Breastfeeding Initiation

Breastfeeding Initiation in United States

United States

Breastfeeding provides infants with nutrition at the beginning of life. It also supports healthy brain and immune system development. Other breastfeeding benefits include:

• Reduced risk of infant mortality.
• Reduced risk of chronic disease for the infant, including childhood asthma, gastroenteritis, diabetes, childhood leukemia and obesity.
• Reduced risk of sudden infant death syndrome.

Breastfeeding benefits for women include decreased risk of breast and ovarian cancers, Type 2 diabetes and high blood pressure.

The World Health Organization (WHO) recommends starting breastfeeding within an hour of giving birth and exclusive breastfeeding for the first six months of a baby’s life. The American Academy of Pediatrics also recommends exclusive breastfeeding for six months. Despite this recommendation, roughly 15% of women never breastfeed their infants.

Racial discrimination negatively affects breastfeeding in Black women, who receive fewer lactation-support referrals and less help for breastfeeding problems than other racial groups. As a result, Black infants have lower rates of breastfeeding initiation than white infants, a disparity existing in most states.

Several social and cultural factors may lead women to never start breastfeeding or to stop breastfeeding early. Factors associated with lower breastfeeding rates include: 

• Not offering paid maternity leave to women with low income.
• Not giving sufficient breaks at work to pump breast milk or breastfeed. 
• Shaming women for breastfeeding in public.
• Past difficulties with breastfeeding other children.
• Struggling with poor positioning and latching.
• Inadequate social support, such as having a family that does not approve of breastfeeding.

Baby-Friendly Hospitals can help encourage women to start and continue breastfeeding, and a higher proportion of Baby-Friendly Hospitals in a state is associated with an increase in breastfeeding. The Baby-Friendly Hospital initiative involves implementing the Ten Steps to Successful Breastfeeding. Increased use of the Ten Steps is associated with a decrease in racial disparities in breastfeeding initiation

A Healthy People 2030 objective is to increase the percent of infants breastfed exclusively for six months.

Ahluwalia, Indu B., Brian Morrow, and Jason Hsia. 2005. “Why Do Women Stop Breastfeeding? Findings From the Pregnancy Risk Assessment and Monitoring System.” Pediatrics 116 (6): 1408–12. https://doi.org/10.1542/peds.2005-0013.

Beauregard, Jennifer L., Heather C. Hamner, Jian Chen, Wendy Avila-Rodriguez, Laurie D. Elam-Evans, and Cria G. Perrine. 2019. “Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015.” MMWR. Morbidity and Mortality Weekly Report 68 (34): 745–48. https://doi.org/10.15585/mmwr.mm6834a3.

Center for Disease Control and Prevention. n.d. “National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity.Data, Trend and Maps [Online].” Accessed September 25, 2023. https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html.

Chiang, Katelyn V., Ruowei Li, Erica H. Anstey, and Cria G. Perrine. 2021. “Racial and Ethnic Disparities in Breastfeeding Initiation - United States, 2019.” MMWR. Morbidity and Mortality Weekly Report 70 (21): 769–74. https://doi.org/10.15585/mmwr.mm7021a1.

Dieterich, Christine M., Julia P. Felice, Elizabeth O’Sullivan, and Kathleen M. Rasmussen. 2013. “Breastfeeding and Health Outcomes for the Mother-Infant Dyad.” Pediatric Clinics of North America 60 (1): 31–48. https://doi.org/10.1016/j.pcl.2012.09.010.

Eidelman, Arthur I., Richard J. Schanler, Margreete Johnston, Susan Landers, Larry Noble, Kinga Szucs, and Laura Viehmann. 2012. “Breastfeeding and the Use of Human Milk.” Pediatrics 129 (3): e827–41. https://doi.org/10.1542/peds.2011-3552.

Jolles, Diana R., and Lauren Hoehn-Velasco. 2021. “Breastfeeding as a Quality Measure: Demonstrating Levers of the National Quality Strategy.” The Journal of Perinatal & Neonatal Nursing 35 (3): 221–27. https://doi.org/10.1097/JPN.0000000000000577.

Li, Ruowei, Julie Ware, Aimin Chen, Jennifer M. Nelson, Jennifer M. Kmet, Sharyn E. Parks, Ardythe L. Morrow, Jian Chen, and Cria G. Perrine. 2022. “Breastfeeding and Post-Perinatal Infant Deaths in the United States, A National Prospective Cohort Analysis.” The Lancet Regional Health - Americas 5 (January). https://doi.org/10.1016/j.lana.2021.100094.

Merewood, Anne, Kimarie Bugg, Laura Burnham, Kirsten Krane, Nathan Nickel, Sarah Broom, Roger Edwards, and Lori Feldman-Winter. 2019. “Addressing Racial Inequities in Breastfeeding in the Southern United States.” Pediatrics 143 (2): e20181897. https://doi.org/10.1542/peds.2018-1897.

Rito, Ana Isabel, Marta Buoncristiano, Angela Spinelli, Benoit Salanave, Marie Kunešová, Tatjana Hejgaard, Marta García Solano, et al. 2019. “Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017.” Obesity Facts 12 (2): 226–43. https://doi.org/10.1159/000500425.

Robinson, Karen, Alissa Fial, and Lisa Hanson. 2019. “Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature.” Journal of Midwifery & Women’s Health 64 (6): 734–42. https://doi.org/10.1111/jmwh.13058.

Rollins, Nigel C., Nita Bhandari, Nemat Hajeebhoy, Susan Horton, Chessa K. Lutter, Jose C. Martines, Ellen G. Piwoz, Linda M. Richter, and Cesar G. Victora. 2016. “Why Invest, and What It Will Take to Improve Breastfeeding Practices?” The Lancet, Breastfeeding 2, 387 (10017): 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.

Thompson, John M.D., Kawai Tanabe, Rachel Y. Moon, Edwin A. Mitchell, Cliona McGarvey, David Tappin, Peter S. Blair, and Fern R. Hauck. 2017. “Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-Analysis.” Pediatrics 140 (5): e20171324. https://doi.org/10.1542/peds.2017-1324.

Victora, Cesar G., Rajiv Bahl, Aluísio J. D. Barros, Giovanny V. A. França, Susan Horton, Julia Krasevec, Simon Murch, Mari Jeeva Sankar, Neff Walker, and Nigel C. Rollins. 2016. “Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Effect.” The Lancet, Breastfeeding 1, 387 (10017): 475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.

Wilson, Keadrea, Tebeb Gebretsadik, Margaret A. Adgent, Christine Loftus, Catherine Karr, Paul E. Moore, Sheela Sathyanarayana, et al. 2022. “The Association between Duration of Breastfeeding and Childhood Asthma Outcomes.” Annals of Allergy, Asthma & Immunology 129 (2): 205–11. https://doi.org/10.1016/j.anai.2022.04.034.