made of their availability to provide professional support within a state. The best measure is the ratio of IBCLCs to the number of live births.

Mother-to-Mother Support

Number of La Leche League Groups per 1,000 live births

La Leche League groups are mother-to-mother support groups for pregnant women considering breastfeeding and mothers who are breastfeeding. La Leche League leaders run these groups and also provide breastfeeding support within their communities. The availability of this kind of peer support is an important element of comprehensive support for mothers with infants. The number of La Leche League groups per 1,000 live births provides a broad estimate of the availability of breastfeeding assistance in any given community.

Legislation

Laws protecting breastfeeding in public
Laws supporting breastfeeding mothers who return to work

Most states now have some form of legislation (laws) protecting the basic human right to breastfeed. Unfortunately, despite protective laws, mothers and babies who breastfeed "in public" still face obstacles and negative reactions. Legislation reflects social acceptance of breastfeeding as a "normal" activity, concern for the health and well-being of children, and the importance of breastfeeding as a public health issue.

Laws supporting breastfeeding mothers who return to work serve a dual purpose: they not only encourage employers to support their employees, they also encourage mothers to continue breastfeeding after returning to work. Such laws support the economic goals of employers and employees as well as the well-being of mothers and children.

Infrastructure

State health department full-time equivalents (FTEs) responsible for breastfeeding
State breastfeeding coalition
Coalition World Wide Web site

State agencies responsible for public health and welfare of women and children include the state health department, WIC program, and Early Intervention program. They help ensure that breastfeeding is included in public programs and services that affect women and infants. FTEs dedicated to the protection, promotion, and support of breastfeeding are needed to develop and implement breastfeeding interventions.

A statewide coalition dedicated to breastfeeding represents a basic level of community support for breastfeeding. State breastfeeding coalitions differ between states in terms of what they do and how they do it. What they have in common is an understanding of the need for community members who can be agents of change locally. The coalition members make the case to their community for the importance of breastfeeding.

State coalitions with a Web site have an effective way to communicate. On their Web site, they can share information with existing coalition members and also recruit new members interested in the issues related to breastfeeding. Coalition Web sites are also an excellent way to reach community members who want quality breastfeeding information and online support.

Map

State Progress on Healthy People 2010 Breastfeeding Objectives

Source: National Immunization Survey, Centers for Disease Control and Prevention, Department of Health and Human Services This data is also available in table form.

Data Sources

Breastfeeding outcome indicators – Ever Breastfed, Breastfeeding at 6 months, Breastfeeding at 12 months, Exclusive breastfeeding at 3 months, Exclusive breastfeeding at 6 months

CDC National Immunization Survey, 2004 births. http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm

Breastfeeding process indicators
- Modes of support per live births by state
  Source: Total live birth information: CDC National Center for Health Statistics (NCHS) 2005 births http://www.cdc.gov/nchs/data/hestat/prelimbirths05/prelimbirths05.htm
  - Percent of live births at facilities designated as Baby Friendly (BFHI)
    Source: Baby Friendly USA. Baby-Friendly Hospitals and Birth Centers as of June 2007. http://www.babyfriendlyusa.org/eng/03.html
    - Hospital annual birth census information: American Hospital Association Annual Survey Database for Fiscal Year 2005
  - Number of IBCLCs per 1,000 live births
    Source: International Board of Lactation Consultant Examiners. IBCLC Facts and Figures as of June 2007. http://americas.iblce.org/factsandfigures.php#USstate
  - Number of La Leche League Groups per 1,000 live births
    Source: La Leche League in the USA list of groups by state as of June 2007 http://www.lllusa.org/groups.php
- Number of state health dept FTEs dedicated to breastfeeding
  Source: Personal communications with state WIC Breastfeeding Coordinators and other state employees in each state
- State legislation about breastfeeding
  Source: National Conference of State Legislatures: the Forum for America’s Ideas. 50 State Summary of Breastfeeding Laws as of June 2007. http://www.ncsl.org/programs/health/breast50.htm
  - Breastfeeding in public places
  - Lactation and employment
- State breastfeeding coalitions
  Source: United States Breastfeeding Committee. State and Territory Breastfeeding Coalitions Directory
  http://www.usbreastfeeding.org/State-Coalitions/coalitions-directory.html
  - Presence of an active statewide breastfeeding coalition
  - Presence of coalition website