Healthy Beginnings / Increasing Breastfeeding Duration

Indicator: Exclusive breastfeeding at 3 months postpartum

Indicator Description: The Maternal and Infant Health Assessment (MIHA) collects self-reported information on infant feeding practices, including breastfeeding initiation, duration and exclusivity. MIHA captures whether birthing individuals ever breastfed their infants, whether they are still breastfeeding at the time of the survey, and if not, when they stopped breastfeeding. Respondents are further asked if and when they began supplementing breast milk with formula, other liquids or solid foods. Exclusive breastfeeding at 3 months postpartum is defined as feeding an infant only breast milk (no supplementation with formula, other liquids or food) for at least three months after delivery; excluding from the denominator individuals whose infants did not reside with them or whose infants were not yet three months old at the time of the survey.

Data Limitations: MIHA surveys birthing individuals with a recent live birth and is only administered in English and Spanish. The survey excludes individuals who were non-residents, were younger than 15 years old at delivery, had a multiple birth greater than triplets, or had a missing address on the birth certificate.

Indicator Source: California Department of Public Health, Maternal, Child and Adolescent Health Division, Maternal and Infant Health Assessment (MIHA) Survey

Indicator Calculation Methodology: Five questions on infant feeding are used to compute the duration of exclusive breastfeeding. This indicator shows the prevalence of birthing individuals who reported that they fed their infant only breast milk (no supplementation with formula, other liquids or food) for at least three months after delivery. For more information see MIHA Technical Notes at: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/MIHA-TechnicalDocument.pdf.

MIHA questions on infant feeding are in alignment with the National Immunization Survey (NIS) which serves as the official data source for Healthy People 2020 objective for infant feeding and care. However, MIHA and NIS differ regarding timing and mode of data collection and are therefore not comparable. For more information on the National Immunization Survey (NIS) Methods visit: https://www.cdc.gov/breastfeeding/data/nis_data/survey_methods.htm.

Estimates are calculated using three-year aggregated data. Some estimates are suppressed due to various reasons (i.e., the RSE is greater than 50% or could not be calculated, sample numerator is less than five, or the weighted population denominator is less than 100).

Data Collection Methodology: The Maternal and Infant Health Assessment (MIHA) is a statewide-representative survey of birthing individuals with a recent live birth in California in a given year. MIHA has been conducted annually since 1999 and is a stratified random sample of English-or Spanish-speaking individuals. MIHA data are weighted to represent all birthing individuals with a live birth in California, excluding those who were non-residents, were younger than 15 years old at delivery, had a multiple birth greater than triplets, or had a missing address on the birth certificate.

MIHA data are collected by mail with telephone follow-up to non-respondents. The questionnaire collects information about maternal and infant experiences before, during and shortly after pregnancy. The MIHA questionnaire and methods are similar to those used by the Centers for Disease Control and Prevention in conducting the multi-state Pregnancy Risk Assessment Monitoring System (PRAMS).

Starting in 2013, county-level estimates are available for the 35 counties with the greatest number of births. Due to their smaller birth populations and sample sizes, county-level estimates are not provided for the remaining 23 counties. For more information visit the MIHA website at: www.cdph.ca.gov/MIHA or see MIHA Technical Notes at: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/MIHA-TechnicalDocument.pdf.

Program URL Link: MIHA: www.cdph.ca.gov/miha; California Department of Public Health: Maternal, Child & Adolescent Health Division: https://www.cdph.ca.gov/Programs/CFH/DMCAH/surveillance/Pages/Breastfeeding-Intention-and-Duration.aspx

Reporting Cycle:  Annual (January)

1. Younger Meek, J., & Noble, L. (2022). Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 150 (1): e2022057988. Retrieved on December 10, 2024. https://doi.org/10.1542/peds.2022-057988

2. World Health Organization (2023). Exclusive breastfeeding for optimal growth, development and health of infants. Retrieved on December 10, 2024. https://www.who.int/tools/elena/interventions/exclusive-breastfeeding