If 90% of US families could comply with current medical guidelines to breastfeed exclusively for 6 months, the US could avoid about $18.5 billion per year in increased health care costs (2014 dollars). 1
The multiple health benefits of exclusive breastfeeding for both the infant and mother are well established. Exclusive breastfeeding includes only breast milk, without any additional food or drink, not even water.
Breast milk is a complete food source and provides all the energy and nutrients that an infant needs for the first months of life. Breast milk provides infant’s protection from various infections, reduces the risk of Sudden Infant Death Syndrome, and decreases the likelihood of developing obesity and chronic conditions such as diabetes, allergies, and asthma later in life.
The physical connection of breastfeeding provides psychological benefits to both baby and mother, and also provides multiple health advantages to mothers, reducing the risk of breast and ovarian cancer, diabetes and cardiovascular disease.2
All of the major professional medical organizations for providers of pregnant women and infants recommend that infants be exclusively breastfed for the first six months, followed by continued breastfeeding with complementary foods until at least 12 months.3
Family members, health care professionals and staff from medical facilities, workplaces, childcare and schools are encouraged to promote and support breastfeeding, the normal infant feeding method. There are many potential actions that can be taken to improve breastfeeding rates. The Surgeon General’s Call to Action to Support Breastfeeding4 provides 20 recommended actions to promote optimum infant feeding through public health.
While breastfeeding rates generally have been on the rise, and 92% of California infants start out with any breastfeeding, only 43% are exclusively breastfeeding at one month of age and 27% at three months. Further, disparities persist in breastfeeding intention, in-hospital initiation, and continuation.3
Although a majority of women initiate breastfeeding in California, few are able to meet the goal of exclusive breastfeeding through six months postpartum and significant disparities persist.
To increase breastfeeding rates, it is imperative that mothers receive information and support from the start in order to initiate and maintain breastfeeding through infancy. To succeed, mothers must overcome physical and emotional challenges which impose structural barriers that leave certain groups, particularly women of color, with less support to truly make this choice. Overlapping structural inequities in housing, healthcare, and employment are often prevalent in certain communities, leading to disparities in breastfeeding outcomes.
New mothers are more likely to breastfeed exclusively when hospitals develop supportive breastfeeding policies such as facilitating breastfeeding within one hour after birth, keeping mothers and infants together, and limiting non-medically indicated formula supplementation. Mothers sometimes discontinue breastfeeding due to lack of insurance coverage for, or limited availability of, lactation consultants or breast pumps; or due to other barriers such as unsupportive workplaces. Continued breastfeeding is more likely to occur when women have support from family, health care providers and insurers, employers, child care providers, and communities.5
Data Snapshot: Trends and Disparities
White women are twice as likely to exclusively breastfeed at three months postpartum compared to other race/ethnic groups.
Women with lower household income are less likely to exclusively breastfeed at three months postpartum than women with higher household income.
Exclusive breastfeeding varies significantly by county. Several Southern and Central Valley counties had worse exclusive breastfeeding rates than the rest of California.
Exclusive Breastfeeding 3 Months after Delivery, by Demographic Category
Exclusive Breastfeeding 3 Months after Delivery, by County
Data Source: California Department of Public Health, Maternal, Child and Adolescent Health Division, Maternal and Infant Health Assessment (MIHA) Survey
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 a woman ever breastfed her infant, whether she is still breastfeeding at the time of the survey, and if not, when she 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 women whose infant did not reside with them or whose infant was not yet three months old at the time of the survey.
Data Calculation Methodology: Five questions on infant feeding are used to compute the duration of exclusive breastfeeding. This indicator shows the prevalence of women 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 in regards to 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.
Small Cell Size Suppression Policy: Estimates not shown when the relative standard error (RSE) is greater than 50% or fewer than 5 women reported.
Data Collection Methodology: The Maternal and Infant Health Assessment (MIHA) is a statewide-representative survey of women 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 women. MIHA data are weighted to represent all women with a live birth in California, excluding women 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 nonrespondents. 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.
Data Limitations: MIHA surveys women with a recent live birth and is only administered in English and Spanish. MIHA excludes women 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.
Program URL Link: www.cdph.ca.gov/miha
Tags (Keywords): Infant Health, Infant feeding, Breastfeeding, Exclusive Breastfeeding, Maternal and Infant Health Assessment, MIHA
Reporting Cycle: Annual survey and reporting.
1. Bartick, M. C., Schwarz, E. B., Green, B. D., Jegier, B. J., Reinhold, A. G., Colaizy, T. T., . . . Stuebe, A. M. (2016). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal & Child Nutrition, 13(1). doi:10.1111/mcn.12366. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27647492
2. Eidelman, A. I. (2012). Breastfeeding and the Use of Human Milk: An Analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement. Breastfeeding Medicine, 7(5), 323-324. doi:10.1089/bfm.2012.0067. Available from: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2011-3552
3. California Department of Public Health, Maternal and Infant Health Assessment (MIHA) Survey, 2013-2014. Available from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/Pages/default.aspx
4. The Surgeon Generals call to action to support breastfeeding. (2011). Washington, DC: U.S. Department of Health and Human Services, U.S. Public Health Service, Office of the Surgeon General. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52682/
5. Removing Barriers to Breastfeeding: A Structural Race Analysis of First Food. (2015). New York, NY: Center for Social Inclusion. Available from: http://www.centerforsocialinclusion.org/publication/removing-barriers-to-breastfeeding-a-structural-race-analysis-of-first-food/