Breastfeeding Initiation in United States

United States

Breastfeeding benefits mothers and infants in many ways. Initiating breastfeeding within an hour of giving birth can protect infants and reduce newborn mortality. 

Breastfeeding provides infants with vital nutrients and supports healthy immune system development. Additional benefits to infants include:

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

Breastfeeding benefits for mothers include decreased risk of breast and ovarian cancers, Type 2 diabetes and high blood pressure. Breastfeeding also supports the development of the maternal-infant bond.

Both the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of a baby’s life. Despite these recommendations, nearly 14% of women never breastfed their infants. 

According to a systematic review, obstacles to breastfeeding include:

• Health care factors: Inadequate counseling or support from medical staff.
• Sociocultural factors: Negative judgment around public breastfeeding, misinformation or a lack of encouragement from partners and family, and misconceptions that formula is a modern or superior choice.
• Personal factors: Psychological strain from trying to balance work duties, social expectations and feeding challenges such as latching difficulties, sucking problems and delayed milk production.

A 2025 National Academies report indicated that suboptimal breastfeeding rates result in significant preventable economic losses for the U.S., with annual estimates ranging from $17 billion to more than $100 billion.

Racial discrimination negatively affects breastfeeding among 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 Asian infants, and the lowest rate in 26 states.

Hospitals participating in the Baby-Friendly Hospital Initiative, which involves implementing the Ten Steps to Successful Breastfeeding, help encourage new mothers to start and continue breastfeeding. Higher proportions of Baby-Friendly Hospitals at the state level are associated with increased breastfeeding rates. Moreover, increased use of the Ten Steps is associated with reduced racial health disparities in breastfeeding initiation. Improving the delivery of culturally relevant breastfeeding services tailored to meet the needs of communities with the lowest rates of breastfeeding initiation. 

Prenatal breastfeeding education interventions work to increase women’s knowledge of breastfeeding and promote positive breastfeeding practices. New mothers who know more about breastfeeding are more likely to initiate breastfeeding and continue it longer. A 2024 study showed that breastfeeding peer counseling positively affected breastfeeding duration at 3 and 6 months postpartum. In particular, doula care has increased rates of breastfeeding initiation and duration.

Healthy People 2030 has an objective to increase the percentage of infants breastfed exclusively for six months.

Chiang, Katelyn V., Ruowei Li, Erica H. Anstey, and Cria G. Perrine. “Racial and Ethnic Disparities in Breastfeeding Initiation - United States, 2019.” MMWR. Morbidity and Mortality Weekly Report 70, no. 21 (May 28, 2021): 769–74. https://doi.org/10.15585/mmwr.mm7021a1.

Interrante, Julia D., Alyssa H. Fritz, Marcia B. McCoy, and Katy Backes Kozhimannil. “Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota.” Women’s Health Issues 34, no. 3 (May 2024): 232–40. https://doi.org/10.1016/j.whi.2023.12.001.

Jolles, Diana R., and Lauren Hoehn-Velasco. “Breastfeeding as a Quality Measure: Demonstrating Levers of the National Quality Strategy.” The Journal of Perinatal & Neonatal Nursing 35, no. 3 (September 2021): 221–27. https://doi.org/10.1097/JPN.0000000000000577.

Kehinde, Jennifer, Claire O’Donnell, and Annmarie Grealish. “The Effectiveness of Prenatal Breastfeeding Education on Breastfeeding Uptake Postpartum: A Systematic Review.” Midwifery 118 (March 2023): 103579. https://doi.org/10.1016/j.midw.2022.103579.

Kim, Tae Hyeon, Hyeri Lee, Selin Woo, Hayeon Lee, Jaeyu Park, Guillaume Fond, Laurent Boyer, Jong Woo Hahn, Jiseung Kang, and Dong Keon Yon. “Prenatal and Postnatal Factors Associated With Sudden Infant Death Syndrome: An Umbrella Review of Meta-Analyses.” World Journal of Pediatrics 20, no. 5 (May 2024): 451–60. https://doi.org/10.1007/s12519-024-00806-1.

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

Masi, Andrea C., and Christopher J. Stewart. “Role of Breastfeeding in Disease Prevention.” Microbial Biotechnology 17, no. 7 (July 2024): e14520. https://doi.org/10.1111/1751-7915.14520.

Meek, Joan Younger, and Lawrence Noble. “Policy Statement: Breastfeeding and the Use of Human Milk.” Pediatrics, Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children, 150, no. 1 (July 1, 2022): e2022057988. https://doi.org/10.1542/peds.2022-057988.

Merewood, Anne, Kimarie Bugg, Laura Burnham, Kirsten Krane, Nathan Nickel, Sarah Broom, Roger Edwards, and Lori Feldman-Winter. “Addressing Racial Inequities in Breastfeeding in the Southern United States.” Pediatrics 143, no. 2 (February 1, 2019): e20181897. https://doi.org/10.1542/peds.2018-1897.

Moret-Tatay, Amparo, Marcelino Pérez-Bermejo, Adalberto Asins-Cubells, Carmen Moret-Tatay, and María Teresa Murillo-Llorente. “A Systematic Review of Multifactorial Barriers Related to Breastfeeding.” Healthcare 13, no. 11 (May 23, 2025): 1225. https://doi.org/10.3390/healthcare13111225.

National Academies of Sciences, Engineering, and Medicine. Breastfeeding in the United States: Strategies to Support Families and Achieve National Goals. Edited by Ifeyinwa Asiodu, Julie A. Caswell, and Meredith Young. Washington, D.C.: National Academies Press, 2025. https://doi.org/10.17226/29118.

Rito, Ana Isabel, Marta Buoncristiano, Angela Spinelli, Benoit Salanave, Marie Kunešová, Tatjana Hejgaard, Marta García Solano, et al. “Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017.” Obesity Facts 12, no. 2 (2019): 226–43. https://doi.org/10.1159/000500425.

Robinson, Karen, Alissa Fial, and Lisa Hanson. “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, no. 6 (November 2019): 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. “Why Invest, and What It Will Take to Improve Breastfeeding Practices?” The Lancet, Breastfeeding 2, 387, no. 10017 (January 30, 2016): 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.

Wilson, Keadrea, Tebeb Gebretsadik, Margaret A. Adgent, Christine Loftus, Catherine Karr, Paul E. Moore, Sheela Sathyanarayana, et al. “The Association Between Duration of Breastfeeding and Childhood Asthma Outcomes.” Annals of Allergy, Asthma & Immunology 129, no. 2 (August 2022): 205–11. https://doi.org/10.1016/j.anai.2022.04.034.