Breastfeeding Initiation

Breastfeeding Initiation in United States

United States

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

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

Initiating breastfeeding within an hour of giving birth is recommended by the World Health Organization (WHO) and exclusive breastfeeding is recommended for the first six months of a baby’s life by the WHO and the American Academy of Pediatrics. Despite this recommendation, roughly 15% of mothers never breastfeed their infants. Breastfeeding benefits for mothers include decreased risk of breast and ovarian cancers, Type 2 diabetes and high blood pressure.

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

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

Racial discrimination negatively affects breastfeeding in Black mothers, who receive fewer lactation support referrals and less assistance for breastfeeding problems than other racial groups. As a result, Black infants have lower rates of breastfeeding initiation than white infants, a disparity that can be seen in most states.

Baby-Friendly Hospitals can help encourage mothers to start and continue breastfeeding, and a higher proportion of Baby-Friendly Hospitals in a state is associated with an increase in mothers 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.

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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.

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.

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.

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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.

León-Cava, Natalia, Chessa Lutter, Jay Ross, and Luann Martin. 2002. “Quantifying the Benefits of Breastfeeding: A Summary of the Evidence.” PAHO Document Reference Number HPN/66/2. Academy for Education Development: Food and Nutrition Program, Pan American Health Organization: LINKAGES Project. https://www.paho.org/hq/dmdocuments/2011/benefitsLM.pdf.

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): 100094. 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.

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.